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Hippy Crack Detoxification comprises:

A symptom-managed approach, treating intracranial hypertension with acetazolamide as needed
Providing 1000-2000 μg vitamin B12 as required

What Is Hippy Crack Detoxification?

There is no specific medication prescribed for hippy crack detoxification, although withdrawal is symptom-managed during a 28-day rehab programme, including:

Daily vitamin B12 supplementation (typically 1000 μg) to manage paresthesia of extremities (hands, arms, legs, or feet) in up to 80% caused by cobalamin deficiencies (B12 <150 pmol/L) after 7 months of hippy crack abuse [1]
Supplemental oxygen via masks or nasal cannulas to provide 1 – 4 litres of oxygen per minute alongside regular pulse oximetry checks to increase oxygen saturation levels from 76% to 95 – 100% after inhaling up to 250 balloons a day [2] [3]

What Are The Physical Symptoms Of Hippy Crack Detoxification?

Intracranial Hypertension

Intracranial Hypertension is a physical symptom of hippy crack detoxification as a result of elevated intracranial pressure (>20 mmHg) and a buildup of cerebrospinal fluid (>10% of skull’s volume) after consuming 0.5L of nitrous oxide daily for 4 months, leading to [4][5]:

Severe, constant, ‘diffuse’ headaches (worse in the morning or aggravated by coughing/bending forward) with photophobia and phonophobia (light/sound sensitivity) caused by a CSF opening pressure of 51 cm H20 (normal range = 10 – 20 cm H20) [4][5]
Fulminant papilloedema with haemorrhages and cotton wool spots caused by increased thickness (437 – 466 µm) of the global peripapillary retinal nerve fibre layer in both eyes (normal values 72 - 171 µm) [5]
Diplopia (double vision), a loss of colour vision, ‘flashing lights’ or ‘gradual dimming’ in one or both eyes, with reduced visual acuity (6/12 - 6/18) and relative afferent pupillary defects caused by intracranial hypertension [4][5]

Intracranial hypertension typically resolves within 2 weeks of N₂O cessation, B12 supplementation, and 1-4g of Acetazolamide daily to prevent permanent vision loss by inhibiting enzymes in the choroid plexus and stabilising the production of cerebrospinal fluid [4][5].

Temperature Fluctuations

Temperature Fluctuations are physical symptoms of hippy crack withdrawal because the restoration of nerve function and blood flow balances thermoregulatory responses (e.g. shivering, sweating) after being blunted by 22 – 25% during active use [6].

Up to 38% excessively sweat and feel feverish within 48 hours of nitrous oxide cessation as the heat loss threshold is no longer raised by 1.0 °C and the heat maintenance threshold is no longer reduced by 2.5 °C after nitrous oxide is removed from the body [7][8].

Temperature fluctuations typically subside within 3 days of nitrous oxide withdrawal as core body temperature is restored to 37°C and skin blood flow is mediated by the noradrenergic vasoconstrictor and nonadrenergic active vasodilator systems in the SNS [7].

Disturbed Sleep And Vivid Dreams

Disturbed sleep and vivid dreams are physical symptoms of nitrous oxide withdrawal as a result of glutamate rebound and excitability, whilst the brain attempts to compensate for irregular sleep patterns during active use, as some users report “Falling asleep with a balloon in the mouth, waking up after 90 minutes and inhaling again” [9].

Nitrous oxide detoxification provides sleep hygiene advice (e.g. avoiding caffeine or daytime napping) and medication (e.g. 7.5mg zopiclone) if necessary to manage insomnia, hypersomnia, or vivid dreams experienced by up to 64% of patients during withdrawal [8].

Sleep disturbances typically ease within 1 week of N₂O cessation as REM sleep is no longer suppressed, although some persist for up to 3 months and are likely to be exacerbated in 5% of patients with sleep disorders (e.g. sleep apnea) after 9 months of N₂O misuse [10].

What Are The Psychological Symptoms Of Hippy Crack Detoxification?

Rebound Anxiety

Rebound anxiety is a psychological symptom of nitrous oxide withdrawal because GABAergic activity is no longer increased by 15%, and NMDAR excitatory autaptic currents are no longer inhibited by 49% following the cessation of nitrous oxide's anxiolytic effect [11].

Up to 45% experience rebound anxiety, with heart palpitations and sweating within 72 hours of N₂O cessation, typically easing within 1 week, although anxiety is heightened by up to 200% in users with a history of co-occurring volatile solvent (e.g. butane) abuse [8][12].

Nitrous oxide detoxification manages rebound anxiety by:

Encouraging patients to practice deep breathing (e.g. 4-7-8 breathing or box breathing methods) and engage in daily exercise (e.g. a 20-minute walk or jog)
Regularly monitoring psychological and physical anxiety symptoms (e.g. excessive worrying, sweaty palms) using the Modified Mini Screen (MMS) and Mental Status Examination (MSE)
Administering beta blockers (e.g. 40mg propranolol 1 –3 times daily) or SSRIs (e.g. 10 – 40mg citalopram once daily) for persisting anxiety

Derealisation And Depersonalisation

Depersonalisation/Derealisation are psychological symptoms of N₂O withdrawal caused by rebound excitotoxicity after NMDA receptors are blocked during active use, leading to some users feeling “Less human" or in a “Fifth dimension" for up to 7 days after cessation [13].

Patients are encouraged to practice grounding techniques (e.g. naming red objects, toe-wiggling), and psychological assessments take place regularly during N₂O withdrawal to track changes in the presence, frequency, and intensity of dissociative symptoms such as:

Feeling detached from the body, in a dream, or that time is moving slowly
Feeling like the external world is unreal, distant, or distorted
Fixed or 'glazed' eyes, extended periods of silence, or speaking with a monotone voice

Dissociation during N₂O withdrawal may be exacerbated in up to 30% of users with pre-existing trauma (e.g. witnessing death) or head injuries after an extended loss of consciousness, as up to 67% develop depersonalisation-derealisation disorder after the event [12][14].

Brain Fog

Brain fog is a psychological symptom of nitrous oxide withdrawal because GABAergic neurotransmission is no longer elevated by 15% within the central nervous system, resulting in users feeling "Dumb", “A haze over the head," or a loss of short-term memory for up to 1 week after cessation [11][13].

Nitrous oxide detoxification manages brain fog (e.g. impaired decision making, attention, or concentration) in up to 27% by providing [8]:

Nutritionally balanced meals during treatment, including 40% of carbohydrates (e.g. pasta, bread, rice), 40% of fibre (e.g. fruit, vegetables, beans), and 20% of protein, dairy, and fats (e.g. fish, eggs, yoghurt) [15]
Daily 1000 μg vitamin B12 supplements to raise energy levels and restore cognitive function after recreational use of nitrous oxide causes deficiencies (B12 <150 pmol/L) in 85% [1]
Information about sleep hygiene practices (e.g. attempting to sleep 7 – 9 hours a night) whilst encouraging 20-60 minutes of daily exercise to enhance mental clarity

How Do Respiratory Conditions Change Hippy Crack Detoxification?

Chronic Obstructive Pulmonary Disease

Patients suffering with chronic obstructive pulmonary disease (COPD) change nitrous oxide withdrawal as a result of chronic inflammation, destruction of lung parenchyma, and suppressed cough reflex after repeated laughing gas inhalation, leading to:

Shortness of breath on exertion, a mucus-filled cough, and wheezing, requiring inhalers (e.g. beta-2 agonist, antimuscarinic) to be used 2 – 4 times daily to encourage steady breathing by relaxing and widening the airways [16]
Theophylline or carbocisteine tablets/capsules up to 4 times a day to treat persistent chesty coughs by controlling swelling in the airways, relaxing the muscle lining, and thinning phlegm in the throat [16]
Antibiotics (e.g. amoxicillin) for patients that develop signs of a chest infection (e.g. brown/green phlegm) or short-term steroid treatment (e.g. 5 days) to manage COPD ‘flare up’s’ [16]

Hospital care with referrals to COPD specialists is arranged for patients needing surgery (e.g. bullectomy), long-term oxygen (>15 hours daily), or steroid treatment (>4 weeks) to address symptoms unable to be controlled by medication during N₂O withdrawal [16].

Asthma

Patients suffering from asthma change N₂O withdrawal as a result of displaced oxygen within the alveoli, asphyxiation, bronchospasms, and a 6 – 20% reduction in diffusing capacity after repeatedly inhaling psychoactive substances, leading to [17]:

Wheezing, persistent coughing, shortness of breath, and chest tightness, requiring oxygen therapy and 3-weekly arterial blood gas (ABG) tests to monitor progress in patients with severe chronic asthma (PaO2<7.3 kPa) [3]
Requirements for reliever, preventer, or combined inhalers (e.g. 2 uses twice daily of 100mcg Clenil Modulite) and/or Leukotriene receptor antagonists (e.g 10mg Montelukast daily) to control swelling and inflammation in the airways [18]

GPs are likely to be consulted, and hospital care may be arranged for patients with severe asthma exacerbated by N₂O abuse due to requirements for mechanical ventilation, chest x-rays, and 24-hour monitoring to manage severe hypoxia (SpO2 <92%) or abnormal respirations (>25 breaths/min) [18].

Cystic Fibrosis

Patients suffering from cystic fibrosis change nitrous oxide withdrawal as a result of exacerbated airway resistance caused by elevated methemoglobin levels (>7%) and a buildup of thick mucus in the lungs after nitrous oxide abuse, leading to [19]:

Aggravated coughing and dyspnea in up to 40% due to the diminution of the oxygen-carrying capacity of circulating hemoglobin, requiring airway clearance techniques (e.g. active cycle of breathing, autogenic drainage) to loosen lung mucus [20]
Antibiotics (e.g. Levofloxacin 240mg/3mL twice daily), corticosteroids, bronchodilators (e.g. salbutamol), or mucus thinners (e.g. hypertonic saline) to prevent/treat infections, control inflammation, clear mucus, and relax/open the airways

Nitrous oxide addiction rehabs liaise with specialised cystic fibrosis care teams (including respiratory specialists, genetic counsellors, and urologists) and refer patients to hospital during withdrawal for:

Treatment with CFTR modulators (e.g. elexacaftor-tezacaftor-ivacaftor) to regulate the flow of salt and water across cell membranes, as inhalant abuse increases the odds of needing CFTR modulators by almost 3-fold [21]
Extracorporeal membrane oxygenation to pump blood through an artificial lung to add O₂ and remove CO₂ for around 2 weeks, whilst receiving education about airway clearance therapy, infection control, and adhering to medication schedules [22]

Positive Markers Of Hippy Crack Detoxification

Oxygen Levels Stabilisation

Nitrous oxide detoxification stabilises oxygen levels by 25%, increasing O₂ saturation from 76% to 95 – 100% within 3 weeks of being cannulated with venous arterial extracorporeal membrane oxygenation to control dyspnea after inhaling 250 balloons a day [2].

Rehabs do not provide oxygen as part of nitrous oxide detoxification, and hospital care is arranged for patients requiring a respirator during treatment to receive 24-hour monitoring of cardiac rhythm, pulse, blood pressure, oxygen saturation, and respiration rates.

Elevated Vitamin B12 Levels

Nitrous oxide detoxification elevates Vitamin B12 levels by around 33% within 1 month of cessation by providing supplementation (1000 - 2000μg per day) to address B12 deficiencies (<200 pg/mL) in up to 85% after 3 - 18 months of N₂O abuse, resulting in [1]:

The ability to walk independently within 3 weeks of intravenous vitamin B12 supplementation, after being unable to walk alone due to dystonia in four limbs and a progressive unsteady gait caused by using nitrous oxide recreationally for 2 years [23]
Improvements in Lhermitte’s sign (electric-shock-like sensations elicited by neck flexion) and diffuse numbness within 5 days of taking 5mg sublingual vitamin B12 and 4mg folic acid daily after consuming 8 - 30 N₂O canisters a day for 1 year [24]
A 92% decrease in homocysteine levels and complete recovery from severe sensorimotor axonal polyneuropathy with acute denervation within 9 months of receiving daily 1000 mcg B12 injections after 24 months of daily nitrous oxide use [25]

Increased Cognitive And Mental Clarity

Nitrous oxide withdrawal increases cognitive function by 13% within 20 days (MoCA scores = 23/30 to 26/30) using 2mg subcutaneous hydroxocobalamin injections and 1mg oral cyanocobalamin to restore mental clarity after inhaling six 615g N₂O cylinders per day [26].

Marotta and Kesserwani (2020) documented how a 41-year-old's mental clarity normalised and irritability dissipated within 14 days of cessation and daily B12/folic acid supplementation after experiencing low mood, mental ‘fogginess,' and forgetfulness as a result of nitrous oxide abuse [24].

Hippy Crack Detoxification At Abbeycare

Hippy crack detoxification at Abbeycare comprises:

Symptom managed care specific to each patient as part of a 4-week rehab programme
Prescribed vitamin B12, acetazolamide and propranolol as needed

References

[1] Oussalah, Abderrahim, et al. “Global Burden Related to Nitrous Oxide Exposure in Medical and Recreational Settings: A Systematic Review and Individual Patient Data Meta-Analysis.” Journal of Clinical Medicine, vol. 8, no. 4, Apr. 2019, p. 551. Accessed 26 Mar. 2025. “Table 3.”
[2] 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 26 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%.”
[3] NICE. “Oxygen.” NICE, 2025. Accessed 26 Mar. 2025.“Oxygen flow can be adjusted as the cylinders are equipped with an oxygen flow meter with ‘medium’ (2 litres/minute) and ‘high’ (4 litres/minute) setting.”
[4] Sharma, Sandeep, et al. “Intracranial Hypertension.” PubMed, 3 Mar. 2024. Accessed 26 Mar. 2025.“An elevated opening pressure (>20 mm Hg in adults) suggests intracranial hypertension, ... . CSF pressures greater than 250 mm H20 in adults and 200 mm H20 in children generally signify increased ICP.”
[5] Goel, Aimee, et al. “Vision Threatening Raised Intracranial Pressure Associated with Recreational Nitrous Oxide Use.” Neuro-Ophthalmology, vol. 48, no. 4, Informa UK Limited, Jan. 2024, pp. 279–86. Accessed 26 Mar. 2025.“He was a heavy recreational user of nitrous oxide, using balloon delivery with an estimated 0.5 litre canister daily in the preceding 4 months, ... Dilated slit-lamp examination revealed symmetrical Frisén grade 5 papilloedema with haemorrhages and cotton wool spots.”
[6] Moes, Maaike I., et al. “Nitrous Oxide Consistently Attenuates Thermogenic and Thermoperceptual Responses to Repetitive Cold Stress in Humans.” Journal of Applied Physiology, vol. 135, no. 3, American Physiological Society, Sept. 2023, pp. 631–41. Accessed 26 Mar. 2025.“N2O invariably blunted the cold-induced elevation of metabolic heat production by ~22-25% (P < 0.001).”
[7] Miroljub Jakovljević. EFFECT of INERT GASES on THERMAL STIMULI SENSATION. 15 May 2021. Accessed 26 Mar. 2025.“Substances like halothane, fentanyl, nitrous oxide, enflurane and isoflurane act in a consistent manner raising heat loss threshold by about 1.0 °C and lowering the heat maintenance threshold by 2.5 °C.”
[8] Perron, Brian, et al. “The Prevalence and Clinical Significance of Inhalant Withdrawal Symptoms among a National Sample.” Substance Abuse and Rehabilitation, Apr. 2011, p. 69. Accessed 26 Mar. 2025.“Table 1.”
[9] Nabben, Ton, et al. “Problematic Use of Nitrous Oxide by Young Moroccan–Dutch Adults.” International Journal of Environmental Research and Public Health, vol. 18, no. 11, May 2021, p. 5574. Accessed 27 Mar. 2025.“Some enter a timeless vacuum during their nitrous oxide binge where hours and days seem to merge into one long trip. ‘You fall asleep with a balloon in your mouth, wake up after an hour and a half, and go on with balloons’ (Man, 22 years old).”
[10] Li, Yueyue, et al. “Clinical Epidemiological Characteristics of Nitrous Oxide Abusers: A Single‐Center Experience in a Hospital in China.” Brain and Behavior, vol. 11, no. 12, Wiley, Nov. 2021. Accessed 27 Mar. 2025.“Table 4.”
[11] Mennerick, Steven, et al. “Effect of Nitrous Oxide on Excitatory and Inhibitory Synaptic Transmission in Hippocampal Cultures.” Journal of Neuroscience, vol. 18, no. 23, Dec. 1998, pp. 9716–26. Accessed 27 Mar. 2025.“N2O resulted in a 15% increase in the IAC charge transfer, ... a subanesthetic concentration of 80% (volume percent) N2O applied to isolated microculture neurons inhibited peak NMDAR EACs by 49%.”
[12] Garland, Eric L., et al. “Nitrous Oxide Inhalation among Adolescents: Prevalence, Correlates, and Co-Occurrence with Volatile Solvent Inhalation.” Journal of Psychoactive Drugs, vol. 41, no. 4, Dec. 2009, pp. 337–47. Accessed 27 Mar. 2025.“Table 3.”
[13] 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 28 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."
[14] Grigsby, Jim, and Kathryn Kaye. “Incidence and Correlates of Depersonalization Following Head Trauma.” Brain Injury, vol. 7, no. 6, Jan. 1993, pp. 507–13. Accessed 28 Mar. 2025.Among those whose head trauma could be classfied as mild, more than 60% complained of a depersonalization syndrome, ... as many as 67% of persons who sustain mild head injury may experience feelings of unreality."
[15] Public Health England. The Eatwell Guide: How to Use in Promotional Material. 24 Aug. 2016. Accessed 28 Mar. 2025.“Eat at least 5 portions of a variety of fruit and vegetables every day, ... drink 6 to 8 cups/glasses of fluid a day.”
[16] NHS. Treatment - Chronic Obstructive Pulmonary Disease (COPD). 11 Apr. 2023. Accessed 28 Mar. 2025.“Short-acting inhalers should be used when you feel breathless, up to a maximum of 4 times a day, ... longer courses of steroid tablets must be prescribed by a COPD specialist.”
[17] Bryson, Ethan O., and Elizabeth Frost. “Perioperative Addiction.” Springer EBooks, Springer Nature, 2011. Accessed 31 Mar. 2025.“Inhaled vapors may displace oxygen within the alveoli, leading to asphyxiation, ... other changes include decreased diffusing capacity (6–20%).”
[18] Duncan Wilson , and Satnaam Nandra. APC Guideline Diagnosis and Management of Asthma in Adults Diagnosis and Management of Asthma in Adults Pan-Birmingham Respiratory Clinical Network Contents. June 2019. Accessed 31 Mar. 2025.“Appendix 1 - 3.”
[19] Bentur, Lea, et al. “Pilot Study to Test Inhaled Nitric Oxide in Cystic Fibrosis Patients with Refractory Mycobacterium Abscessus Lung Infection.” Journal of Cystic Fibrosis, May 2019. Accessed 31 Mar. 2025. "A large portion of iNO combines with oxyhemoglobin to form methemoglobin (MetHb) and nitrates, ... elevated MetHb or methemoglobinemia (defined as >7%) results in impaired oxygen delivery to tissues and is monitored."
[20] Stern, Robert S., et al. “Recreational Use of Psychoactive Drugs by Patients with Cystic Fibrosis.” The Journal of Pediatrics, vol. 111, no. 2, Aug. 1987, pp. 293–99. Accessed 31 Mar. 2025.“Immediate worsening (usually cough, occasionally dyspnea) was noted by 12 (30% of users), and long-term worsening (usually increased cough and sputum production) by 16 (40% of users).”
[21] Vaziri, Sanaz, et al. Time to Be Blunt: Substance Use in Cystic Fibrosis. Authorea, Inc., Sept. 2023. Accessed 31 Mar. 2025.“E-cigarette users were 2.9 times more likely to use CFTR modulators (95% CI 0.98-11.00, p=0.08) and current marijuana users were 2.5 times more likely to use CFTR modulators compared to non-users, adjusted for confounders.”
[22] Guy's and St Thomas' NHS Foundation Trust. Extracorporeal Membrane Oxygenation (ECMO) - Overview. 2025. Accessed 31 Mar. 2025.“The average time that people spend on ECMO is 2 weeks, ... Blood is pumped from 1 tube through an artificial lung, where oxygen is added and carbon dioxide is removed.”
[23] 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 31 Mar. 2025.“A 20-year-old woman presented with one month of progressive unsteady gait, involuntary movement in the four limbs, ... The patient was treated with high-dose intravenous vitamin B12 supplementation (2000 μg per day) for the first three days, ... she could walk independently slowly three weeks later.”
[24] Marotta, Dario A., and Hassan Kesserwani. “Nitrous Oxide Induced Posterior Cord Myelopathy: Beware of the Methyl Folate Trap.” Cureus, July 2020. Accessed 31 Mar. 2025.“He consumed anywhere from eight to 30 canisters per day, ... four days later he started experiencing the Lhermitte phenomenon, ... patient continues on 5mg mega doses of sublingual vitamin B12 and 4 mg folic acid daily, ... his diffuse numbness, including Lhermitte phenomenon, stopped worsening after five days, and may have improved slightly.”
[25] Kongkiat Kulkantrakorn, et al. “Nitrous Oxide Abuse and Associated Neurological Diseases.” BMC Neurology, vol. 24, no. 1, BioMed Central, Nov. 2024. Accessed 31 Mar. 2025.“She was treated with B12 injections of 1000 mcg daily for one week, followed by weekly or biweekly injections for 6 weeks, ... A follow-up examination showed overall improvement at 3 months and complete recovery at 9 months.”
[26] Lindeman, Erik, et al. “Neuropathy with Cerebral Features Induced by Nitrous Oxide Abuse—a Case Report.” Toxics, vol. 11, no. 12, Multidisciplinary Digital Publishing Institute, Nov. 2023, pp. 959–59. Accessed 31 Mar. 2025.“Three weeks before presenting, the patient had dramatically escalated his N2O use to six 615 g cylinders per day, ... Cognitive evaluation using the Montreal Cognitive Assessment (MoCA) test yielded 23/30 points.”
[27] 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 31 Mar. 2025.“Thirty-four patients (67%) recovered completely, 17 patients (33%) had residual limb numbness, and only one patient experienced relapse.”

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: July 4, 2025