Will somebody please explain to the Daily Mail that ‘overdose’ does not mean the same as ‘to put a plastic bag over your head’

I’ve taken a break from debunking Daily Mail articles for a while, not because they have improved but simply because I don’t have the will to read them or the time to keep up with them. Due to popular demand however,  I’ve done a brief swipe at their latest overblown, factually devoid, celerbrity inspired piece of trash.

From the Daily Mail’s recent article on laughing gas (Nitrous Oxide):

“An overdose can be fatal… The International Centre For Drug Policy charts deaths in the UK from volatile substance misuse, including the gas. Their most recent report, from 2010, notes that ‘in 2008 there were two deaths (three in 2007) associated with the inhalation of nitrous oxide, which had been obtained for non-medical purposes’. Finding more up-to-date figures is problematic, as the report is not currently active because of Department Of Health belt-tightening”

Never-mind more recent figures, lets just actually read the rest of the sentence..

‘In 2008 there were two deaths (four in 2007) associated with the inhalation of anaestheticagents. Both cases involved nitrous oxide, supplied for non-medical use as cylinders or as caplets designed to be employed with cream-whipping devices, and were the result of asphyxiation where the nitrous oxide had been inhaled using a plastic bag over the head.‘

I won’t go in to the rest of the unsubstantiated claims that the Daily Mail makes, such as that Nitrous Oxide causes strokes and chronic depression. Suffice to say that the drug is contained in every emergency ambulance and doctors surgery in the country and is deemed safe enough to be considered a first port of call emergency anaesthetic and is even provided for hours on end to women in Labour.

The Daily Mail does note one solitary useful point, that taking the gas straight from a cannister (i.e. without a balloon) can cause the lungs to freeze but this valuable information is buried so far in the sea of nonsense that readers will probably presume the Daily Mail made that up to. Which is precisely the problem with scaremongering nonsense such as this.

If you’d like to know more about Nitrous Oxide I’ve pasted the facts below directly from the BNF¹. If you use laughing gas regularly, particularly if you are a vegetarian, take note of the fact that the drug depletes B-vitamins and get yourself a bottle.

Nitrous oxide is used for maintenance of anaesthesia and, in sub-anaesthetic concentrations, for analgesia. For anaesthesia, nitrous oxide is commonly used in a concentration of 50 to 66% in oxygen as part of a balanced technique in association with other inhalational or intravenous agents. Nitrous oxide is unsatisfactory as a sole anaesthetic owing to lack of potency, but is useful as part of a combination of drugs since it allows a significant reduction in dosage.

For analgesia (without loss of consciousness), a mixture of nitrous oxide and oxygen containing 50% of each gas (Entonox®, Equanox®) is used. Self-administration using a demand valve is popular in obstetric practice, for changing painful dressings, as an aid to postoperative physiotherapy, and in emergency ambulances.

Nitrous oxide may have a deleterious effect if used in patients with an air-containing closed space since nitrous oxide diffuses into such a space with a resulting increase in pressure. This effect may be dangerous in the presence of a pneumothorax, which may enlarge to compromise respiration, or in the presence of intracranial air after head injury.

Hypoxia can occur immediately following the administration of nitrous oxide; additional oxygen should always be given for several minutes after stopping the flow of nitrous oxide.

Exposure of patients to nitrous oxide for prolonged periods, either by continuous or by intermittent administration, may result in megaloblastic anaemia owing to interference with the action of vitamin B₁₂; neurological toxic effects can occur without preceding overt haematological changes. For the same reason, exposure of theatre staff to nitrous oxide should be minimised. Depression of white cell formation may also occur.

Assessment of plasma-vitamin B₁₂ concentration should be considered in those at risk of deficiency, including the elderly, those who have a poor or vegetarian diet, and those with a history of anaemia. Nitrous oxide should not be given continuously for longer than 24 hours or more frequently than every 4 days without close supervision and haematological monitoring.

British Medical Association and the Royal Pharmaceutical Society of Great Britain (2009). British National Formulary BMJ Publishing Group, 58th ed

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