153 deaths. Here’s the context they left out.

A few sessions in, my new client mentioned using nitrous at a show. They said it as casually as mentioning a glass of wine. I had already asked about inhalant use; they said no. They were not lying. They just didn’t think nitrous was covered by that question.

This is about categorization, not disclosure. Most people think "inhalants" means glue or solvents, not nitrous. Nitrous carries different risks and cultural meanings. Lumping them together leads to bad data and honest mistakes. Clinicians believe they asked the right question, but they didn’t.

This week, Governor Bob Ferguson signed a bill banning retail sales of nitrous oxide in Washington, effective this summer. Washington is the second state to ban it after Louisiana. Oregon recently restricted minor access but did not ban nitrous.

The legislation cites 153 nitrous-related deaths in the U.S. in 2023, up from 23 in 2010. A 600% increase! That number gets press. It is accurate. But the news coverage misses key context.

In 2023, fentanyl killed over 72,000 Americans. Cocaine killed nearly 30,000. Meth killed around 35,000. Benzodiazepines, over 10,000. Tobacco kills roughly 480,000 people a year in the U.S. every year.

Nitrous killed 153 people. Most deaths were not from the drug’s pharmacology. They were from asphyxiation caused by dangerous use: bags on heads or inhaling directly from tanks. DanceSafe, known for evidence-based drug info, notes the most immediate risk is falling down. That’s what we’re regulating.

The serious clinical harms from nitrous are real, but they’re concentrated in a specific population: heavy, compulsive users consuming hundreds of canisters per day over months. The published case literature documents spinal cord damage, peripheral neuropathy, and psychiatric symptoms in these patients. Some of these symptoms can be irreversible. These are people in significant distress, using a substance as a primary coping mechanism, who need clinical support. They do not need a supply-side ban that leaves them without information or access to care.

For recreational users at festivals or raves, harms are lower. The main risks: immediate safety. Sit down. Breathe fresh air between doses. Don’t use alone. These are harm-reduction messages, not justifications for banning nitrous.

Washington’s law is a mistake. The harms are real, but bans do not stop compulsive use. Bans lower purity, stifle information, and make patients less likely to disclose use. The Lancet’s 2025 review found criminalization increases the poverty-disability cycle, as those most hurt are already vulnerable.

What to do in practice: Ask about nitrous. Your intake form probably misses it. Nitrous shows up with psychedelics, in harm reduction talks, or in histories of recreational use. Don’t ask only about 'inhalants.' That wording leads to no. Instead, ask, “Some people use nitrous, whippets, or laughing gas recreationally. Is that true for you?”

What have you been seeing? I’m curious whether this comes up in your work, and how you’ve been handling it when it does.

— Peter

P.S. I’m building a course specifically on psychedelic harm reduction assessment. How to take a substance history that captures what people are actually using, not just what they think you’re asking about. It’ll be the first thing I launch on my new platform. If that’s something you’d want, hit reply and let me know. It helps me know I’m building something people actually need.