Irish researchers are warning of a growing public health concern after new data revealed a sharp increase in hospital admissions linked to recreational nitrous oxide use, with young adults presenting with potentially serious neurological complications.
Dr Catherine McGorrian, Mater Misericordiae University Hospital
Source: Irish Pharmacy News, June 2026, pages 20 and 22.
Often perceived as a harmless drug, recreational use of nitrous oxide gas, often called “whippets” by users, is increasingly being used with significant nerve damage and prolonged hospital stays among young people in Ireland.
The warning comes following the publication of a new study in the Irish Medical Journal which examined nitrous oxide-related hospital admissions across the Republic of Ireland between 2020 and 2024. Researchers identified 63 hospital discharges involving nitrous oxide exposure alongside neurological complications or vitamin B12 deficiency, representing a dramatic increase in presentations over the four-year period.
The study, conducted by Dr Shahzad Bakhshi, Dr Catherine McGorrian and Dr Suzanne O’Mahony from the Mater Misericordiae University Hospital, found that admissions increased more than four-fold during the study period. Patients were overwhelmingly young, with an average age of just under 20 years, while more than 87 per cent came from the Dublin area.
Speaking to Irish Pharmacy News, co-author Dr Catherine McGorrian said the research was prompted by observations made by clinicians on the frontline.
“We started seeing patients coming into hospital with disturbances of their walking,” she explained. “They would have pins and needles or changes in sensation in their feet and legs, and they would have this characteristic dragging walk. The striking thing was that these patients were really young – 17, 18, 19 years old – and they were coming in with nerve damage to their legs. It was really shocking to us.”
A Hidden Consequence
Nitrous oxide has long been used safely in healthcare settings for its anaesthetic and analgesic properties and remains widely used in dentistry and maternity care. However, the gas is also readily available in catering products where it is used as a propellant in whipped cream dispensers.
According to Dr McGorrian, the ease of access to catering-grade nitrous oxide has contributed to its growing popularity among young people.
“You could go on the internet now and order a box of whippets if you wanted to. There is no problem accessing nitrous oxide because it’s used in the catering industry. Anyone can buy it,” she said.
Users typically transfer the gas into balloons before inhaling it repeatedly to achieve a short-lived euphoric effect. While many may be aware of the risk of cold burns caused by the freezing temperatures of the gas, fewer appear to understand the neurological consequences.
The problem stems from nitrous oxide’s ability to inactivate vitamin B12, creating what clinicians describe as a “functional B12 deficiency”. This disrupts the body’s ability to maintain healthy myelin, the protective sheath surrounding nerves and the spinal cord.
“People still have vitamin B12 in their body, but it becomes unavailable to support the health of their spinal cord and nerves,” Dr McGorrian explained. “That’s how they develop these neurological effects.”
The resulting condition, known as subacute combined degeneration of the spinal cord, was once considered relatively rare.
“It was a condition we all learned about in medical school but rarely ever saw,” she said. “Suddenly we were seeing it again, but this time in teenagers and young adults because of nitrous oxide use.”
Serious Impact on Young Lives
The study paints a concerning picture of the burden these cases place on both patients and healthcare services. Researchers found an average hospital stay of more than six days, with admissions accounting for almost 400 inpatient bed days during the study period.
For Dr McGorrian, however, the statistics only tell part of the story.
“These are young people who shouldn’t be in hospital,” she said. “The average age was 19. It’s dreadful for them.”
She recalls treating very young women with this new physical limitation from nitrous oxide misuse.
“You can see beautiful young people who clearly take pride in themselves, and their walking is clearly damaged by the nerve damage.”
Many patients require extensive investigations including MRI scans and specialised blood tests to establish the diagnosis and rule out other neurological conditions. Treatment typically involves immediate cessation of nitrous oxide use alongside aggressive vitamin B12 replacement therapy.
While some patients recover well, delayed treatment may result in longer-term complications.
“There are data suggesting that if you treat quickly and stop the nitrous oxide use, patients can recover,” said Dr McGorrian. “But I also know anecdotally of people who have had more long-term consequences.”
A Role for Community Pharmacy
The findings have particular relevance for community pharmacists, who may encounter patients long before they present to emergency departments.
Dr McGorrian believes pharmacy teams could play an important role in recognising early warning signs and initiating conversations with young people.
“I think early treatment is really important,” she said. “If somebody has changes in sensation, pins and needles or difficulties walking, they should be advised to attend an emergency department.”
She also encouraged pharmacists to ask direct but non-judgemental questions where appropriate.
“I generally just try to be straightforward with people and ask, ‘Have you been doing whippets?’ Young people will usually tell you the truth if you ask them in a supportive way because they want the best healthcare.”
Interestingly, some patients appear to have some awareness of the link between nitrous oxide and vitamin B12 deficiency.
“I met one young man who was actually taking B12 tablets while continuing to use nitrous oxide,” she recalled. “Unfortunately oral B12 replacement alone wasn’t sufficient to prevent the nerve damage for him.”
This observation raises an intriguing possibility for community pharmacists.
“Perhaps pharmacists might notice young people unexpectedly looking for vitamin B12 supplements and feel comfortable opening a conversation,” she suggested.
Dr McGorrian believes community pharmacists are uniquely positioned to offer support.
“The community pharmacist is a trusted person outside the family who is still part of the community. There is potentially a harm reduction role there.”
Calls for Greater Awareness
The researchers hope the study will help raise awareness among healthcare professionals, policymakers and the public.
International evidence suggests that awareness of nitrous oxide’s neurological risks remains low among young people. Yet the Irish findings mirror trends being reported across Europe, where health authorities are increasingly expressing concern about recreational use of the gas.
Dr McGorrian believes both education and regulation deserve consideration.
“There has to be something we can do to prevent recreational use of this agent,” she said. “Every box of canisters dumped in a park represents young people putting their nerve health and ability to walk at risk.”
As festival season and summer gatherings approach, she is urging young people to recognise that nitrous oxide is far from harmless.
“This is a high-risk thing to do,” she warned. “People can become habituated to it and use larger and larger amounts. There’s no room for complacency.”
For pharmacists, the message is equally clear. While nitrous oxide misuse may not always be immediately apparent, unexplained neurological symptoms, unusual requests for vitamin B12 supplements, or conversations about recreational drug use may provide opportunities for early intervention.
As the study concludes, admissions related to nitrous oxide misuse are rising rapidly in Ireland, predominantly affecting young adults and placing increasing pressure on acute hospital services. Preventing further harm will require awareness, education and collaboration across healthcare settings – with community pharmacy potentially playing an important role in identifying those at risk before lasting damage occurs.
