Senator Teresa Costello: I thank the Minister of State for being here. I wanted to have this discussion today because, like many others, I am genuinely concerned about the growing use of nitrous oxide, commonly known as laughing gas. Tallaght Tidy Towns volunteers, in particular Nico Crowley, collected 305 nitrous oxide canisters in January alone from just five locations. Just think about that for a moment - in one part of a community, in one month. The reality is that that figure is almost certainly only a fraction of what is actually being used. Everywhere you look - parks, footpaths, green areas, estates - you can see these canisters discarded. They have become a part of our street litter.

Behind that litter, however, is something far more worrying, namely, the health impact on our young people. What I find particularly frightening is what has now been revealed in a new Irish study. A study published in the American Journal of Neuroradiology shows that young people in Ireland are increasingly being diagnosed with spinal cord damage caused by the recreational use of nitrous oxide. The research was led by Professor Seamus Looby, consultant neuroradiologist at Beaumont Hospital and honorary associate professor at the RCSI. The findings show a very clear and disturbing trend. Between 2012 and 2020, not a single case of spinal cord damage related to nitrous oxide was recorded at Beaumont Hospital. Between 2021 and 2024, however, 14 cases were diagnosed, with the median age of those patients being 20 years. It is a dramatic change in a short period

This clinical evidence confirms what youth workers and community organisations have been warning for years, that is, that this misuse is rising rapidly among children and young adults. Nitrous oxide is cheap, easy to buy online for a legitimate commercial use and widely perceived as harmless fun, but the medical evidence tells a different story. It interferes with the body's ability to process vitamin B12. This can lead to a serious condition called subacute combined degeneration of the spinal cord. The symptoms include numbness in the hands and feet, difficulty walking, poor balance and problems with co-ordination. Professor Looby has warned that many teenagers who would not consider using other drugs are inhaling from these canisters because they believe them to be safe, but what doctors are seeing is spinal cord damage and in many cases permanent damage. Although most of the patients in the study improved with treatment, none of them made a full recovery and every single person was left with some level of lasting neurological injury. It is an extraordinarily frightening outcome for a drug that young people kind of perceive as being harmless. We need to be honest about the wider risks and side effects. Inhaling directly from the canister without a balloon is particularly dangerous. The gas is cold and can cause frostbite to the mouth and nose and damage to the throat and lungs. Other people are at greater risk if they have heart conditions. There are also risks about the settings in which people are taking this. People can fall, collapse or have accidents. There are a whole lot of issues around this practice.

It is not only a health issue, however; it is an environmental and community issue too. The sheer scale of these discarded canisters in our communities and neighbourhoods sends a very clear signal that this problem is growing and we cannot ignore it. Education around it is vital. We need to be clear, honest and consistent with our information for our young people in particular, as well as parents, schools and youth services about the real risks.

We need far better reporting and monitoring of the health incidences relating to nitrous oxide in order that communities can understand the true scale of harm.

I am not here to blame young people or judge them. I just really want them to be protected in this. The evidence now is showing clearly that it is not harmless and the cost to young lives on long-term health is already being felt in hospitals and communities.

Deputy Jennifer Murnane O'Connor: I thank Senator Costello for highlighting and raising these serious concerns. As the Senator has said, things are changing and trends are changing the whole time. I see it within the drugs strategy section of the Department. First of all, it was really important that the Senator highlighted this. I will give an update on the response to the use of nitrous oxide and the ongoing development of our national drug strategy including its focus on prevention and education for young people of the use of drugs. That is part of the drugs strategy. We are looking at the prevention and awareness. Education will have to play a huge role and that is part of what we are doing within my own remit.

Nitrous oxide is a psychoactive substance, and it is already addressed under two pieces of legislation. Section 3 of the Criminal Justice (Psychoactive Substances Act) 2010 states that a person who sells a psychoactive substance, knowing or being reckless as to whether that substance is being acquired or supplied for human consumption, shall be guilty of an offence. So, people cannot be selling it. This is the thing. This is part of the awareness we have to look at. We have to make sure that it is not being sold to children and younger people who it is really affecting. Section 74 of the Child Care Act 1991 states:

It shall be an offence for a person to sell, offer or make available a substance to a person under the age of eighteen years, or to a person acting on behalf of that person if he knows or has reasonable cause to believe that the substance is, or its fumes are, likely to be inhaled by that person under the age of eighteen years for the purpose of causing intoxication.

That is what it is. You cannot sell it to, and it is illegal to sell to, those under the age of 18. It comes under the two Acts I have read out. Responsibility for these do rest with the Department of Justice, Home Affairs and Migration and with the Department of Children, Disability and Equality. That is where this remit lies under health and well-being.

I am aware there is significant concern about the rising use of the substance and the illegal importation of canisters at our ports. This issue was brought up on many occasions recently. It was discussed in the Dáil quite recently. The Minister for justice has indicated that this will be looked at in closer detail in the coming months by his Department. I look forward to engaging with the Minister for justice on this. I can assure the Senator that the Minister is very much aware of this in our ports as well. That absolutely has to be addressed.

In the meantime, the HSE and various community groups are monitoring the situation and are responding to the rise in its use. We are doing this as well. Through public awareness campaigns, harm reduction advice and engagement with at-risk groups, we are now working to minimise the very real health risks, including nerve damage. We are very much aware of the nerve damage. As a key part of this approach the HSE has a harm reduction fact sheet, detailing risks, effects, and advice, for drug and alcohol task forces, student unions, and at festivals. We are trying to target through health and well-being the areas that we feel we need to. This is available in local health services, through drug task forces and online. Parents are also supported with information through various sources, including the drugs.ie website, dedicated fact sheets, and a series of webinars. There are a lot of webinars going on. Maybe we need to make sure that people are aware that these are happening and we need to maybe get more communication out on this. The HSE’s website, drugs.ie, and its social media channels provide content that is informative, helpful and shareable. It gives them advice. The HSE social media team responds directly to people’s questions about substances - if they have a question they get them answered - through direct messages on all channels. They are answered through the HSE. I would encourage anyone who may be using nitrous oxide or anyone who has a loved one who may be using this substance to engage with the HSE or its drug and alcohol helpline to get confidential support and advice. This is about the awareness and information about what can happen and what the long-term effects are. Within my own remit under health and well-being that is what we are doing. I thank the Senator for raising this. It is very important.

Senator Teresa Costello: I thank the Minister of State for the response. I do not really like to use the word often but I think we are in an "emergency" situation with this. Not to be dismissive of anything that the Minister of State has said, a fact sheet is not going to cut it with a 16-year-old or a 17-year-old. We need to reach young people. Given that something so easily available can cause spinal cord damage, we need immediate action on this. We do not want a tragedy. I do not want to wake up and read on the front page of a paper that there has been a huge tragedy. This is everywhere. In a small area of Tallaght the amount that is being consumed, and the size of those canisters, is frightening. We definitely need something that will reach the younger people. I genuinely do not think it is fact sheets. Something more proactive has to be done to reach young people and educate them and drive the message home.

Deputy Jennifer Murnane O'Connor: In response to the Senator, I reiterate this is a start. It is a very serious issue. An allocation of €1.5 million has been made by the Department of Health for a three-year drug and alcohol prevention and education programme. First of all we must get the awareness and the education out there, get it to the families and get it to the people who are using it to show the dangers of that. This aims to strengthen the prevention and highlight the relative harm, especially for younger people. I have published the draft of the new drug strategy, which contains a renewed focus on the protection of people, children, families and communities on the harmful effects of drugs and alcohol. We know that the challenge of regulating the nitrous oxides cuts across multiple Departments and the existing law. It is a public health issue for my Department and the HSE. It is a public order issue for the Department of justice and for the Garda Síochána. I want to commend Revenue on its tackling of the illegal importation of nitrous oxide at our ports. It is also an environmental issue concerning hazardous waste disposals for the Department of the environment. It is now a trade and enterprise issue for the Department of Enterprise, Tourism and Employment. We have all our different Departments now and we all need to work together. As we work together we will get stronger because this actually falls within all our remits.

I want to thank the Senator for highlighting this really serious issue in her own area and I am sure it is in other areas too. I assure the Senator that we are working with other Departments too. I will meet the Minister for justice, Deputy Jim O'Callaghan, shortly to do with this as well. I know all of us within the different Departments will meet on it. I thank both Senators for bringing up drug issues. It is really important. We need to make sure that we get the services and the information out. How we can deliver this is going to be vital.