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The UK government has announced* that possession of nitrous oxide for human consumption will be made a criminal offence.
Prof David Nutt, The Edmond J Safra Chair and Head of the Centre for Neuropsychopharmacology, Division of Brain Sciences, Dept of Medicine, Imperial College London, said:
“This ban is not based on scientific evidence. The ACMD report is clear that harms do not warrant making personal possession illegal. To do this would also be in clear contradiction to last year’s position statement from the UNODC/WHO that we should stop criminalising drug users.
“Scientific evidence suggests that there is around one death per year in the UK from around 1 million nitrous oxide users (a comparison with alcohol would be that around 28,000 deaths happen per year in around 40 million users of alcohol).
“The government has taken other factors into account (other than what the evidence says about harms to users) in making this decision.
“It is not unusual for the government to come to a different view on drugs policy than the ACMD has done – I can’t recall a time they accepted the major recommendation of an ACMD report.
“The metal canisters that nitrous oxide comes in are called whippits – the problem we all have is that because whippits are so easy to detect (they chink when carried) people have moved to cylinders that contain much more gas, so dosing is going up. This has the potential to cause more harm and if so would be a classic predicted impact of the perverse consequences of banning an innocuous drug potentially leading to greater harms from alternatives.”
Dr David Caldicott, Senior Lecturer at the ANU Medical School, Australian National University (ANU), said:
“Nitrous oxide is a legitimate dual use gas that is used extensively in medical situations, as well as in catering. That it is used medically for obstetrics, as well as a safe analgesic for minor procedures for all ages, would render the argument that it should be banned on safety grounds a difficult one to prosecute. That it can cause medical harm is certainly not a matter of debate – at very high rates of consumption, it can cause a ‘subacute combined degeneration of the spinal cord’ (SCDSC), through its interference with the metabolism of Vitamin B12. While the frequency of SCDSC is increasing with the increasing use of nitrous oxide, as a percentage of those affected compared to those who consume, it remains exceedingly rare.
“From afar, it appears that the announcement by the UK Government is less about ‘medical concern’, than it is about ‘social control’. Any drugs policy associated with the term ‘zero tolerance’ should be viewed as being a ‘red flag’ to the society to which it is being pitched. Such policies are generally associated with failure, at a number of levels. In this case, it is difficult to see how such a ‘zero tolerance’ approach will be enforced, and a law that cannot be enforced is not a particularly useful one with which to engage a younger population of consumers. There is always a finite group of consumers of drugs in a society who will, if only for a brief period of time in their lives, choose to consume products that alter their reality. There is no moral valency to this choice – it is simply a fact. There is a clear danger that those whose choice was once nitrous oxide will look elsewhere, to something that is of greater medical concern to healthcare providers. Such transitions have been previously well-described.
“The advice from the AMCD has been sound. It was sound in 2015 when it was first released, and it remains sound this year, when it was reiterated. Nitrous oxide is something that we know very well in medicine, and it is not the medicine that has significantly changed. That this position of experts differs from that of elected representatives is probably an outcome that the citizens of the UK have become familiar with in recent years, but one which is not at all uncommon in drugs policy. Such differences are generally found to be more of a reflection of political issues facing a government, than the medical necessity to implement policies that are at best unlikely to have the impact that might have been intended, and at worst, have outcomes far worse than those anticipated.”
Declared interests
Prof David Nutt: “No conflicts.”
Dr David Caldicott: “I have no conflicts of interest. In addition to my current position as Emergency Consultant in Canberra, my academic affilliations to the Australian National University, as a Senior Lecturer at the ANU Medical School, I am now also the Clinical Lead at Australia’s first and only drug checking service, CanTEST.”