Poppers

Popper is a slang term given broadly to drugs of the chemical class called alkyl nitrites that are inhaled. Most widely sold products include the original isoamyl nitrite or isopentyl nitrite, and isopropyl nitrite. Isobutyl nitrite is also widely used but is banned in the European Union. In some countries, poppers are labeled or packaged as room deodorizers, leather polish, nail polish remover, or videotape head cleaner to evade anti-drug laws.

A selection of poppers

Popper use has a relaxation effect on involuntary smooth muscles, such as those in the throat and anus.[1][2] It is used for practical purposes to facilitate anal sex by increasing blood flow and relaxing sphincter muscles.[3] The drug is also used for recreational drug purposes, typically for the "high" or "rush" that the drug can create.

Poppers were part of club culture from the mid-1970s disco scene and returned to popularity in the 1980s and 1990s rave scene.[4][5]

History

19th-century discovery

The French chemist Antoine Jérôme Balard synthesized amyl nitrite in 1844.[6] Sir Thomas Lauder Brunton, a Scottish physician born in the year of amyl nitrite's first synthesis, documented its clinical use to treat angina pectoris in 1867 when patients experiencing chest pains would experience complete relief after inhalation.[7] Brunton was inspired by earlier work with the same agent, performed by Arthur Gamgee and Benjamin Ward Richardson.[7] Brunton reasoned that the angina sufferer's pain and discomfort could be reduced by administering amyl nitrite—to dilate the coronary arteries of patients, thus improving blood flow to the heart muscle.[7]

Amyl nitrites were originally enclosed in a glass mesh called "pearls". The usual administration of these pearls was done by crushing them between the fingers, followed by a popping sound. This administration process seems to be the origin of the slang term "poppers". It was then administered by direct inhalation of the vapours or inhalation through silk that covered the capsule. Brunton found that amyl nitrites had effects of dilating blood vessels and flushing of the face. Butyl nitrites were also documented around the late 1890s by Brunton and despite being found to have generally the same effects as amyl nitrites, they were never used as a clinical alternative to amyl nitrates. Brunton also found that propyl nitrites had the same effects as well.[8][9]

20th-century use

Although amyl nitrite is known for its practical therapeutic applications, the first documented case of recreational use was in 1964.[10][11] The poppers "craze" began in the early 1970s in the gay male community in bars, discothèques and bathhouses.[12][13] It was packaged and sold pharmaceutically in fragile glass ampoules wrapped in cloth sleeves which, when crushed or "popped" in the fingers, released the amyl nitrite for inhalation, hence the colloquialism poppers.[12] The term extended to the drug in any form as well as to other drugs with similar effects, e.g. butyl nitrite which is packaged under a variety of trade names in small bottles.[12]

In the late 1970s Time magazine[14] and The Wall Street Journal[15] reported that popper use among gay men began as a way to enhance sexual pleasure, but "quickly spread to avant-garde heterosexuals". A series of interviews conducted in the late 1970s revealed a wide spectrum of users.[14]

Chemistry

Poppers contain a class of chemicals called alkyl nitrites. To the extent that poppers products contain alkyl nitrites, the following applies.

The following table summarizes alkyl nitrite chemical and physical properties, including chemical structure:[16]

Alkyl nitriteCASFormulaMolecular weight (g·mol−1)Physical stateBoiling point (°C)
Amyl nitrite (isoamyl nitrite, isopentyl nitrite) 110-46-3 (CH3)2CH(CH2)2ONO 117.15 Transparent liquid 97–99
Pentyl nitrite (n-pentyl nitrite) 463-04-7 CH3(CH2)4ONO 117.15 Yellow liquid 104
Butyl nitrite (n-butyl nitrite) 544-16-1 CH3(CH2)3ONO 103.12 Oily liquid 78.2
Isobutyl nitrite (2-methylpropyl nitrite) 542-56-3 (CH3)2CHCH2ONO 103.12 Colourless liquid 67
Isopropyl nitrite (2-propyl nitrite) 541-42-4 (CH3)2CHONO 89.09 Clear pale yellow oil 39
Hexyl nitrite 638-51-7 C6H13NO2 131.17 Clear liquid 52

Administration and effects
A selection of poppers

Administration

Poppers come in liquid form, but this liquid is not directly consumed. When the bottle is opened, the vapors are inhaled, rather than the liquid. This is typically done through the nasal cavities, commonly directly from the bottle (avoiding touching the bottle to the skin) or with the help of small inhalators.

Principal effect

Inhaling nitrites causes giddiness and relaxes smooth muscles throughout the body, as well as sphincter muscles of the anus and the vagina.[17] Smooth muscle surrounds the body's blood vessels and when relaxed causes these vessels to dilate resulting in an immediate increase in heart rate and blood flow throughout the body, producing a sensation of heat and excitement that usually lasts for a couple of minutes.[18][19] When these vessels dilate, a further result is an immediate decrease in blood pressure.[20]

Interactions

Alkyl nitrites interact with other vasodilators, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), to cause a serious decrease in blood pressure, which can cause strokes, and low blood pressure leading to people fainting.[21] Side effects of popper abuse include tachycardia, headaches, migraines, dizziness and fainting.[22]

Toxicity

The Merck Manual of Diagnosis and Therapy reports insignificant hazard associated with inhalation of alkyl nitrites,[23] and British governmental guidance on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs.[24]

Swallowing poppers (rather than inhaling the vapour) may cause cyanosis, methemoglobinemia, unconsciousness, coma, and complications leading to death.[17][25][26][27][28] Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia.[29]

Isopropyl nitrite poppers may be a cause of maculopathy (eye damage), as reported in France and the United Kingdom.[30] Some studies have concluded that there may be increased risk for at least temporary retinal damage with habitual popper use in certain users; in a letter to the New England Journal of Medicine,[31] an ophthalmologist described four cases in which recreational users of isopropyl nitrite poppers suffered temporary changes in vision.[32] Foveal (center-of-gaze) damage has also been described, in six habitual users of isopropyl nitrite poppers.[33] Furthermore, in June 2014, optometrists and ophthalmologists reported having noticed an increase in vision loss in chronic popper users in the United Kingdom associated with isopropyl nitrite (substitute for isobutyl nitrite which was banned in 2007).[34][35] In November 2014, it was observed maculopathy is a rare complication of isopropyl nitrite abuse. A full recovery of visual acuity in longterm abuse could be demonstrated after drug abstinence.[36] Studies have shown that poppers users who have HIV and/or use Sildenafil in combination with poppers are at an increased risk of developing poppers‐associated maculopathy.[37]

Isobutyl nitrite toxicity

Isobutyl nitrite is known to cause methemoglobinemia.[38] Severe methemoglobinemia may be treated with methylene blue.[39]

Early in the AIDS crisis, widespread use of poppers among AIDS patients led to the later disproved hypothesis that poppers contributed to the development of Kaposi's sarcoma, a rare form of cancer that occurs in AIDS patients.[40][41] Modest, short-term reductions in immune function were observed in animal studies.[42][43]

Cyanide treatment

Amyl nitrites were part of some kits used to treat cyanide poisoning, containing amyl nitrite, sodium nitrite, and sodium thiosulfate. The nitrites were administered to produce methemoglobin and induce vasodilation.[44][45] Amyl nitrites were discontinued in 2012 in standard cyanide kits.[46] Cyanide kits now use hydroxocobalamin.[47]

Australia

Poppers are legal in Australia, and from 2020, poppers can be purchased as a schedule 3 substance from pharmacies, or a schedule 4 substance with a prescription.[48]

History of poppers legislation in Australia

In June 2018, the Therapeutic Goods Administration (TGA) motioned to reschedule alkyl nitrites to be in the same category as heroin and cocaine (Schedule 9).[49] This was met by criticism from the LGBTQI community for being discriminatory and further evidence was demanded and further consultation sought.[50]

In October 2018, the Australian Federation of AIDS Organisations (AFAO) pointed out the lack of quality evidence provided by the TGA to justify the rescheduling[51] and that use of amyl nitrites has been stable over the past decade with very little evidence of harm and has been in use by a high proportion of gay men over a long period.

A final decision was pushed back from 29 November 2018 to late January or early February 2019 for further consultation with the public.[52]

As of March 2019, two public meetings have taken place in Sydney and Melbourne with The Kirby Institute and the Australian Research Centre in Sex, Health and Society (ARCSHS). Along with 70 written public proposals, there was significant opposition to alkyl nitrites rescheduling.[53] Banning alkyl nitrites was not considered acceptable as their use was said to help reduce harms such as anal injury and blood-borne disease transmission during anal sex.[54]

In June 2019 Australia decided not to ban poppers.[55]

Canada

Since 2013, Health Canada has banned all distribution and sales of poppers.[56]

Continental Europe

Since 2007, reformulated poppers containing isopropyl nitrite are sold in the EU; isobutyl nitrite is prohibited.[57]

In France, the sale of products containing butyl nitrite has been prohibited since 1990 on grounds of danger to consumers.[58] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.[59] After litigation by sex shop owners, this extension was quashed by the Council of State on the grounds that the government had failed to justify such a blanket prohibition: according to the court, the risks cited, concerning rare accidents often following abnormal usage, rather justified compulsory warnings on the packaging.[60]

The possession in Germany, Austria and Switzerland is not subject to any regulations regarding anesthetic drugs and is therefore legal; however, the purchase, sale or trade of amyl nitrite without permission violates the drug laws of the corresponding countries. Occasionally, poppers were seized from sex shops, when sold there illegally.[61][62]

United Kingdom

Poppers are sold in nightclubs, bars, sex shops, drug paraphernalia head shops, over the Internet and in markets. It is illegal under Medicines Act 1968 to sell them advertised for human consumption. The Advisory Council on the Misuse of Drugs noted in 2011 that poppers, rather than being psychoactive substance or 'legal high', "appear to fall within the scope of The Intoxicating Substances (Supply) Act 1985".[63] The Psychoactive Substances Act 2016, scheduled to be enacted 1 April 2016, was initially claimed to impose a blanket ban on the production, import and distribution of all poppers.[64] On 20 January 2016 a motion to exempt poppers (alkyl nitrites) from this legislation was defeated.[65] This was opposed by Conservative MP Ben Howlett. Howlett's fellow Conservative MP Crispin Blunt declared that he has used and currently uses poppers. Manufacturers expressed concern over loss of business and potential unemployment.[66][67] In March 2016, the Advisory Council on the Misuse of Drugs stated that, because alkyl nitrites do not directly stimulate or depress the central nervous system, poppers do not fall within the scope of the Psychoactive Substances Act 2016.[68]

United States

Amyl nitrite was originally marketed as a prescription drug in 1937. It remained so until 1960, when the Food and Drug Administration removed the prescription requirement due to its safety record. This requirement was reinstated in 1969, after observing an increase in recreational use. There was a huge increase in the number of brands for butyl nitrites after the FDA put in the prescription requirement again in 1969.[7]

Butyl nitrites were outlawed in 1988 by the Anti-Drug Abuse Act of 1988.[69] This prompted distributors to sell other alkyl nitrites not yet banned, like isopropyl nitrites.[7] In 1990, isopropyl nitrites and other nitrites not yet banned were outlawed by the Crime Control Act of 1990.[70] Both of these laws include an exception for commercial purpose, defined as any use other than for the production of consumer products containing volatile alkyl nitrites meant for inhaling or otherwise introducing volatile alkyl nitrites into the human body for euphoric or physical effects.[71]

See also

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