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Once a rare phenomenon, the consumption of nitrous oxide, commonly known as laughing gas, has increased in France, raising public health concerns and prompting medical and legal measures.

Medically, nitrous oxide is used for anaesthesia and pain relief and as a propellant in aerosol products in the food industry (eg, whipping cream propellant).

“Since the 2000s, the Observatoire français des drogues et des tendances addictives (OFDT) and its monitoring system for emerging drug trends (TREND) have reported recreational use of nitrous oxide, which produces brief euphoric effects. Users typically release the gas from food-grade cartridges, such as those used for whipped cream, into a balloon and inhale it,” the OFDT said.

The sale of nitrous oxide has been widespread in France since 2017 and is available in local shops, bars, and nightclubs. In 2019, online platforms began offering canisters of up to 600 g, enough for approximately 80 balloons, or bottles weighing up to 15 kg, allowing 1000-2000 balloons to be produced.

Since 2020, nitrous oxide resale has been linked to drug trafficking networks. “A quantity of 7 tons of nitrous oxide with a market value of 2.7 million euros was seized by law enforcement in Seine-et-Marne, Île-de-France, France, in December 2021,” the OFDT said.

It is accessible and inexpensive and is primarily used by adolescents and students. According to the national survey in 2021 on health and substance use in middle and high schools in France (EnCLASS), 5.5% of 9th grade students reported consuming nitrous oxide.

A 2023 European survey on recreational psychoactive substances (EROPP) found that 6.7% of adults aged 18-64 years had used nitrous oxide at least once.

According to the OFDT, the mechanism of action is not fully understood; the acute effects include reduced pain, euphoria, reduced anxiety, sensory illusions, and altered consciousness, which subside within minutes.

According to Santé Publique France, repeated and prolonged use of nitrous oxide can lead to dependence and serious complications. These include neurologic disorders, such as numbness, muscle weakness, severe nerve pain, coordination problems, and urinary symptoms; cardiovascular issues, including blood clot formation; and psychiatric problems, such as hallucinations, delusional episodes, and mood disorders.

As nitrous oxide use has increased, severe cases have become more frequent. The Centre d’Addictovigilance de Lille (CEIP-A Lille, Addictovigilance Centre) in Lille, France, reported 17 serious cases in 2017, which increased to 81 in 2022, all requiring hospitalisation.

Medical and Legislative Measures

In 2024, the Hospices Civils de Lyon (HCL) in Lyon, France, launched a teleconsultation service specifically for individuals misusing nitrous oxide. Christophe Riou, MD, an addiction specialist at HCL, explained, “Because the sale of nitrous oxide is legal and its euphoric effects are brief, many users believe it is harmless. However, it can be addictive, activating pleasure receptors, creating emotional dependence, and being neurotoxic. Excessive use can cause serious, irreversible neurological damage, including limb paralysis. Early symptoms, often mild tingling in the arms or legs, are frequently overlooked; therefore, many patients, mostly young people, seek help only when the damage is severe. Teleconsultation allows us to intervene at the subclinical stage.”

The service offers four appointment slots every Tuesday afternoon, with follow-up care that may include drug treatment, monitoring, or hospitalisation.

In June 2021, France enacted Law No. 2021-695, aimed at curbing the misuse of nitrous oxide. This legislation prohibits the sale or distribution of nitrous oxide to minors and imposes a €15,000 fine on anyone found guilty of encouraging a minor to misuse the substance because of its psychoactive effect.

It also restricts sales in certain venues, including bars, nightclubs, and temporary drinking establishments, such as fairs, public festivals, and tobacco shops. The law allows limits on the quantity of nitrous oxide that can be sold to individuals and bans the sale and distribution of accessories that facilitate its consumption, such as “crackers” or balloons intended for this purpose.

In response to rising concerns over recreational nitrous oxide use, several cities in northern France have issued local legal orders to restrict it. Roubaix and Lille, both in Hauts-de-France, France, for example, ban the possession, use, transfer, and resale of nitrous oxide in public spaces, regardless of packaging. Other French cities have introduced similar rules to curb misuse.

The French National Assembly passed a bill to restrict the sale of nitrous oxide to professionals and strengthen the prevention of its misuse. The text has since been referred to the Senate for consideration.

Article 1 bans the sale of nitrous oxide to consumers, both in shops and online, in France. Article 2 would strengthen coordination between the Interministerial Mission for the Fight Against Drugs and Addictive Behaviours and Regional Health Agencies to monitor misuse, publish reports, and run prevention programs. Article 3 includes prevention measures in schools, and Article 4 calls for an evaluation report of the said law.

The French Senate approved a bill pending review by the National Assembly. It would make nitrous oxide misuse illegal, increase penalties for selling to minors, require licences for sales, ban sales at night, and fine people who leave any form of nitrous oxide containers in public areas.

This story was translated from Medscape’s French edition.