Poppers

A selection of poppers

Poppers is a slang term given broadly to the chemical class called alkyl nitrites, that are inhaled for recreational drug purposes, typically for the "high" or "rush" that the drug can create. Poppers are also used for sexual encounters, particularly in the LGBT community.^[1]

Popper use has a relaxation effect on involuntary smooth muscles (such as those in the throat and anus).^[2][3]

Poppers were part of club culture from the 1970s disco scene to the 1980s, and the 1990s rave scene made their use popular again.^[4] As explained by Dr. Lucy Robinson, Sussex University history lecturer,

“If you trace the bottle of amyl [a type of alkyl nitrite] through late 20th-century history, you trace the legacies of gay culture on popular culture in the 20th century. We wouldn’t have had rave, disco or club culture as we know it today without the gay community.”^[5]

Most widely sold products include the original amyl nitrite (isoamyl nitrite, isopentyl nitrite), but also variants such as, isobutyl nitrite, isopropyl nitrite (2-propyl nitrite, increasingly, after EU ban of the isobutyl form). In some countries, to evade anti-drug laws, poppers are packaged labelled as room deodorizers, leather polish or tape head cleaner.

History

The French chemist Antoine Jérôme Balard synthesized amyl nitrite In 1844. Sir Thomas Lauder Brunton, a Scottish physician born in the year of amyl nitrite's first synthesis, famously pioneered its use to treat angina pectoris. Brunton was inspired by earlier work with the same agent, performed by Arthur Gamgee and Benjamin Ward Richardson. 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.

Time^[6] and the Wall Street Journal^[7] reported that popper use among homosexual 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.^[6]

Pharmacology and physiology

Inhaling nitrites relaxes smooth muscles throughout the body, including the sphincter muscles of the anus and the vagina.^[8] 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.^[9] When these vessels dilate, a further result is an immediate decrease in blood pressure.^[10]

Chemistry

Composition

Poppers contain a class of chemicals called alkyl nitrites.

To the extent that poppers products contain alkyl nitrites, the following applies.

Alkyl nitrite properties

The following table summarizes alkyl nitrite chemical and physical properties, including chemical structure:^[11]

Use

Administration

Poppers are inhaled.

Popularity

A selection of poppers

Through the 1970s, use by minors has been described as minimal, due to the ban on sales to minors by major manufacturers (for public relations reasons), and because some jurisdictions regulate sales to minors by statute.^[12] A 1987 study commissioned by the United States Senate and conducted by the Department of Health and Human Services found that less than 3% of the overall population had ever used poppers.^[13]

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 fainting, stroke, and low blood pressure leading to potential heart attack.^[14]

Side effects

Common side effects of popper use include headaches,^[15]

Toxicity

While an earlier edition of the 2005 Merck Manual of Diagnosis and Therapy reported insignificant hazard associated with inhalation of alkyl nitrites,^[1] and British governmental guidance before 2007 on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs,^[16].

Swallowing poppers (rather than inhaling the vapour) may cause cyanosis, unconsciousness, coma, and complications leading to death. Methemoglobinemia can occur if poppers have been swallowed.^{[8][17][18][19][20]} Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia.^[21]

Isopropyl Nitrite Poppers may be a cause maculopathy (eye damage), as reported in France and the United Kingdom.^[22] 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, an ophthalmologist described four cases in which recreational users of poppers suffered temporary changes in vision.^[23] Foveal (center-of-gaze) damage has also been described, in six habitual users of poppers.^[24] In 2014, optometrists and ophthalmologists reported having noticed an increase in vision loss in chronic popper users in the United Kingdom, associated with the substitution of isopropyl nitrite.^[25][26]

Disproven link with HIV/AIDS

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, which occurs in AIDS patients.^[27][28] Modest, short-term reductions in immune function were observed in animal studies,^[29][30] but direct support for a role of nitrites in development of AIDS-associated diseases has not found broad agreement.^[31] A study examining men who have sex with men, and who also take recreational drugs, suggested poppers, when used in a pattern of recreational drug taking could be associated with increase in sexual risk-taking.^[32]

Legal status

Australia

It is illegal to sell poppers as inhalants in Australia, although some, including amyl nitrite, are often sold in sex shops misleadingly labeled as DVD or leather cleaner.^[33]

European Union

Since 2007, reformulated poppers containing isopropyl nitrite are sold in Europe; isobutyl nitrite is prohibited.^[34]

France

In France, the sale of products containing butyl nitrite has been prohibited since 1990 on grounds of danger to consumers.^[35] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.^[36] 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.^[37]

United Kingdom

In the 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".^[38] 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.^[39] On the 20th January 2016 a motion to exempt poppers (Alkyl nitrites) from this legislation was defeated.^[40] This was opposed by Conservative MP Ben Howlett. Mr Howlett's fellow Tory MP Crispin Blunt declared that he has used and currently uses poppers. Manufacturers expressed concern over loss of business and potential unemployment. ^{[41] [42]} 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.^[43]

United States

In the U.S., amyl nitrite was originally marketed as a prescription drug in 1937 and remained so until 1960, when the Food and Drug Administration removed the prescription requirement due to its good safety record. This requirement was reinstated in 1969, after observation of an increase in recreational use.

Other alkyl nitrites were outlawed in the U.S. by Congress through the Anti-Drug Abuse Act of 1988. The law includes 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.^[44] The law came into effect in 1990.

Substances containing alkyl nitrites other than amyl nitrite are available at many retailers—typically sex shops and stores that sell recreational-drug paraphernalia—and may be purchased legally.

See also

• Alcohol and sex
• Sex and drugs

References