An unusual case of ‘laughing gas’ addiction in Singapore

Abstract

ObjectiveRecreational use of nitrous oxide (N20) or ‘laughing gas’ inhalation is a common phenomenon in countries like UK and US where it is associated with music festivals and parties. However, as far as we know, recreational N20 use in Singapore has hitherto not been reported in the press or scientific journals. We report the first case of N20 use and addiction in a young Singaporean male who was introduced to it by a friend from a Western country where its use is prevalent.MethodsA 20-year-old Singaporean male with an existing psychiatric diagnosis of major depression, presented with a 3 year history of solitary regular N20 inhalation that escalated from infrequent low dose use to the current daily high-dose use which he was unable to control. He exhibited symptoms of dependence — including preoccupation, tolerance, withdrawal and difficulty in cutting down. No major adverse medical complications were noted so far.ResultsThe patient was assessed to have Nitrous Oxide Dependence; and is currently undergoing regular counselling sessions in an attempt to motivate him to cut down or stop his N20 use.ConclusionThis case is unique for 2 reasons:– extant literature suggests that only anectodal evidence exists for psychological dependence of N20 in Singapore; yet our patient clearly demonstrates psychological dependence;– this is the first reported case of N20 use disorder in Singapore; and perhaps ASEAN, with the unusual presentation in a young male whose use is solitary and private.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Nitrous oxide: a unique official French addictovigilance national survey

“…The nitrous oxide approval mentions "pharmacodependence," although abuse and dependence are mentioned in a few published cases of somatic complications but without detailing the different items of abuse and dependence (43,44). Only for a very few cases were DSM items such as tolerance and withdrawal reported (42, [45][46][47], and to our knowledge, only one published case fulfilled the DSM-IV-TR criteria of substance dependence (48). In a first article (49), we analyzed the nitrous oxide cases reported to the whole addictovigilance network without any time limit until 2016 and including the cases concerning EMONO.…”

High Incidence of Signs of Neuropathy and Self-Reported Substance Use Disorder for Nitrous Oxide in Patients Intoxicated with Nitrous Oxide

“…Also, some N 2 O users met at least 2–3 out of 11 Diagnostic and Statistical Manual of Mental Disorders (DSM)-V criteria for substance use disorder (SUD), which suggests the presence of mild SUD [22]. In addition, published case reports describe addictive behavior among N 2 O users, such as continuous use of large amounts (>100 whippets per day) [23], the presence of withdrawal symptoms, and difficulties quitting N 2 O use [24, 25]. These signs could indicate that N 2 O use is addictive.…”