Recreational use of nitrous oxide (N20) 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 N20 use in Singapore has hitherto not been reported in the press or scientific journals. We report the first case of N20 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.

A 20-year-old Singaporean male with an existing psychiatric diagnosis of major depression, presented with a 3 year history of solitary regular N20 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.

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 N20 use.

This case is unique for 2 reasons:

– extant literature suggests that only anectodal evidence exists for psychological dependence of N20 in Singapore; yet our patient clearly demonstrates psychological dependence;

– this is the first reported case of N20 use disorder in Singapore; and perhaps ASEAN, with the unusual presentation in a young male whose use is solitary and private.

The authors have not supplied their declaration of competing interest.