This is an article by Joseph Holcomb Adams from the Substack, Ecstatic Integration, which covers psychedelic and ecstatic ethics, integration and harm reduction.
Last December, I saw two Phil Lesh & Friends shows at the Warfield in San Francisco. When I walked out of the theater after the second night, I heard familiar and abrasive sounds: the hissing of nitrous oxide tanks, balloons loudly expanding and sometimes popping, and the barking calls of the nitrous salesmen (“Ice cold fatties, fresh of the tank!” “three for twenty, ice cold, ice cold!”). Concert attendees (young and old) were gathering around the nitrous tanks, exchanging cash for gas-filled balloons of various sizes and colors. People stood around and walked down the street while taking hits from their balloons. There was a visible police presence, but they clearly didn’t care at all about the nitrous sales.
This is a scene that I’m used to encountering outside of concerts, but to this day it still seems bizarre and surreal to me. Everything about it is very loud, and not just in the literal sense of all the hisses and pops and salesman barks. There’s a fast, frantic pace to all of the activity around the tanks, as salesmen try to sell as many balloons as they can as quickly as possible, and as eager customers return again and again, gathering around like pigeons in the park circling an old man who is throwing out bread crumbs. This all can create an edgy, unpleasant sort of mood in the air outside of the concerts, especially when I see the ground becoming littered with discarded empty balloons.
As soon as I exited the Warfield, I noticed that it had been raining during the show, and that the sidewalk was extremely wet. Oh no, I thought, this is not good. I was already well aware of the phenomenon of people falling down and hitting their heads while inhaling nitrous balloons, and I could see that the present conditions were especially dangerous in that regard.
I was very, very concerned that people were going to hurt themselves that night, and so I went around trying to encourage folks with balloons to find a place to sit down while inhaling the gas. The people almost always acknowledged me, but they generally did not seem interested.
Within a few minutes of walking down the sidewalk, I noticed an ambulance, and saw a man with blood dripping from the back of his head being put into a stretcher by EMTs. I asked one of the other EMTs what had happened. The EMT confirmed what I had suspected: the man had been inhaling nitrous oxide, and had then slipped and hit his head. I still think about that guy, and I really hope he’s ok.
To me, this event really demonstrated the urgent need for harm reduction efforts in the nitrous oxide balloon scene. Falling down and getting injured is only one of the risks presented by nitrous oxide use; there are other very serious ones as well, most of which are associated with heavy use. It’s crucial that we discuss these risks, consider harm reduction strategies, and pay attention to patterns of use; one might say that we ought to mind the gas.
Fans outside a Phish festival
Currently, the use of of nitrous oxide as a psychoactive drug in naturalistic (non-clinical) contexts is quite prevalent, and it has been increasing quickly in recent years. Much of this use appears to occur in people’s homes, at parties, etc., but I can also attest (without hard data) that the balloon scene outside of concerts appeared to have steadily expanded over the past few years.
Online, there are many nitrous oxide harm reduction guides that identify all the risks and suggest harm reduction practices. This article is not meant to be another one of those comprehensive guides; instead, I focus on just three distinct dangers associated with nitrous oxide use.
The first section is about the risk of falling down and getting injured while on nitrous oxide (focusing on the context of the balloon scene), the second one discusses the risk of neurological damage from heavy use, and the third discusses compulsive use and the “nitrous demons” phenomenon.
Ecstatic Integration | Jules Evans, Joseph Holcomb Adams and Ed Prideaux| Substack
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Face-Plant into Lot
A number of my friends have been involved in the Grateful Dead scene for decades, and they’ve shared many, many stories of balloon users injuring themselves on the lot outside of the shows. Looking through the Phish and Dead SubReddits has also revealed an extremely large number of these stories. One poster even saw multiple falls in a single night outside of a Dead & Go show last year:
Saw 3 people go down at Citi (all of who got back up surprisingly) but some guy full blown convulsed falling straight backward and banged his head against the concrete. Couldn’t believe he was okay.
In almost all of the nitrous-related threads I’ve read on those SubReddits, I saw at least one comment about the importance of sitting down. Here’s an example of one where the poster describes his attempts to help nitrous users stay safe:
I spend every summer lecturing kids to sit down with their balloons. They never listen. Seen people fish and split their heads wide open way more than once.
When I was encouraging nitrous users to sit down with their balloons outside the Warfield, they didn’t listen to me either. Perhaps the harm reduction strategy of ‘one concerned guy walking around suggesting that people sit down’ is not necessarily an effective one. Still, something must be done. Perhaps there are other more effective ways for educating people about the face-plant-into-lot risk.
However, even when a person is aware of the danger and intentionally makes the choice to sit down, sometimes this isn’t enough to stay safe. To demonstrate this point, I’ll share the story of someone (referred to here by the pseudonym “Brian N. Roberts”) who hit his head on the pavement after inhaling a balloon, despite his efforts to avoid this danger. The impact caused a subdermal hematoma, requiring surgeons to remove a piece of his skull to drain the blood before putting the piece back in place.
The story begins with Brian and his friends purchasing a few balloons outside of a Radiohead show in 2003. They all knew about the risk of falling down, so they intentionally brought their balloons to their parked car so that they could safely sit in the seats while inhaling the gas (and like anyone with common sense, Brian and his friends never entertained the absurdly stupid idea of driving a car while taking nitrous). The last thing Brian remembers is getting into the car and asking his friend to put on Welcome to the Machine by Pink Floyd. The next thing he knew, he was lying on the asphalt outside the car, surrounded by people asking him if he was alright.
Brian made it clear that he had very intentionally taken measures to mitigate the danger, but ended up getting hurt anyway. What went wrong? Brian suggests that once he was high on the gas while sitting in the car, he became too impaired to think straight. As a result, he exited the vehicle, and took a hit of the balloon while standing up in the lot, which he wouldn’t have done if he was in his right mind.
There are two clear lessons from Brian’s story:
- Even if you put yourself in a safe situation before you begin inhaling nitrous (e.g. sitting down somewhere), once you are under the influence, you can end up unintentionally putting yourself in danger as a result of being impaired.
- It’s important to have at least one non-impaired person watching out for you while you are inhaling your balloon, to help you stay safe while you are impaired by the effects of the gas.
I think that probably the most important harm reduction strategy for reducing injuries in the balloon scene (and in other contexts) is for people to watch out for each other. If a group of friends chooses to use nitrous oxide, they should take turns acting as sitters for one another. It’s important that sitters take the role seriously, and don’t get distracted by what’s going on around them in the lot (or wherever); it might only take a few seconds for a seated nitrous user to suddenly stand up, lose their balance, and fall down.
Perhaps harm reduction organizations could send trained volunteers to settings where the balloon scene pops up, similarly to how such organizations send volunteers to festivals and clubs where various other drugs are commonly used. They could act as sitters, and roam around looking for people who appear to need help (e.g. users who are visibly teetering on the edge of falling). Even when nitrous users on the lot want to sit down, they might find themselves simply standing there because they’ve got nowhere to go. Perhaps harm reduction volunteers could provide an intentional space for people to sit, next to a harm reduction booth.
Perhaps another strategy for reducing face-plant-into-lot harms could be spreading harm reduction messages as memes within the music scenes/subcultures, in a way that not only makes the messages propagate, but also makes them seem “cool,” for lack of a better term. A while ago, I thought of a catchy slogan that might work: “You know your brain is made of meat, so if you hit a balloon, please take a seat.”
What if someone made a bunch of stickers printed with the slogan (and perhaps non- distracting psychedelic art), and passed them out on the lot? I imagine that many nitrous users would respond much better to being handed a trippy-looking sticker rather than being “lectured” or verbally encouraged to sit down.
The slogan could also go on T shirts, pins, etc., and perhaps even on inexpensive mats or cushions that nitrous users could sit on, provided by harm reduction volunteers. Maybe some of the bands themselves could even be convinced to promote the slogan and/or other harm reduction messages from the stage.
Neurological Damage from Nitrous-Oxide-Induced Vitamin B12 Deficiency
I also know a person (“Jed” is his pseudonym here) who suffered neurological damage from his heavy use of nitrous oxide.
Several years ago, through means that Jed does not wish to disclose (so that others do not go down the path he did), he was suddenly able to secure access to a virtually unlimited amount of extremely pure nitrous oxide. Over the course of two weeks, Jed used nitrous oxide almost constantly, going through fourteen tanks all by himself, each of which contained 20 lbs of gas (for context, a typical whip-it cartridge contains 8g). It didn’t take much time before Jed began to notice some troubling symptoms. He began to lose feeling in parts of his body, especially his feet, and began having trouble reading signs on the road. He spoke to some other people who had used a lot of gas, and heard about how other heavy users had begun to suffer from peripheral neuropathy, in some cases to the extent that they were confined to wheelchairs for multiple years. He told me that all of these people reported that they eventually recovered (mostly) from the peripheral neuropathy after stopping their nitrous use and taking other measures to treat the damage.
After Jed realized the seriousness of the danger he was exposing himself to, he completely stopped using nitrous oxide. For seven months, he consistently took vitamin B12 supplements, and he reports that his noticeable symptoms disappeared almost completely over that time. About a year after that, he tried a single balloon. Immediately, he experienced neurological symptoms again, including numbness in his left arm from his shoulder down into his pinky finger. Jed did not take any more nitrous, and began taking vitamin B12 again. After two and a half months or so, his symptoms appeared to recede and disappear.
Unfortunately, Jed reports that just a few weeks ago, he spontaneously began experiencing some numbness in his feet again, without having taken any nitrous oxide. He began taking lots of B12 and other supplements, exercised more, and cut out gluten from his diet. He tells me that almost all of the feeling has returned to his feet.
I wholeheartedly hope that Jed is able to fully recover and flourish. He told me that he is grateful to share his story, so that others don’t hurt themselves like he did.
It is an established fact that heavy use of nitrous oxide causes neurological damage, which can in some cases be permanent and irreversible. This damage happens because nitrous oxide deactivates vitamin B12 (by oxidizing the cobalt ion in the compound), meaning that heavier use can lead to functional vitamin B12 deficiency. Vitamin B12 is essential for the production and maintenance of the myelin that coats our neurons, and if the body doesn’t have enough vitamin B12 available, this leads to demyelination of the central and peripheral nervous system. The demyelination can cause the progressive degeneration of the spinal cord, and a cluster of serious neurological issues called “generalized demyelinating polyneuropathy.” This damage can produce physiological symptoms including numbness, muscle weakness, partial or total paralysis of parts of the body, and paresthesia. It is also associated with psychiatric symptoms such as anxiety, depression, cognitive impairments, and even hallucinations.
Fortunately, in many cases nitrous-oxide-induced neurological damage can be treated with vitamin B12 supplementation, which helps the body repair the demyelination, and allows the nervous system to recover. This, of course, is only effective if the user also stops using nitrous oxide.
It is not clear how much nitrous oxide use is sufficient for causing vitamin B12 deficiency and neurological damage. Jed consumed an obscene amount of nitrous oxide in that two week period, but there have been many reported cases of neurological damage in patients who used far, far less of the gas, and in different patterns. Individuals presumably have different levels of vulnerability depending on their particular physiologies. Jed used a lot of nitrous oxide in his youth without reporting any noticeable neurological symptoms, but then when he went on his two week binge decades later, he did experience severe harm. This may be in part due to changes in his body as he got older, or any number of unknown factors.
I have not found any survey data, but my impression is that most people don’t know about nitrous oxide’s capacity to cause serious neurological damage by inducing vitamin B12 deficiency. Therefore, I believe that raising awareness about this serious risk (and the utility of vitamin B12 supplementation) is one of the most important strategies for harm reduction. Every online nitrous oxide harm reduction guide discusses the topic, but only users who actively seek out these guides are going to read the information there. Perhaps the information could be more effectively transmitted to users if head shops, online vendors, etc. voluntarily provided harm reduction messages/safety warnings to customers. If that isn’t feasible, perhaps laws could be enacted that make warning labels mandatory on all nitrous oxide products. These are just some ideas.
Nitrous Oxide Addiction and “Nitrous Demons”
“Hippie crack” is one of the slang terms for nitrous oxide, and it is not difficult see why this term is used. Although the substance’s acute effects are much more akin to ketamine than they are to cocaine, these effects hit immediately after ingestion, quickly reaching an intense and typically euphoric peak, then rapidly fading away. It is not at all surprising that some nitrous oxide users fall into patterns of compulsively dosing and re-dosing the substance.
Although the scientific research into nitrous oxide’s dependence potential has not yet produced conclusive results, hypotheses have been proposed about the neuropharmacological mechanisms through which use of the drug could create a reward/craving cycle. Nevertheless, we already have enough evidence indicating that addiction is a risk associated with nitrous oxide use. In addition to a mountain of anecdotal reports and individual case studies, we can look to recent data suggesting that nitrous oxide addiction is a very real problem. For example, more and more individuals have been seeking emergency care and/or treatment for symptoms of nitrous oxide use, and large portions of these patients report that they had been using the substance heavily and frequently.
There have been some high-profile cases of nitrous oxide addiction in recent years. In 2020, Zappos founder Tony Hsieh died at 46 in a house fire, possibly while intoxicated, after a period of time in which he descended into a spiral of heavy, frequent, compulsive nitrous oxide use. He was apparently first addicted to ketamine, and then switched to nitrous, consuming 50 cartridges a day, including during business meetings.
On the left, Tony Hsieh as one of the most successful young entrepreneurs in the US. On the right, weeks before his death, emaciated and clutching a nitrous oxide whippet
Stephen Gilchrist Glover, better known as “Steve-O” from the Jackass movies, spent time in the depths of what he explicitly described as “nitrous addiction,” although he was eventually able to get out of this self-destructive pattern of use. During his addiction, Steve-O reported some very unsettling phenomena. He eventually developed hallucinations, including audible voices telling him to keep taking more nitrous oxide.
“I was being instructed to kill myself, and I considered that demon sprits,” he told the NYT, describing how he would try to avoid breathing air between lungfuls of nitrous oxide, as instructed by the perceived demonic spirits. He reported that when he would end up taking a breath of air, “his demons would berate him.”
In the same NYT article, we hear of a young woman who similarly described feeling possessed by what she called a “whippet demon” that was making her endlessly inhale nitrous oxide cartridges (this woman spent over 5000 dollars on nitrous oxide in a single month at one point). Furthermore, I’ve found forum posts in which nitrous oxide users report experiencing malevolent spirit encounters that they attributed to their heavy and/or compulsive use of the substance.
I have also read countless reports of nitrous-facilitated entity encounters (positive, neutral, and negative) that are not necessarily associated with heavy and/or compulsive use. Nitrous oxide, as a powerful and certifiably weird dissociative substance, is clearly capable of facilitating entity encounters (rather than being simply a straightforward euphoriant). It makes sense that when this drug is used in compulsive patterns, some users might experience nitrous-facilitated entity encounters that are shaped by, and that feed into, the self-destructive pattern of use. Hallucinations are a known adverse effect of excessive nitrous oxide use, and it makes sense that these hallucinations would sometimes develop into, or weave together with, repeated experiences of “nitrous demons” that seem to urge or force users to maintain or deepen their addictions.
This phenomenon seems similar to other compulsive-use-perpetuating double-bind feedback loops observed with other substances. For example, I know a very troubled person who went on a methamphetamine binge that was maintained in part by paranoia that they would be harmed by an assailant if they went to sleep, leading them to keep re-dosing the drug in order to stay awake. I have heard of extremely similar things happening to other methamphetamine users; one story involved a user compulsively re-dosing because they believed that evil clowns would come to kill them if they went to sleep. When people are in the grips of addiction and/or compulsive use of a substance, their thoughts, emotions, motivations, and even (if present) hallucinations can seem to orient themselves around the “attractor” of maintaining the pattern of use. When continued use of the substance increasingly impairs the person, and especially when it increasingly leads to hallucinations/delusions/detachment from consensus reality, then all of these progressive effects can increasingly enable and feed into maintenance of the compulsive use.
I will not offer suggestions here for how to mitigate the risk of nitrous oxide addiction; that discussion is outside the scope of this article, although I will say that raising awareness about the risk is itself an important step towards mitigation. With regard to mitigating the risk of encountering “nitrous demons” that compel users to keep inhaling more gas, I would imagine that the most effective strategy would be to avoid sinking into the depths of nitrous oxide addiction in the first place (this suggestion is not particularly helpful, I know).
If you asked a shamanic practitioner, or someone else who works within a framework that understands disembodied spirits as being real, autonomous beings, you might receive a different answer to the question of how people can protect themselves from “nitrous demons.” This is also a discussion that is outside the scope of this article.
Although nitrous oxide is sometimes viewed as a harmless, even goofy party favor, or as an innocuous substance that they give to kids at the dentist, serious harms can occur without appropriate risk mitigation steps. I hope this article will spark further nitrous oxide harm reduction conversations and harm reduction efforts. Stay safe, everyone.
In other news: here’s a Vice brief history of humans’ use of nitrous oxide, which was first discovered in the 18th century.