The Gozitan scene – The OASI Foundation said that its concern on N2O abuse is increasing since it is receiving several reports as well as witness evidence that “implies N2O increasing use in our younger generations for the following reasons:”

1. It is not the first time that we found 8 gr N2O cannisters and balloons in parking areas within 100 metres of schools in Gozo. We have made several attempts to inform the relevant authorities.

2. We had parents contacting us concerned about their children celebrating with laughing gas use provided by and in the presence of the coach after winning the minors’ league.

3. Other parents told us that the nearby supermarket ended up without any balloons as these were all purchased by foreign students together with N2O cannisters.

4. A mayor of local community sent us a photo requesting information on the content since the box was disposed of in front to the Local Council Office door

5. Secondary school children shared with us that laughing gas balloons are being sold for €5 for two balloons at time youth leisure places.

6. Pictures were sent to us by a local leader. The 1 litre bottles were collected from a playing field following the Sunday of the village feast. The village has a population of between 2500 and 3000 persons.

7. Picture shows paraphernalia associated with N2O use dumped in a field in Gozo nearby a village of less than 3000 habitants.

8. The first person on the Maltese Island to be taken to Emergency Department happened in Gozo.

The OASI Foundation stressed that Nitrous Oxide (N2O), or better known as laughing gas, is on the increase in a number of spheres. Although it has different usage, its multiple mechanisms of action are not fully comprehended and mastered (Commission on Narcotic Drugs, 2023). “It has analgesic effects since it stimulates endogenous opioid release. It also has anaesthetic effects as it inhibits the glutamatergic neurotransmitters (Back et al., 2023).”

It went on to say that Nitrous Oxide has been in use for the last 250 years, introduced in 1772 in “laughing gas parties” mostly frequented by the British upper class. Its use started to fade away then and reemerged in the 1960s with its introduction in the medical field as a pain and anxiety relief in dentistry and other medical areas, to later be used by university students during parties.

Nitrous Oxide surfaced once more in the 1990s, peaking in 2010 in the drug use industry, mainly during parties (EUDA, 2024; van Aerts et al., 2022). What is different between now and then is that N2O is widely available and extremely cheap. The Foundation noted that “the perception that it is a harmless recreational drug increases its use, heightening in quantities, frequency and early onset (EUDA, 2024; van Aerts et al., 2022).”

Use

The Foundation explained that N2O is used in the food industry as a food preservative and in the automobile industry as a combustion agent. As mentioned, it is an effective instant pain relief with a very short half-life, effective in dentistry and child labour (Allan et al., 2022; Commission on Narcotic Drugs, 2023). “As with any other medicine, it is effective when prescribed by professional medical personnel following appropriate protocol based on research and studies.”

Abuse

On the other hand, OASI Foundation said that “as much as N2O can cause laughter, it can cause several difficulties. In the short term, Nitrous Oxide use in humans may cause dizziness, vision impairment, loss of balance, difficulties in sensory-motor coordination and judgement difficulties. Long-term use can cause vitamin B12 deficiency, neurotoxicity, bowel and bladder dysfunction, as well as sexual difficulties, and the risk of death (Garakani et al., 2016). It can also cause psychiatric symptoms such as altered mental state, hallucinations, psychotic episodes and mood disturbances (van Aerts et al., 2022).”

Supply

The Foundation explained that Nitrous Oxide is supplied in commercial tanks, litre bottle or 8 gr cannister. Generally, the sale of N2O on commercial level or for medical use, is regulated and generally controlled. “On the other hand, when it comes recreational use, supply is less monitor. The gas may be provided by some local suppliers as well as purchased over the internet, where it is being promoted as whipped cream agent (EUDA, 2024; van Aerts et al., 2022.”

Recommendations

The OASI Foundation said that research shows that awareness of harm is inversely proportional to drug use. Hence, it strongly suggests:

1. Restricting the maximum quantity of cartridges that can be supplied at any one time;

2. Age-restricted sales, typically to those aged 18 and over, including requiring the display of a notice on premises that details the offence of selling to under 18s, and requiring age verification in both brick-and mortar shops and online;

3. Restricting sales of nitrous oxide products during the night (such as between 10pm and 5am), which may include online sales;

4. Preventing nitrous oxide products from being visible or accessible to the public in retail stores;

5. Prohibiting the sale of nitrous oxide by bars and clubs, or in shops selling alcohol, tobacco products or electronic cigarettes. This should also include stationary shops;

6. Requiring warning labels on nitrous oxide products, including the 8-gram cartridges that are the most common source of the gas. Warnings may also provide contact details for poison centres;

7. Requiring sellers to keep records of sales to verify that sales have been legal;

8. Prohibiting sale of crackers and balloons when intended to be used with nitrous oxide;

9. Strengthening legislation around safe transport and storage of nitrous oxid.

Photos: OASI Foundation; From left – nitrous oxide supplied in litre bottles or 8 gr cannisters; Photo sent in by local community Mayor of box left in front of local council offices; Photos sent by local leader, bottles collected from playing field following the Sunday feast; and paraphernalia associated with its use dumped in a field in Gozo.

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