The UK’s drug advisory panel has rejected calls to ban the sale and possession of nitrous oxide for recreational use, despite the Home Office’s eagerness to do so, a new report has revealed. While supplying nitrous oxide for psychoactive purposes is already banned, laughing gas or “nos” remains hugely popular among young people. Its growing use has thrown concerns about possible associated health and social problems into the spotlight. In 2021 the Independent Advisory Council on the Misuse of Drugs (ACMD) was asked to review the harms of nitrous oxide by the then home secretary, Priti Patel, who vowed to “take tough action” on use of the drug. The stance appears to have been backed by the current home secretary, Suella Braverman. In January a spokesperson for the department said the government was “determined to crack down on this scourge to protect our streets” adding it was “actively considering a ban on the sale and use of this harmful drug”. In February this year Chris Philp, the minister of state for crime, policing and fire, wrote to the ACMD to hasten the review, asking for it to be completed by the end of the month. However the crackdown plans have suffered a setback after the ACMD ruled that nitrous oxide should not be subjected to control under the Misuse of Drugs Act 1971. The panel wrote that current evidence suggested the health and social harms of nitrous oxide were not commensurate with such a move, while sanctions that would apply under the act would be disproportionate for the level of harm associated with the drug. The panel also said a ban could cause problems for those who needed the gas for legitimate purposes. Nitrous oxide is used in the food industry as a whipped cream propellant and in medical settings for sedation and pain relief. “Control under the Misuse of Drugs Act 1971 could produce significant burdens for legitimate medical, industrial, commercial, and academic uses,” the panel wrote. Instead the ACMD said efforts should be focused on enforcing the Psychoactive Substances Act 2016, which already covers the drug, and tackling non-legitimate supply, for example by imposing restrictions on direct-to-consumer sales, canister sizes, and the volumes people can buy. Among other recommendations, the ACMD has called for websites selling nitrous oxide for non-legitimate uses to be closed down. The panel added that there should be comprehensive health warnings on nitrous oxide packaging, as well as an educational campaign on its harms, and dissemination of information and guidance to healthcare professionals on harmful use and treatments. Doctors recently warned that they had seen a rise in cases of spinal cord and nerve damage linked to the use of nitrous oxide, although experts have said such outcomes are still very rare. The panel said that at present, there was “no substantive evidence linking nitrous oxide with antisocial behaviour or widespread criminal activities”, adding that this, together with road traffic accidents, deaths, health harms and littering linked to nitrous oxide needed improved monitoring. It is not the first time the ACMD has rejected calls for a ban on nitrous oxide, with the panel coming to a similar conclusion in 2015. Prof David Nutt, the director of the neuropsychopharmacology unit in the division of brain sciences at Imperial College London, described efforts to ban nitrous oxide as a “storm in a teacup”, driven by concerns over the littering of small nitrous oxide canisters known as “whippets”. “People are using it as a short way of getting high that is way less damaging in the long term than alcohol, much less likely to cause aggression, much less impairing of people’s driving performance,” he said, adding serious harms were rare. “We don’t ban bungee jumping [although] some people get retinal detachments; we don’t ban people jumping out of airplanes with parachutes, even though they break their backs; we don’t ban things that cause a lot more toxic damage to people’s bodies than nitrous oxide,” said Nutt. Harry Sumnall, a professor of substance use at Liverpool John Moores University, also raised concerns about any potential ban, saying there would be challenges around enforcement, and exemption of legitimate uses. “For example, how will legislation exempt legitimate purchases of large amounts of [nitrous oxide] for catering, but prevent purchase for intoxication?” he asked. “In terms of short and long term damage to the self and others, then alcohol poses much more of a threat to healthy development than [nitrous oxide],” he added. A Home Office spokesperson said: “This government is working to crack down on drug misuse in our communities, that is why we asked the Advisory Council on the Misuse of Drugs to provide updated advice on nitrous oxide. We thank them for their report, which we will now consider.”