A recent national study has revealed a dramatic increase in nitrous oxide poisoning deaths in the United States of America in the past decade. Also referred to as laughing gas or whippets, nitrous oxide is a long-standing anesthetic used in medicine and dentistry, now increasingly misused as a recreational inhalant, and has resulted in dire health effects and a growing number of deaths.
More than 13 million Americans have reported using nitrous oxide at least once. Although the gas causes short-term euphoria, its overuse leads to risky conditions such as oxygen depletion, hypoxia, brain-related injury, and even fatality. It has been recognized that emergency department visits related to nitrous oxide have been increasing. Still, relatively complete national data on related deaths caused by poisoning have been scarce until today.
In the current study, the researchers evaluated the mortality rates from 2010 to 2023 using data from the multiple cause-of-death database provided by the Centers for Disease Control and Prevention (CDC). The analysis was restricted to the age group 15-74, and the deaths with nitrous oxide were retrieved by ICD-10 code T59.0, which also includes other nitrogen-oxygen mixtures. The study categorized deaths by intent, including accidental poisoning, intentional overdose, and homicide, and also those that were of uncertain intent.
There are 1,240 deaths recorded in the 14 years in the analysis. The fatalities in 2010 were 23, which then increased almost seven times to 156 in 2023. In their turn, correspondingly, the crude death rate was 0.0100 per 100,000 individuals (95% confidence interval [CI]: 0.0064-0.0151) in 2010 and 0.0622 per 100,000 (95% CI: 0.0524-0.0719) in 2023.
Employing Joinpoint regression software, the researchers have determined that the mortality rates increased significantly between 2010-2018. Over this period, annual percentage change (APC) was 24.5% (95% CI: 18.6 % to 51.2 %); P < 0.001). However, between 2019 and 2023, the growth flattened, with an APC of 3.6% (95% CI: -20.8% to 14.3%; P = 0.67), implying that no significant rise in mortality occurred in the latter years.
Experts indicate that this trend is consistent with increased recreational use of nitrous oxide, especially among teenagers and young adults. It has been suggested that the availability of the gas and low prices are among the factors that will lead to its further misuse, but these were not directly explored during the study.
Although the research presents useful information, it still has limitations. Scientists indicated that the study did not account for the deaths of nonresidents, and that underreporting might happen as long as nitrous oxide was not tested at trial during postmortem investigations. The small sample sizes also contributed to the exclusion of some data, and it was not possible to divide the data by age group or purpose of the poisonings.
Nevertheless, the results highlight an issue of paramount and increasing importance. The analysis cites the importance of improved national monitoring and specific public health approaches that include prevention. With the use of nitrous oxide rising steadily, especially among younger demographics, scholars caution that without available policy-based solutions and educational campaigns, a fatal trend could be incoming, which would necessitate urgent interventions.
References: Yockey RA, Hoopsick RA. US Nitrous Oxide Mortality. JAMA Netw Open. 2025;8(7):e2522164. doi:10.1001/jamanetworkopen.2025.22164
