To the Editor: Published evidence recognises that the recreational misuse of nitrous oxide (N2O) can be associated with vitamin B12 deficiency and subacute combined degeneration of the spinal cord.1 Misuse of N2O is increasing,2 with canisters (known as “nangs” or “whippits”) readily available for legal purchase in convenience stores and online ostensibly for the purpose of whipping cream.
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- 1. Garakani A, Jaffe RJ, Savla D, et al. Neurologic, psychiatric, and other medical manifestations of nitrous oxide abuse: A systematic review of the case literature. Am J Addict 2016; 25: 358–369.
- 2. Winstock AR, Timmerman C, Davies E, et al. Global Drug Survey 2020 psychedelics key findings report. GDS, 2021, https://www.globaldrugsurvey.com/wp‐content/uploads/2021/03/GDS2020‐Psychedelics‐report.pdf (viewed March 2021).
- 3. Bethmont A, Harper CE, Chan BS, et al. Increasing illicit use of nitrous oxide in presentations to NSW emergency departments. Med J Aust 2019; 211: 429. https://www.mja.com.au/journal/2019/211/9/increasing‐illicit‐use‐nitrous‐oxide‐presentations‐nsw‐emergency‐departments
- 4. Blair C, Tremonti C, Edwards L, et al. Vitamin B12 supplementation futile for preventing demyelination in ongoing nitrous oxide misuse. Med J Aust 2019; 211: 428. https://www.mja.com.au/journal/2019/211/9/vitamin‐b12‐supplementation‐futile‐preventing‐demyelination‐ongoing‐nitrous
- 5. NSW Health. Nitrous oxide: the facts [fact sheet]. Sydney: NSW Health. https://yourroom.health.nsw.gov.au/resources/publications/Pages/nitrous‐oxide‐drug‐facts‐english.aspx (viewed March 2021).
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