The patient admitted last fall to the University of Florida’s addiction treatment center had worked as a professional pilot.
But months of abusing nitrous oxide, an anesthesia gas that can induce euphoria, had wreaked havoc on his neurological system and left him irreversibly paralyzed, said Dr. Kent Mathias, director of the UF Health Florida Recovery Center.
Florida resident Meg Caldwell, 29, was found dead outside an Orange County smoke shop in November after becoming hooked on “whippets”, a slang term for small canisters that contain the gas, according to her autopsy report.
It wasn’t hard to fuel their addictions. Under brand names like Galaxy Gas and Doodlez, nitrous oxide can be bought in gas stations and smoke shops across Florida. Brightly colored canisters of the gas infused with flavors like blueberry mango and vanilla cupcake are sold on Amazon and marketed on social media sites like TikTok.
And abuse has continued to rise despite repeated public health warnings.
A first nationwide study of deaths linked to the drug published in the medical journal JAMA in July found that 13 million Americans reported using the inhalant. It was linked to 156 deaths in 2023, a 578% increase from the 23 fatalities in 2010, the study found.
America’s Poison Centers data shows a nearly 60% increase in reports of intentional exposure to the drug from 2023 to 2024.
Commonly known as laughing gas, nitrous oxide is used by dentists as anesthesia. That should mean that it’s closely controlled and regulated by the Food and Drug Administration, Mathias said.
But because there are legitimate commercial uses of nitrous oxide canisters, including for tuning car engines and as an ingredient in whipped cream, the product is not a controlled substance and can be sold legally.
Under Florida law, the gas can only be sold in canisters of up to 16 grams, although it includes exemptions for dentists and food preparation. A random sampling of five smoke shops in the Riverview and Gibsonton area found the product for sale in four of them.
“Now, it’s harder to buy a tank of oxygen than it is to get nitrous oxide,” Mathias said. “Why it’s available in gas stations is beyond me.”
The drug’s easy availability combined with appealing properties for those who abuse it is a potentially deadly combination, Mathias warned.
The drug doesn’t stay in the body long enough to leave biomarkers so it’s undetectable in drug tests of urine, blood or hair, he said. It produces a profound sense of euphoria and disassociation, and, like most inhalants, it works fast.
“The faster drugs work, the more addictive they are, especially if euphoria is there,” Mathias said.
Repeated inhalation of the gas can lead to abnormal blood counts, asphyxiation, blood clots, frostbite, headache, impaired bowel and bladder function among other health issues, the public health advisory warns. It weakens the immune system and can deplete the body’s B12 reserves, leading to damage to the sheath that surrounds nerves in the body. If the abuse continues, the result is numbness and tingling in the hands and feet, weakness in the legs, and eventually, paralysis.
“It’s an addiction that exemplifies what an addiction is,” Mathias said. “You’re losing your ability to walk and yet somehow justify using it.”
The Orange County lawsuit, which was filed in February, accuses smoke shops and vape stores of selling the gas “to their patrons knowing full well they are not seeking these items to cook, but rather to abuse as a recreational drug.”
It names seven smoke shops where Caldwell purchased nitrous oxide canisters and eight companies that either manufacture or distribute canisters.
Those companies marketed the gas to minors and other “vulnerable populations,” the lawsuit said. The defendants includes United Brands, a San Diego company that was ordered by a jury in a 2023 civil trial to pay $720 million to the family of a 25-year-old woman who was killed after her car was hit by a driver high on nitrous oxide.
The defendants in the Orange County lawsuit have yet to file a response and the case is still pending. United Brands did not respond to a request for comment.
Caldwell became heavily addicted to the gas last year, the lawsuit said. She would often inhale it in the parking lot of the smoke shops and was sometimes scolded by shop staffers for littering their lots with empty canisters.
“These products have caused widespread addiction, death and severe bodily harm, and have resulted in a veritable public health crisis,” the lawsuit said.
One recent patient at UF Health’s addiction center was brought there by worried parents after they noticed their child, a young adult, struggling to walk, Mathias said.
Center staffers who reviewed photographs of the youth’s bedroom saw a number of nitrous oxide canisters.
Louisiana in 2024 became the first state to ban the retail sale of the drug with a bill that also increased penalties for violators and gave its Alcohol and Tobacco Control agency more enforcement authority.
Mathias wants the Food and Drug Administration to have more control of the gas’s use and distribution, as it does with other restricted medication.
“While it remains a medical drug, it should be treated like one in all areas that it’s used,” he said. “Without that, this problem will continue to get worse.”
***
For emergency assistance with a suspected poison call Poison Help at 1.800.222.1222 to speak with a poison expert, or visit PoisonHelp.org for support and resources. Call 911 if the exposed person is unresponsive/unconscious, not breathing, or having a seizure.
