What Is Hippy Crack Addiction

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Hippy crack (Nitrous oxide, N2O, laughing gas) addiction is defined by:

Inhaling 50 – 70 balloons per session, leading to vitamin B12 deficiency (<200 pg/mL) and peripheral neuropathy [1]
Increasing the ‘usual’ amount of N2O (e.g. 500 to 1000 balloons p/wk) within a 12-month period, to achieve the same effect [1]

Physical Indicators Of Hippy Crack Addiction

Hypoxia

Hypoxia is a physical indicator of nitrous oxide dependence as a result of a low blood solubility (blood-gas partition coefficient = 0.47) and rapid oxygen dilution in the alveoli within 2 - 5 minutes of drug-taking, leading to [2]:

Fainting in 4 – 6% after taking 8 – 10 ‘hits’ in one session via various inhalation methods (e.g. cream dispenser, plastic bag, or gas bulb) [3]
Skin pallor caused by low oxygen saturation levels (76% vs normal range = 95 – 100%) and hypotension (60/40 mmHg) after consuming up to 250 balloons per day for 9 months [4][5]

Around 90% of those who faint after consuming nitrous oxide are drunk or high on other drugs at the same time, leading to intense euphoria within 1 - 2 minutes and possibly asphyxial death caused by a lack of oxygen after consuming high concentrations (>50%) of N₂O in an enclosed space [3].

Vitamin B12 Deficiency

Being deficient in Vitamin B12 is a physical indicator of laughing gas abuse as a result of nitrous oxide inactivating methionine synthase via oxidation of the cobalt in vitamin B12, resulting in:

Hypochromic macrocytic anaemia in 20%, with a mean corpuscular volume of 107.1 fL (normal values 83–101 fL) and fatigue, headaches, and dyspnea caused by B12 deficiencies (<200 pg/mL) in up to 60% after 1 year of nitrous oxide abuse [6]
Jaundice of the skin and whites of the eyes caused by elevated bilirubin levels in the blood (5.2 mg/dL vs normal values = 0.3 to 1.2 mg/dL) after repeated inhalation [7]

Kulkantrakorn et al, (2024) studied a 19-year-old girl who developed macrocytic anaemia after consuming nitrous oxide continuously for 8 weeks, presenting with low serum B12 levels (65.2 pg/mL), a complete blood count of 100 f/L, and fatigue and weakness that persisted for 2 months [4].

Oesophageal/ Facial Burns

Oesophageal/facial burns are physical indicators of nitrous oxide dependence as a result of direct contact with freezing temperatures (around - 40 ̊ C) as the gas is discharged from a pressurised container for direct inhalation or to fill a balloon, leading to frostbite on the lips, nose, or throat as the skin and underlying tissue drops to –2 ̊ C [8][9].

Murphy et al, (2024) noted a 17-year-old female who sustained a contact burn injury to the chin and lower lip (0.5% total body surface area) after directly inhaling nitrous oxide gas from a canister, requiring treatment with silver dressings and paraffin for 10 days to encourage re-epithelialisation [8].

Being addicted to nitrous oxide also leads to burns on the fingertips, hands, arms, and legs (up to 4% TBSA) due to gas leaking from a ‘cracker’ device, although some burns heal within 4 weeks, others require a split-thickness skin graft, often resulting in hypopigmented scarring and contour deformities [8].

Balance Issues

Ataxia is a physical indicator of nitrous oxide dependence as a result of N₂O-induced subacute combined degeneration of the spinal cord, resulting in an unsteady gait and limb weakness in 34 – 52% after 6 months of drug abuse [10].

Kulkantrakorn et al (2024) found that 7 patients aged 19 – 32 developed acute or subacute ataxia after misusing nitrous oxide for up to 1 year, leading to:

A wide-based gait, unsteadiness, and weakness in the arms and legs caused by hyper signal intensity at the posterior aspect of the spinal cord (along C4-C7 levels) after 9 months of daily inhalation
Motor weakness in both legs (graded 3 out of 5 on the MRC scale), residual footdrop, and distal foot numbness due to segmental T2 hyperintense foci at the posterolateral cord after using nitrous oxide twice weekly for over 2 months
Ataxic neuropathy and instability during a tandem walk after 6 months of weekly use, with weakness in ankle and toe movements and ongoing balance issues (e.g. difficulties standing on one foot) for up to 1 year [4].

Chen, et al (2016) studied a 20-year-old who struggled to walk independently due to a segmental hyperintense lesion on the spinal cord after 2 years of recreational nitrous oxide use, resulting in an unsteady gait and involuntary lower limb movements, although balance and gait improved within 3 weeks of taking vitamin B12 supplementation (2000 μg per day) [11].

Lhermitte's Sign

Lhermitte’s sign (electric shock sensations in the spine and limbs) is a physical indicator of nitrous oxide dependence as a result of low B12 levels (<150 pmol/L) in 70.7% and T2 signal hyperintensity in the cervical region of the spinal cord in 68% after consuming around 25 cartridges per day for 7 months [12].

Marcotta and Kesserwani (2020) studied a 41-year-old man who developed Lhermitte’s sign after buying whipped cream chargers in canisters from the internet and consuming 8 – 30 per day for a year, each containing 8g of nitrous oxide that was emptied into a balloon and inhaled for 1 – 2 minutes:

Describing the experience elicited by neck flexion as a powerful tingling vibration that travelled down the arms, trunk, and legs, continuing down to the feet
Symptoms were a stiff neck, and experiencing an “electrifying sensation” in the anterior abdomen whilst elevating arms due to posterior cord demyelination and mild bilateral peri-atrial hazy demyelination [13]

15% develop Lhermitte’s sign after abusing laughing gas for 3 – 18 months, although the electric shock sensation begins to subside after two weeks of taking 5mg doses of sublingual vitamin B12 and 4mg folic acid daily [12][13].

Psychological Indicators Of Hippy Crack Addiction

Cognitive Fragmentation

Cognitive fragmentation is a psychological indicator of nitrous oxide abuse as a result of low B12 levels (148 pmol/L) after intermittent use (e.g. 6 sessions per month), resulting in perseverative thinking (e.g. concerns over others' safety) and the repetition of words and short phrases [14].

Chen et al, (2018) noted a 19-year-old man developed fragmentation in his listening comprehension, struggled to distinguish between nightmares/dreams and reality, and had ongoing suspicions that his family were against him after inhaling laughing gas 2 – 3 times daily for around 1 year [15].

Cognitive fragmentation caused by nitrous oxide abuse typically resolves after drug cessation and short-term (e.g. 1 – 2 weeks) supplementation with intramuscular or oral 1000μg cobalamin and 15mg folic acid daily [14][15].

Auditory Distortions

Auditory distortions are psychological indicators of nitrous oxide abuse as a result of homocysteine imbalances caused by NMDA receptor antagonism and elevations in middle ear pressure (0.09kPa per min) as N₂O is inhaled and rapidly absorbed into the bloodstream, leading to [16]:

Sound distortions (e.g. metallic, “wah wah”, robotic, or echoing) sounds within 20 seconds of consumption, lasting up to 2 minutes each time in heavy nitrous oxide users (75 – 2000 canisters consumed per week) [17]
‘Diminished’ sound in 73% or ‘sharpened’ hearing in 13%, as some users claim “My hearing became more acute and I distinctly heard every sound in the room" after inhaling laughing gas [18][19]

Sheldon, Rollo, et al, (2019) noted a 37-year-old woman experienced ongoing auditory command hallucinations within 1 day of inhaling 24 nitrous oxide bulbs, although the disturbances subsided after 7 weeks of treatment with 1mg hydroxocobalamin (vitamin B12) intramuscular injections [20].

Sensory Disconnection

Sensory disconnection is a psychological indicator of nitrous oxide abuse as a result of a 35% reduction in glutamatergic synaptic transmission in the basolateral amygdala within 5 minutes of consumption, leading to [21]:

Depersonalisation (detachment from oneself) whilst feeling like thoughts, feelings, and actions are being observed from an outside perspective and derealisation (detachment from surroundings) and feeling like the external world is unreal or distorted within 10 – 30 seconds of inhalation [22]
Disassociation and floating sensations typically for 1 - 30 minutes after using, although some users report feeling “A little less human”, possessed, or being in a “fifth dimension” for up to 1 week after abusing “Nang crackers” [22][23]

Hippy Crack Mechanism Of Action

Nitrous Oxide's mechanism of action involves:

Blocking NMDAR-activated currents in the hippocampus with an approximate half-maximal effective concentration (EC50) of 30–40%, leading to a 20% potentiation of GABA-A receptors whilst blocking 30% of kainate currents [24]
Dopamine disinhibition due to the antagonistic action on NMDA receptors, leading to an 144% increase in dopamine firing in the nucleus accumbens and ventral tegmental area within 60 minutes of drug exposure, as well as a 1.54-fold increase in GABA-evoked currents [25][26]

Who Is Most Likely To Become Addicted to Hippy Crack?

Demographics	Why?
18 - 25 Year Olds	3x more likely to use than over 25s due to a 20% increase in impulsivity + accessibility and affordability, as around 40% buy from friends, the internet, or a supermarket for £1.50 (individual ‘whippet’) or £15 - 20 for a box of 50 [3][22][27][28]
Borderline Personality Disorder	Impulsive behaviour is 42% higher than users without BPD, and 47% develop an SUD after seeking immediate gratification (an intense high within 10 - 20 seconds) [29]
High-Frequency Binge Inhalation	Around 10 ‘hits’ per session to maintain high = tolerance + psychological dependence develops = higher/more frequent doses (e.g. up to 50 ‘hits’) to achieve the same effect
Perceiving Hippy Crack Use As ‘Harmless’	Ongoing use with no safety precautions (e.g. using >5 balloons per session in poorly ventilated spaces) as 77% ‘do not worry’ about the effects on physical/mental health due to a lack of awareness of nerve damage, hypoxia, etc. [3]
Existing B12 Deficiency/Vegetarian Diet	Compulsive use to receive short (1-2 minute) euphoric bursts as a temporary relief for fatigue, low mood/anhedonia, or nerve pain caused by a 78% reduction in daily B12 intake (μg/day) and 35% lower serum B12 levels (pmol/l) compared to meat eaters [36]

Mixing Hippy Crack With Other Drugs

Polydrug Combination	How It Changes Euphoria	How It Changes Addiction Risk
Combined With MDMA	Intensified feelings of emotional warmth due to a 144% dopamine increase from N₂O + a 5-8-fold increase of DA + serotonin from MDMA [25][30][31]	Habitual use occurs after redosing during a ‘come-down’ from the 30 - 60 second rush + flattened effect of MDMA
Combined With Cocaine	Amplified pleasure from a stimulant and sedative with feelings of being ‘superhuman’ for up to 45 minutes	15 - 24-year-olds have the highest addiction rates for both substances compared to other age groups (e.g. 25% vs 12% for over 45s) [32]
Combined With Alcohol	Heightened relaxation and disorientation as both substances inhibit glutamatergic transmission + increase GABAergic activity by nearly 2-fold [26]	Males are more likely to become addicted to both substances compared to females (21% vs 9%) due to higher rates of impulsivity (55% vs 45%) [26][32]
Combined With Heroin	Extended high (e.g. up to 6 hours vs 1 minute) with extreme dissociation (e.g. ‘nodding’ off) whilst being in a ‘dreamlike’ state	Up to 44% become addicted to heroin, whereas N₂O use is mostly (80%) recreational (e.g. <10 balloons per month) [32][33]
Combined With Ketamine	Euphoric effects for up to 1 hour + may result in a ‘K-hole’ with intensified dissociation + sensory distortions (warped sounds or kaleidoscope vision)	Cross-tolerance and cravings occur after repeated ritualised party use alters the brain’s reward system via the NMDAR antagonist effect of both drugs

How Do Different Forms Of Nitrous Oxide Change Nitrous Oxide Addiction?

Form	Typical Units Of Nitrous Oxide	Impact On Addiction Risk
Cream Chargers	8 - 16g of 100% pure N₂O	Low cost and accessibility (boxes of 24 online or in supermarkets for £10) encourages regular use and binging patterns (e.g. 25 per session)
Catering Cannisters	Around 600g	Contain 100% N₂O and inhaled amounts are uncontrolled, leading to accidental consumption of high volumes and quicker tolerance development and cravings
Medical Grade Nitrous Oxide	900 to 18,000L	Mixed with at least 30% O₂ when administered, usually short-term and in controlled settings by medical professionals to prevent excessive use + tolerance build up
Balloons	Typically filled with 8g of N₂O from a ‘cracker’	Readily available at festivals or parties (e.g. pre-filled balloon costs £1.50) = habitual use in social settings + stacking to maintain the 60-second high
Entonox “Gas And Air”	700 - 3500L cylinders filled 50:50 with N₂O + oxygen	Low addiction potential as mixed with 50% O₂ to provide gradual pain relief rather than an instant high + supervision in hospitals/dental clinics to prevent abuse

Legal Status Of Nitrous Oxide

In 2023, nitrous oxide was classified as a Class C drug in the UK (under the Misuse of Drugs Act 1971) after previously being controlled under the Psychoactive Substances Act 2016, meaning that possession of the drug was legal (except in custodial settings) but is now illegal when intended for ‘wrongful inhalation’ (e.g. other than medical or dental purposes), resulting in:

An unlimited fine, a visible community punishment (e.g. wearing a high visibility orange vest to complete 40 to 300 hours of unpaid work, i.e. removing graffiti or clearing wasteland), or a caution that appears on the individual’s criminal record
A prison sentence of up to 2 years, an unlimited fine, or both if found in unlawful possession of nitrous oxide on more than one occasion [34][35]

Nitrous oxide is still available in the UK for catering purposes (e.g. as a propellant for dairy foam) and in healthcare settings (e.g. to provide mild-moderate sedation during dental treatment or as pain relief during labour).

Nitrous Oxide Misuse In The UK

The UK has the highest global prevalence of lifetime nitrous oxide use (39%), most commonly used by 24-year-olds and typically inhaled 3 – 10 times per session via balloon or whipped-cream dispenser at a festival or house party [3][22].

Past-year nitrous oxide abuse is 4 – 6 times higher in the UK than Switzerland, Germany, Australia, and New Zealand and the number of individuals receiving treatment for N₂O dependency has increased by over 6-fold within 10 years due to widespread availability and many users perceiving the drug as 'harmless' [3][28].

References

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[2] Knuf, Kayla, and Christopher V. Maani. Nitrous Oxide. 28 Aug. 2023. Accessed 20 Mar. 2025." Nitrous oxide has a low blood solubility (blood-gas partition coefficient of 0.47), leading to a quick onset and offset, ... the concentration gradient between the gases in the lung and alveolar circulation rapidly reverses, leading to rapid oxygen dilution in the alveoli and subsequent hypoxia."
[3] Kaar, Stephen J., et al. “Up: The Rise of Nitrous Oxide Abuse. An International Survey of Contemporary Nitrous Oxide Use.” Journal of Psychopharmacology, vol. 30, no. 4, Apr. 2016, pp. 395–401. Accessed 20 Mar. 2025. “Table 2-3.”
[4] Kongkiat Kulkantrakorn, et al. “Nitrous Oxide Abuse and Associated Neurological Diseases.” BMC Neurology, vol. 24, no. 1, BioMed Central, Nov. 2024. Accessed 20 Mar. 2025. “A 20-year-old patient had a history of daily laughing gas use for 9 months, ... physical examination revealed alertness, pallor, and weakness in all extremities (grade 3 out of 5 MRC score).”
[5] Vollenbrock, Sophie E., et al. “Nitrous Oxide Abuse Associated with Severe Thromboembolic Complications.” European Journal of Vascular and Endovascular Surgery, vol. 62, no. 4, Elsevier BV, July 2021, pp. 656–57. Accessed 20 Mar. 2025.“A 27-year-old male presented with acute shortness of breath. His history included morbid obesity, smoking, and N2O abuse (250 balloons/day, 2 kg). On arrival at the ED, oxygen saturation was 76%, and his blood pressure was 60/40 mmHg.”
[6] Yu, Miao, et al. “Analysis of Clinical Characteristics and Prognostic Factors in 110 Patients with Nitrous Oxide Abuse.” Brain and Behavior, vol. 12, no. 4, Mar. 2022. Accessed 20 Mar. 2025.“60% (34 out of 57 cases) of patients were deficient in vitamin B12, .... and 20% (five out of 25 cases) of these patients presented with hypochromic macrocytic anemia, with a mean corpuscular volume of 107.1 ± 5.2 fl (normal value 83–101 fl).”
[7] Jariwala, Prayag, et al. “Acute Liver Injury and Pulmonary Embolism Secondary to Nitrous Oxide Inhalation: A Case Report .” Journal of Clinical Images and Medical Case Reports, Open Source Publications, Nov. 2024. Accessed 20 Mar. 2025.“Table 1.”
[8] Murphy, D., et al. “Frostbite Injuries from Recreational Nitrous Oxide Use.” Ir Med J, vol. 117, no. 2, Feb. 2024. Accessed 20 Mar. 2025.“Frostbite injury can occur due to direct spraying or spilling of the liquified gas on to the skin, with temperature on contact of approximately -55 to -88 degrees Celsius, ... as N2O is discharged from the highly-pressurised container (for direct inhalation or to fill a balloon) the metal cannister briefly decreases its temperature to approximately - 40 ̊ C.”
[9] Baran, K. C., et al. “Severe Nitrous-Oxide Frostbite Injuries on the Rise in the Netherlands; Let’s Raise Awareness.” Burns, Elsevier BV, Sept. 2020. Accessed 20 Mar. 2025.“The skin and underlying tissue reaches a temperature of - 2 degrees celsius, ice crystals are formed, inducing cell membrane damage or immediate apoptosis.”
[10] Gao, Han, et al. “Clinical and MRI Differences between Patients with Subacute Combined Degeneration of the Spinal Cord Related vs. Unrelated to Recreational Nitrous Oxide Use: A Retrospective Study.” Frontiers in Neurology, vol. 12, Feb. 2021. Accessed 21 Mar. 2025.“Table 1.”
[11] Chen, Hung-Ju, and Chih-Shan Huang. “Nitrous Oxide-Induced Subacute Combined Degeneration Presenting with Dystonia and Pseudoathetosis: A Case Report.” Acta Neurologica Taiwanica, vol. 25, no. 2, June 2016, pp. 50–55. Accessed 21 Mar. 2025.“A 20-year-old woman presented with one month of progressive unsteady gait, involuntary movement in the four limbs, ... she had used N2O and ketamine intermittently for recreational purposes for about two years.”
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[13] Marotta, Dario A., and Hassan Kesserwani. “Nitrous Oxide Induced Posterior Cord Myelopathy: Beware of the Methyl Folate Trap.” Cureus, July 2020. Accessed 21 Mar. 2025.“He bought whipped cream chargers in canisters from the internet and consumed anywhere from eight to 30 canisters per day, ... four days later he started experiencing the Lhermitte phenomenon, which he described as a powerful tingling vibration that travelled down the arms, trunk, legs, and continued all the way down to the feet, elicited by neck flexion.”
[14] Wong, Sophia, et al. “Nitrous Oxide (N2O)-Induced Acute Psychosis.” Canadian Journal of Neurological Sciences, vol. 41, no. 5, Cambridge University Press, Sept. 2014, pp. 672–74. Accessed 21 Mar. 2025..A man in his 30s presented with new-onset psychotic symptoms and personality changes a few days after inhaling N2O for several (<10) hours. He described having demons in his head and expressed concerns over his family’s safety for no apparent reason, ... he was perseverating, repeating words and short phrases.
[15] Tianzhen CHEN et al. “Neuropsychiatric Symptoms Induced by Large Doses of Nitrous Oxide Inhalation: A Case Report.” Shanghai Archives of Psychiatry, vol. 30, no. 1, Feb. 2018, pp. 56–59. Accessed 21 Mar. 2025. "Since November 2016, the patient had started using nitrous oxide 2-3 times a day, 120-150 branches at a time. He experienced fragmentation in his listening comprehension and suspicion, and couldn’t distinguish between dreams and reality."
[16] Perreault, Luc, et al. “Middle Ear Pressure Variations during Nitrous Oxide and Oxygen Anaesthesia.” Canadian Anaesthetists’ Society Journal, vol. 29, no. 5, Springer Science and Business Media LLC, Sept. 1982, pp. 428–34. Accessed 21 Mar. 2025.“The pressure increase reaches the level of 3.68kPa (375 mmH20) during the first thirty minutes, ... the rate of elevation of middle ear pressure is about 0.09kPa (9mmH20) per minute.”
[17] Keddie, Stephen, et al. “No Laughing Matter: Subacute Degeneration of the Spinal Cord due to Nitrous Oxide Inhalation.” Journal of Neurology, vol. 265, no. 5, Mar. 2018, pp. 1089–95. Accessed 21 Mar. 2025.“Inhalation results in almost immediate psychotropic effects including euphoria, giggling, distortion of sound and mild hallucinations, peaking after about 20 s before rapidly diminishing... users often feel entirely normal within 2 min following inhalation.”
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[19] Kaufman, Eliezer, et al. “Sensory Experience Induced by Nitous Oxde Analgesia.” Anesth Prog, vol. 37, 1990, pp. 282–85. Accessed 21 Mar. 2025.“Table 1.”
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[21] Ranft, Andreas, et al. “Nitrous Oxide (N2O) Pre- and Postsynaptically Attenuates NMDA Receptor-Mediated Neurotransmission in the Amygdala.” Neuropharmacology, vol. 52, no. 3, Elsevier BV, Mar. 2007, pp. 716–23. Accessed 24 Mar. 2025.“N2O decreased the amplitude of the NMDAR-EPSCs by 35% within 5 min.”
[22] Drug Watch. Information Sheet Nitrous Oxide Classification: Dissociative Anaesthetic. 22 Dec. 2017. Accessed 24 Mar. 2025.“A single inhalation will result in effects starting almost immediately, peaking about 10-30 seconds after inhalation and then rapidly diminishing. If the dose is repeated, effects reach a plateau about 30-60 seconds after the first breath.”
[23] Walter, Hannah, et al. “Exploring the Experiences and Perceptions of Young People’s Recreational Nitrous Oxide Use.” Advances in Dual Diagnosis, Emerald Publishing Limited, Feb. 2025. Accessed 24 Mar. 2025."The after effects of usage reported by several participants include “a little less human” (#5), ... effects were described as lasting up to a week."
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[35] GOV UK. Community Sentences. 9 Nov. 2011. Accessed 25 Mar. 2025.“You must wear a high visibility orange vest while you work, ... expect to complete anything from 40 to 300 hours of Community Payback, ...You have to work 3 or 4 days each week if you’re unemployed.”
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About the author

Mischa Ezekpo

Mischa Ezekpo has a Bachelors degree in Psychology from Northumbria
University, and a Masters degree in Childhood Development and
Wellbeing, from Manchester Metropolitan University. Since 2018, Mischa
has written and published work on Addiction, Mental Health, Depression, and Eating Disorders. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: August 26, 2025