An unusual case of ‘laughing gas’ addiction in Singapore

Objective Recreational use of nitrous oxide (N 2 0) or ‘laughing gas’ inhalation is a common phenomenon in countries like UK and US where it is associated with music festivals and parties. However, as far as we know, recreational N 2 0 use in Singapore has hitherto not been reported in the press or scientific journals. We report the first case of N 2 0 use and addiction in a young Singaporean male who was introduced to it by a friend from a Western country where its use is prevalent. Methods A 20-year-old Singaporean male with an existing psychiatric diagnosis of major depression, presented with a 3 year history of solitary regular N 2 0 inhalation that escalated from infrequent low dose use to the current daily high-dose use which he was unable to control. He exhibited symptoms of dependence — including preoccupation, tolerance, withdrawal and difficulty in cutting down. No major adverse medical complications were noted so far. Results The patient was assessed to have Nitrous Oxide Dependence; and is currently undergoing regular counselling sessions in an attempt to motivate him to cut down or stop his N 2 0 use. Conclusion This case is unique for 2 reasons: – extant literature suggests that only anectodal evidence exists for psychological dependence of N 2 0 in Singapore; yet our patient clearly demonstrates psychological dependence; – this is the first reported case of N 2 0 use disorder in Singapore; and perhaps ASEAN, with the unusual presentation in a young male whose use is solitary and private. Disclosure of interest The authors have not supplied their declaration of competing interest.