Response to interpellation 2023/24:255 on nitrous oxide abuse
Translated from Swedish by AI; the translation may contain errors. The Swedish text is the original.
Summary AI, written in advance
KD argues that the use of nitrous oxide for intoxication is a growing problem that requires protective legislation and information initiatives 1. KD emphasizes that authorities are already working on disseminating information about the risks and that an investigation should propose regulation of age limits, sales, and supervision 1 2. KD considers that the primary sellers are websites and social media, not physical stores 1. KD views municipalities' use of the public order ordinance to curb sales to young people positively 2. S argues that information about risks must be intensified and that physical stores also play a role 3. S emphasizes the serious neurological and psychiatric consequences of abuse 3. S points out that the regions need resources if they are to take over full responsibility for compulsory care. S hopes for measures such as the closure of websites and information campaigns 4.
Written by AI in advance and may contain errors. The numbers lead to the speech a statement builds on; check against the text below.
Socialministern Jakob Forssmed (KD)
Madam Speaker! [The member] has asked me if I am satisfied with the way information about the risks of nitrous oxide is currently provided, and if not, what initiatives I am prepared to take. Ewa Phil Krabbe has also asked me if I intend to take further measures to alert parents and school staff to the risks of nitrous oxide.
Ewa Phil Krabbe has also asked me if I intend to take the initiative in this matter so that the law on care of addicts can be applied in certain cases even in the case of nitrous oxide abuse. Ewa Phil Krabbe has finally asked me if I intend to initiate contact with the retail chains that now expose nitrous oxide for sale to point out the consequences of their supply.
The use of nitrous oxide for intoxication purposes has become an increasingly common phenomenon in recent years, and there is a need for both protective legislation and additional information initiatives regarding the risks of such use.
The investigation on nitrous oxide and certain issues within the alcohol and tobacco area (S 2022:14) has been tasked with proposing a regulation of non-medical use of nitrous oxide, for example, provisions on age limits, sales, supervision, marketing, and import. The assignment shall be reported by March 31, 2024, at the latest. I look forward to taking part in the investigation's proposals.
The Government has also, pending the investigation's report on its work, given the Medical Products Agency, the Public Health Agency, and the county administrative boards a mandate to disseminate information about risks associated with intoxication from nitrous oxide. The mandate is to be reported by March 1, 2024, at the latest. The agencies are carrying out solid work to disseminate the information and have plans for further measures.
The Mental Health Inquiry (S 2020:08) proposes in its final report, From parts to whole - Compulsory care as part of a coherent and person-centered care chain (SOU 2023:5), how a new compulsory care legislation should be designed regarding persons who have harmful use or addiction. The inquiry's proposal implies that all treatment of harmful use and addiction shall be the responsibility of the regions' health and medical care.
The proposals would mean that the Act (1988:870) on care of addicts is repealed in certain cases and that the so-called LVM activity is phased out. Instead, compulsory care shall be provided at healthcare facilities operated by the region according to the Act (1991:1128) on psychiatric compulsory care.
The reports have been submitted for consultation and are being prepared in the Government Offices.
Nitrous oxide is sold and marketed primarily on websites and via social media that target those who want to use nitrous oxide to get intoxicated. These actors offer large volumes of nitrous oxide with home delivery and express delivery on weekends and nights. Balloons filled with nitrous oxide are also sold on streets and squares, in any case in the major cities. It is thus not primarily physical stores in our immediate environment that are the main sellers of the nitrous oxide used for intoxication. The Government therefore sees a need for other measures than to contact these business chains.
Ewa Pihl Krabbe (S)
Madam Speaker! I would like to thank the Minister for the answer.
The investigation on nitrous oxide and more has the mandate to propose a regulation of non-medical use of nitrous oxide, for example, provisions on age limits and sales and more, as the Minister said. I look forward, just like the Minister, to receiving the investigation's proposals.
As the Minister says, efforts are underway from several agencies to spread information about the risks of nitrous oxide abuse. This is being done, but it needs to be intensified. I have worked as a school psychologist for 47 years. I know how incredibly important it is to immunize children and young people against these kinds of follies and even more to inform their parents about what this abuse looks like. Information is provided at some parent meetings, but not all parents attend. Therefore, the information must be intensified in different ways.
Madam Speaker! I googled the word nitrous oxide a while ago and found many completely uninhibited messages about quick purchases on various sites. They essentially promised overnight delivery or home delivery of the products, and there was no boasting about what the gas would be used for. It is upsetting to see how brazenly the nitrous oxide is exposed.
Regarding physical stores, which the Minister says are not the primary sellers of the gas, I looked at two very large retail chains that brazenly display nitrous oxide in their assortment. I therefore do not believe it is entirely insignificant.
In Kristianstad, where I come from, the local Brå made an effort a few years ago by talking to businesses that sold this product. Some of them then refrained from selling it. In Kristianstad, both Brå and the local housing company ABK still see how the abuse is growing. The waste products are found thrown in the outdoor environment.
On the Giftinformationscentralen website, it is described that the use of nitrous oxide is a growing problem and that it is increasing dramatically among young people and adults. They write that many believe nitrous oxide is harmless, but that is not the case. Abuse of nitrous oxide over a longer period can cause mental problems and chronic damage to the nervous system. It can, of course, also be a gateway to other drugs.
A common misconception is that nitrous oxide is harmless because it is used in healthcare. But on those occasions, the gas is mixed with oxygen and is administered by staff who monitor the amount and strength.
Using nitrous oxide on occasional occasions can entail risks such as unconsciousness and frostbite, and it can also cause a deficiency of vitamin B12. Long-term use can also lead to psychosis and other psychiatric problems. In unusual cases, it can cause blood clots in the brain or the lungs.
This type of nitrous oxide is actually intended for making whipped cream, but I don't think that much whipped cream even exists. As I wrote in my interpellation, 5.7 tonnes of the gas were imported per month in 2015, and in March this year, the import was 100 tonnes per month.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I would like to thank the interpellor for an important interpellation. This is indeed a very great concern, and I am extremely eager that the authorities do what we have told them to do. I am also convinced that they will take further measures. I know that they will provide information on this and that a long series of knowledge-raising initiatives have already been made towards health and medical care and not least personnel categories that come into contact with young people. It is very important.
Just as the interpellor points out, when something has not yet been regulated, as in this case, one can get the feeling that it is harmless. That is definitely not the case when it comes to nitrous oxide. On the contrary, there are significant dangers associated with this.
We know that there are some less accountable actors who exploit the youth's interest in this - for it is primarily youth that it is about. These actors also market other products, for example drugs, and this then becomes a way to come into contact with other things that are also not healthy and can be very harmful.
Surveys show that those who use nitrous oxide also use other substances that they should not use either. CAN recently presented an overview of this, and we can note that it does not seem that the use is increasing but rather decreasing somewhat among high school students. It had gone from 14 percent who had used nitrous oxide during the last year to 10 percent. It is nevertheless an all too high figure, but the information about the dangers may have reached out. It needs, of course, to reach out in an even greater extent while we wait until we can take the measures that I am convinced are needed in the form of regulation regarding age, supervision, and other.
I also view positively the municipalities that have used the local public order ordinance to further curb this and also to signal that it is not a sale that should be accepted in any way and in any context directed at young people moving around in the public environment.
Ewa Pihl Krabbe (S)
Madam Speaker! Thank you for the comments, Minister!
To further exemplify the harmful effects of nitrous oxide abuse, I would like to refer to Läkartidningen, which in several issues has provided case descriptions of what care can look like when the abuse has gone too far. I will not go into the cases described – they are terrible – but they illustrate the serious and multifaceted consequences of nitrous oxide use. They can be neurological, psychiatric, hematological, and thromboembolic. Hallucinations, delusions, and paranoia are common symptoms. Examples are also given of several young people who have received many months of treatment and admission to psychiatric clinics.
I note in the government's response that the regions will likely receive full responsibility for the compulsory care of substance abusers. It is certainly a good proposal, but it requires completely different resources for the regions if they are to manage it. Psychiatric inpatient care is extremely heavily burdened in the current situation. Many who need admission are denied. In Kristianstad, for example, within psychiatry, they have been forced to cut the number of care beds significantly but also close all nights of the week due to a shortage of nurses.
Madam Speaker! One final reflection is that in the Netherlands, nitrous oxide is considered to have been a contributing cause to 1,800 traffic accidents over the last three years. It is not unlikely that it looks like that in Sweden as well. In Denmark, Finland, New Zealand, as well as parts of Great Britain and the USA, there are restrictions on the sale of nitrous oxide to the general public. A recent British investigation advocates for information campaigns on packaging and measures of the type closing websites. I hope that we in Sweden will also reach similar decisions.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I thank the interpellator again for the reflections regarding this. There is no doubt that the greatly increased import of nitrous oxide has not primarily been used to make whipped cream. It is about completely different areas of use. This is used for intoxication purposes.
Many believe that nitrous oxide is harmless, but it is anything but harmless. The interpellor describes several consequences well, not least that very extensive use of nitrous oxide can lead to terrible consequences for the individual. It is important that the authorities now inform about this and that we as quickly as possible then prepare proposals to introduce different types of restrictions. We need to be able to better distinguish the legitimate use from that which occurs for the purpose of intoxication. We see that country after country is regulating this, and there are reasons for Sweden to follow suit. Therefore, I look forward to the proposals that come from the commission in the spring.
Ewa Pihl Krabbe (S)
Madam Speaker! My hope is, therefore, that the government acts to minimize the abuse of nitrous oxide through various measures as soon as possible.
Socialministern Jakob Forssmed (KD)
Madam Speaker! I ask again to be allowed to thank the interpellor for this and for the great commitment the interpellor has in this issue and many other issues concerning the upbringing conditions for children and young people.
Source: The Swedish Parliament. The speeches come from the open data of the Riksdag, translated into English by AI, which may contain errors.