Last fall, a woman in her 20s was rushed to the hospital after inhaling what's known as "laughing gas vape" in a shopping mall parking lot in southern Okinawa. She gradually lost control of her body, collapsed and struck her head hard on the ground.
When taken in an ambulance to the hospital, she experienced intense headaches and drifted in and out of consciousness. Although she had tried the substance before, the incident left her shaken. “It really was something hazardous,” she said.
The drug she had inhaled, known as laughing gas mainly among those in their teens and 20s in Okinawa, contains etomidate, an anesthetic component not approved in Japan. The government designated etomidate as a controlled substance on May 16. Known overseas by names such as “zombie cigarettes,” its abuse has become a serious concern.
According to the woman, laughing gas began spreading in Okinawa around autumn last year, particularly in nightclubs and private rooms at bars. At the time, there were no regulations in place, and so she tried it out of curiosity, asking acquaintances to let her take “just one puff.”
The drug comes as flavored liquid in cartridges and is inhaled as vapor through devices resembling e-cigarettes. From its appearance, it draws little suspicion.
Users report initially feeling lightheaded as if floating, then trembling uncontrollably after a while. They experience difficulty speaking even though words may form in the mind, and they also become emotionally unstable.
When the effects wear off, heavy-headedness and nausea set in — often leading to repeated use to dispel discomfort. Overdosing causes bizarre and erratic behavior. “It’s like watching an insect writhing after being sprayed with insecticide,” the woman said.
The drug has also led to accidents and disputes. Some of her acquaintances caused car crashes after inhaling while driving. Others became involved in altercations, including reported cases of violence over money for the drugs.
The woman had sensed its dangers. But unlike cannabis, possession or use of laughing gas was not punishable by law at the time. And because it was easy to obtain and did not appear to be suspicious, it spread rapidly among Okinawa’s youths, she said.
In May, after authorities confirmed that the substance contained etomidate, it was newly designated as a prohibited drug under Japanese law.
According to the woman, news of the regulation spread quickly via social media, and some bars in Naha and Urasoe posted warnings that anyone caught using laughing gas would be ejected immediately. However, the ban hasn’t stopped some young people from continuing to use the drug.
The woman has since quit using it. “I don’t want to cause any more trouble for my parents,” she said. “If things keep going like this, someone will die.”
Investigators suspect the involvement of organized crime groups is behind the rapid spread of the drug among youths in Okinawa.
Etomidate has circulated in Taiwan and other regions, where its abuse has become a social issue. Police sources say crime groups that have overseas connections may have trafficking routes to Okinawa. At least one gang member is believed to have acted as a broker, arranging face-to-face transactions, they said.
The drug was initially priced below ¥10,000 per set last autumn, but it eventually rose to the ¥20,000 range, with some youths acting as dealers. Violence linked to disputes over sales has been reported, and authorities believe the trade has become a source of revenue for organized crime groups.
Transactions have often taken place via acquaintances or through encrypted apps such as Telegram, making it difficult to trace supply routes.
Around February, Okinawa Prefectural Police began to recognize cases of laughing gas abuse. At crime and accident scenes, young people were found screaming, convulsing violently or even crawling on all fours.
But at the time, police lacked the legal means to act. Drug users could easily discard the substance before being questioned, and its short-lived effects meant it could not be detected through urine tests.
Alarmed by the rapid spread of the drug, Okinawa police conducted laboratory analysis of seized items and confirmed the presence of etomidate in them. Upon request from Okinawa police, the health ministry formally designated etomidate as a prohibited substance, banning its possession, use and sale.
“We had to prevent its spread from Okinawa to the mainland, so the regulation was put in place unusually quickly,” a senior prefectural police official said.
Investigators also warn that other substances could appear in Japan. “We need to uncover the full supply chain before new cases emerge,” one officer said, pointing to a synthetic opioid like fentanyl whose abuse has become a social problem in many Western countries.
According to Kensuke Matsuo, head of the Okinawa branch of the health ministry’s narcotics control department, no major cases of etomidate abuse have been reported in Japan outside Okinawa.
While the substance is mainly used as an anesthetic overseas, its abuse has in recent years become a serious issue in places like Hong Kong, Taiwan and Thailand.
Matsuo explained that the effects of etomidate are relatively limited as it is a short-acting anesthetic, but that makes abusers prone to repeated use. One factor behind the drug’s spread in Okinawa may be its proximity to regions where abuse has become a problem, but the precise reasons remain unclear, he added.
Matsuo also pointed out that the proportion of young people among drug abusers is “exceptionally high” in Okinawa compared to other parts of Japan. With young people’s apparently low mental barrier to illegal substances, Matsuo warns of a quick spread of other substances that may enter the prefecture.
Since the May ban, suspicious social media posts advertising sales of laughing gas have declined.
While acknowledging that the regulation had positive effects to some extent, Matsuo cautioned against complacency. “As with other designer drugs, manufacturers may alter the chemical structure slightly to evade the law,” he said. “We must remain vigilant and monitor developments closely.”
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