Not A Laughing Matter: Emerging Nitrous Oxide Regulatory Oversight

Nitrous oxide (N₂O) is an inhaled anesthetic and analgesic used in minor surgical procedures. Discovered in 1772, it is commonly known as “laughing gas” and causes minimal respiratory depression and hemodynamic changes when compared to other anesthetics.¹

In the culinary industry, N₂O provides the fluffy texture that is characteristic of the whipped cream found in canisters. Whipped cream chargers are also commercially available. These devices contain N₂O that are used by food preparers to provide a smooth texture and added flavoring to certain desserts and beverages.² These devices, along with gases provided in higher volume canisters, are available from retailers, including online suppliers.

Drug Mechanism and Adverse Effects

N₂O has the potential to induce euphoria and hallucinations if misused. This is likely the result of dopamine release from the reward center. Additionally, N₂O has NMDA receptor antagonist action, a property that is shared with the dissociative anesthetic ketamine.³ The analgesic effects afforded by this anesthetic are attributed to the release of endogenous opioid peptides in the body.⁴ Lastly, N₂O can potentiate the effects of GABA, the pharmacological mechanism of sedative-hypnotics such as benzodiazepines, which are used in anesthesia and for the management of anxiety.^4,5 All these medications have the potential for abuse if not monitored under the guidance of a health care professional.

The euphoria induced by laughing gas is rapid but dissipates within minutes, which may cause the misperception that it does not have long-term effects or potential for abuse.⁶ Aside from the physical and psychoactive effects of N₂O, there is a risk of injury from the act of inhaling N₂O gas, which is associated with frostbite and asphyxiation.⁷ A unique adverse effect is megaloblastic anemia and subacute combined degeneration of the spinal cord due to the inactivation of vitamin B₁₂.⁸ Although stores of B₁₂ may last for years in the average person, N₂O can oxidize the cobalt ion in the center of the corrin ring, turning cobalt I into cobalt III, leading to rapid B₁₂ depletion and irreversible nerve damage in chronic or malnourished users.⁸

Social Media Influence and Adolescent Population

Recreational use of N₂O has become prevalent among adolescents in recent years, mainly due to its accessibility, legality, attractiveness, and perceived lack of harm. Modern-day street names for laughing gas include NOS, Nangs, Hippy Crack, Galaxy Gas, and whippets, due to its potential as a foaming agent. N₂O gained popularity on social media video platforms such as TikTok, where young users uploaded videos of themselves at parties decanting N₂O from a bulb into a balloon or dispenser to document its euphoric and hallucinogenic effects following inhalation.⁹ N₂O combined with alcohol, marijuana, and stimulants to intensify euphoria has also been reported.^9,10

A 2025 analysis of National Poison Data System reports reported that cases of N₂O abuse have risen 1332% in those 13 years and older from 2003 to 2024.¹¹ From 2010 to 2023, there were a total of 1240 deaths attributed to N₂O poisoning, with 37% observed in the 20- to 29-year-old demographic group.¹¹ Aside from young adults, patients with mental or substance use disorders are also considered more vulnerable to N₂O abuse.¹²

FDA Oversight

Federal regulation of N₂O as a product is limited to the FDA’s regulation of gas for valid medicinal uses and in food preparation or other industries where good manufacturing practices are followed.¹³ In addition, N₂O is not a controlled substance under federal law, and there is no role for the US Drug Enforcement Agency in regulating the recreational use of N₂O.¹³

However, due to the increase in reported cases of N₂O poisoning, the FDA issued a formal statement in March 2025, outlining the dangers of N₂O inhalation, naming Galaxy Gas along with several other companies known to produce N₂O canisters.¹⁴ Online sellers were also included. In this safety alert, consumers were warned to not inhale or recreationally use any flavor of N₂O in any size canister, tank, or charger. Furthermore, the alert emphasized that when inhaled, these products can result in serious adverse health effects, including death.¹⁴

State Legislation as of 2026

A significant number of states have some type of restriction on the recreational use of N₂O, including several states that have banned the retail sale of these products.¹⁵ Additionally, a dozen states, including California, have criminalized certain amounts of N₂O possession except for medical use.¹⁵ In New York, retailers are required by law to verify that customers purchasing chargers or small cartridges containing N₂O are over the age of 21.¹⁶ This excludes whipped cream sold in cans.¹⁶ The Figure illustrates nitrous oxide regulations across the states.

Federally, the Nitrous Oxide Safety Act of 2026 (HR 7945) was referred to the House Committee on Energy and Commerce on March 16, 2026.¹⁷ If it is passed, it would categorize consumer products containing N₂O as "banned hazardous products" under the Consumer Product Safety Act.¹⁷

Conclusion

N₂O is a widely utilized anesthetic with applications in both the food and automotive industries. While these uses are regulated by the FDA, N₂O is not scheduled as an illicit substance with abuse potential. In 2025, The FDA warned about the dangers of N₂O and said it will continue to monitor retailers who suggest recreational use of laughing gas. Greater legislation on both the federal and state levels may prevent injury and deaths in young adults.

While restricting access can reduce harm, education and communication with adolescents about N₂O recreational use by parents, teachers, coaches, and health care professionals should be provided whenever possible to minimize N₂O misuse.

REFERENCES

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2. Schwarcz J. Whipping up some science. McGill Office for Science and Society. August 14, 2024. Accessed May 15, 2026. https://www.mcgill.ca/oss/article/medical-environment-did-you-know/whipping-some-science

3. Izumi Y, Hsu FF, Conway CR, Nagele P, Mennerick SJ, Zorumski CF. Nitrous oxide, a rapid antidepressant, has ketamine-like effects on excitatory transmission in the adult hippocampus. Biol Psychiatry. 2022;92(12):964-972. doi:10.1016/j.biopsych.2022.06.016

4. Emmanouil DE, Quock RM. Advances in understanding the actions of nitrous oxide. Anesth Prog. 2007;54(1):9-18. doi:10.2344/0033-3006(2007)54[9:AIUTO]2.0.CO;2

5. Dzolijc M, Duijn BV. Nitrous oxide-induced enhancement of gamma-aminobutyric acidA-mediated chloride currents in acutely dissociated hippocampal neurons. Anesthesiology. 1998;88(2):473-480. doi:10.1097/00000542-199802000-00026

6. Vohra V, Matthews H, Stroh-Steiner G. Notes from the field: recreational nitrous oxide misuse – Michigan, 2019-2023. MMWR Morb Mortal Wkly Rep. 2025;74(210-212). doi:10.15585/mmwr.mm7412a3

7. Holm S, Tabrisi R, Zdolsek J. Recreational use of nitrous oxide as a source of frostbite injuries to the skin: a review of the literature and a case report. Eur Burn J. 2025;6(1):14. doi:10.3390/ebj6010014

8. Leleu D, Denimal D. A case of functional vitamin B12 deficiency after recreational nitrous oxide use. Biochem Med (Zagreb). 2024;34(1):010801. doi:10.11613/BM.2024.010801

9. Kor K, Allan J, Cameron J, Simpson H. Co-creating harm reduction resources with young people who use nitrous oxide: what catches their attention? Harm Reduct J. 2025;23(1):8. doi:10.1186/s12954-025-01361-2

10. Walter H, Cameron JJ, Simpson H, Kor K. Exploring the experiences and perceptions of young people’s recreational nitrous oxide use. Adv Dual Diagnosis. 2025;18(18). doi:10.1108/ADD-07-2024-0012

11. Temple C, Lin A, Hughes A. Trends in nitrous oxide abuse and misuse: a 22-year analysis of United States poison center data. Clin Toxicol (Phila). 2026;64(4):284-291. doi:10.1080/15563650.2025.2596142

12. Symes I, Jeyaruban P, Zaloum SA, et al. Social determinants of health in recreational nitrous oxide use: a narrative review. BMJ Public Health. 2026;4(1):e003386

13. Hoke K. Nothing to laugh about: nitrous oxide misuse and the need for a public health response. The Network for Public Health Law. April 30, 2025. Accessed May 15, 2026. https://www.networkforphl.org/news-insights/nothing-to-laugh-about-nitrous-oxide-misuse-and-the-need-for-a-public-health-response/

14. FDA roundup: March 18, 2025. FDA. March 18, 2025. Accessed May 15, 2026. https://www.fda.gov/news-events/press-announcements/fda-roundup-march-18-2025

15. Dershowitz HL. States react to nitrous oxide deaths with unnecessary, unworkable bans. Reason Foundation. April 22, 2026. Accessed May 15, 2026. https://reason.org/commentary/states-react-nitrous-oxide-deaths-unnecessary-unworkable-bans/#:~:text=Instead%20of%20practical%20responses%2C%20states,to%20that%20state's%20governor's%20desk

16. New York State Department of Agriculture and Markets clarifies new law regulating the sale of nitrous oxide cartridges. News release. September 2, 2022. Accessed May 15, 2026. https://agriculture.ny.gov/news/new-york-state-department-agriculture-and-markets-clarifies-new-law-regulating-sale-nitrous

17. Nitrous Oxide Safety Act of 2026 (HR 7945). March 16, 2026. Accessed May 15, 2026. https://www.congress.gov/bill/119th-congress/house-bill/7945