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Wolfson Institute of Population Health

Predominance of young Asian men in UK clinical case series of Nitrous Oxide users

The largest clinical case series to date of young people presenting with probable or confirmed nitrous oxide induced myeloneuropathy at hospitals in London, Birmingham, and Manchester shows a predominance of young men of Asian ethnicity (57%). When compared with census ethnicity data, this group appears to be over-represented relative to the proportion of the population that is Asian or Asian British in each region. Authors say this may indicate genetic susceptibility, or dietary or nutritional predispositions to neurological damage from nitrous oxide exposure, but also may indicate social circumstances predicating use.


In the study of 119 cases presenting from 2014-2022, the average age was 22 (the youngest being 14), and 3 out of 4 patients were male, although in the London hospitals 1 in 3 patients were female. London also featured the highest proportion of drinkers and smokers, excess drinkers, and users of other recreational drugs, such as cannabis and cocaine. Neurological examinations revealed unsteady walking (gait ataxia) in 80 patients, with legs more commonly affected than arms. Average weekly consumption was 318 canisters, but ranged from 1 canister to 35 cylinders (equivalent to roughly 2800 canisters). 

The researchers note that ‘Preventable neurological harm from nitrous oxide abuse is increasingly seen worldwide. Ease of access to canisters and larger cylinder has led to an apparent rise in cases of myeloneuropathy in several areas of the UK. Manufacturers and sellers of nitrous oxide should be held accountable for the apparent increase in harm through policy implementation and/or legislation.’  


Mair D, Paris A, Zaloum SA, White LM, Dodd KC, Englezou C, Patel F, Abualnaja S, Lilleker JB, Gosal D, Hayton T, Liang D, Allroggen H, Pucci M, Keddie S, Noyce AJ. Nitrous oxide-induced myeloneuropathy: a case series. J Neurol Neurosurg Psychiatry. 2023 May 30:jnnp-2023-331131. doi: 10.1136/jnnp-2023-331131. Epub ahead of print. PMID: 37253616.



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