Poppers

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A selection of poppers HOpoppers.jpg
A selection of poppers

Poppers (or popper) is a slang term referring to recreational drugs belonging to the alkyl nitrite family of chemical compounds. When fumes from these substances are inhaled, they act as potent vasodilators, producing mild euphoria, warmth, and dizziness. Most effects have a rapid onset and are short-acting. [1] Its recreational use is believed to be potentially dangerous for people with heart problems, anaemia and glaucoma. Reported adverse effects include fainting, retinal toxicity and vision loss. [2] [3]

Contents

As poppers include a broad range of chemical types, their legality differs across different jurisdictions. They are often packaged under the guise of room deodorizer, leather polish, nail polish remover, or videotape head cleaner to evade anti-drug laws. [1]

The term poppers stems from the "popping" sound of glass vials containing the substance when crushed to release vapour for inhalation. Amyl nitrite, a chemical analogue of alkyl nitrite was originally prescribed in the late 1800s for the medical management of angina. [1] Many analogues exist, such as isoamyl nitrite, isopentyl nitrite, isopropyl nitrite, and isobutyl nitrite. These substances are subject to different regulations, for example, isobutyl nitrite is banned in the European Union.

Poppers act as muscle relaxants, causing involuntary smooth muscles relaxation in tissues such as the throat and anus. [4] [5] Said physiological effects and other effects such as mild euphoria has led to use cases related to recreational drug use, in some cases, party and play (chemsex), to help facilitate anal intercourse. [6] It has been reported that poppers have been part of club culture beginning with the mid-1970s disco scene and surged in popularity in the 1980s and 1990s rave scene. [7] [8]

History

19th-century discovery

The French chemist Antoine Jérôme Balard synthesized amyl nitrite in 1844. [9] 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. [10] Brunton was inspired by earlier work with the same agent, performed by Arthur Gamgee and Benjamin Ward Richardson. [10] 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. [10]

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 via direct inhalation of the vapors or inhalation through silk that covered the capsule.

Brunton found that amyl nitrites had effects of dilating blood vessels and flushing of the face. Isobutyl 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. [11] [12]

20th-century use

Although amyl nitrite is known for its practical therapeutic applications, the first documented case of recreational use was in 1964. [13] [14] The poppers "craze" began in the early 1970s in the gay male community in bars, discothèques and bathhouses. [15] [16] 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. [15] 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. [15]

In the late 1970s Time magazine [17] and The Wall Street Journal [18] 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. [17]

21st-century

Poppers were well established in the gay community, with more than a third of gay men having used poppers at least once. [19] Poppers were partial inspiration for songs such as Troye Sivan's Rush. [20]

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: [21]

Alkyl nitriteCASFormulaMolecular weight (g·mol−1)Physical stateBoiling point (°C)
Amyl nitrite (isoamyl nitrite, isopentyl nitrite)110-46-3(CH3)2CH(CH2)2ONO117.15Transparent liquid97–99
Pentyl nitrite (n-pentyl nitrite)463-04-7CH3(CH2)4ONO117.15Yellow liquid104
Butyl nitrite (n-butyl nitrite)544-16-1CH3(CH2)3ONO103.12Oily liquid78.2
Isobutyl nitrite (2-methylpropyl nitrite)542-56-3(CH3)2CHCH2ONO103.12Colourless liquid67
Isopropyl nitrite (2-propyl nitrite)541-42-4(CH3)2CHONO89.09Clear pale yellow oil39
Hexyl nitrite 638-51-7CH3(CH2)5ONO131.17Clear liquid130

Administration and effects

A selection of poppers Poppers.jpg
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 inhalers.

Physiological effect

Inhaling nitrites produces a fast-acting, short-lived and non-specific relaxation of smooth muscles (along with the sphincter muscles of the anus and the vagina). [22] Blood vessels are surrounded by smooth musculature, which directly influences blood pressure by increasing or decreasing its inward pressure on the blood vessels.

With relaxation of the smooth muscles, the 'inward' pressure on the blood vessels decreases and they dilate, resulting in a drop in blood pressure and an immediate (compensatory) increase in heart rate (reflex tachycardia). Vasodilation may cause giddiness, dizziness, headache, nausea, vomiting and flushing, and may produce a sensation of heat and excitement. Maximum vasodilatory effect is usually reached within 30 seconds, with (secondary) physiological effects lasting for 5 to 10 minutes . [23] [24] [25] [26]

Health harm and side effects

There are evidences that poppers can be harmful to health. [27]

With occasional use:

With regular use, poppers can cause: [36] [27] [37] [38] [39]

Interactions

Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Alkyl nitrites were ranked 20th social and physical harm, and 18th in dependence. Rational harm assessment of drugs radar plot.svg
Addiction experts in psychiatry, chemistry, pharmacology, forensic science, epidemiology, and the police and legal services engaged in delphic analysis regarding 20 popular recreational drugs. Alkyl nitrites were ranked 20th social and physical harm, and 18th in dependence.

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. [41] Side effects of popper abuse include tachycardia, headaches, migraines, dizziness and fainting. [42]

Toxicity

The Merck Manual of Diagnosis and Therapy reports insignificant hazard associated with inhalation of alkyl nitrites, [43] and British governmental guidance on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs. [44]

Swallowing poppers (rather than inhaling the vapour) may cause cyanosis, methemoglobinemia, unconsciousness, coma, and complications leading to death. [22] [45] [46] [47] [48] [ full citation needed ] Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia. [49]

Isopropyl nitrite poppers may be a cause of maculopathy (eye damage), as reported in France and the United Kingdom. [50] 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 , [51] an ophthalmologist described four cases in which recreational users of isopropyl nitrite poppers suffered temporary changes in vision. [52]

Foveal (center-of-gaze) damage has also been described, in six habitual users of isopropyl nitrite poppers. [53] 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). [54] [55]

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. [56] 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. [57]

A working group in 2019 from the International Agency for Research on Cancer determined there to be "sufficient evidence" to suggest carcionogenic properties of isobutyl nitrite on experimental animals, and because they could not find any sufficient studies regarding its carcinogenic effects on humans, they determined that isobutyl nitrite is "possibly carcinogenic to humans". The group primarily looked at 2 studies on animals, one on rats and one on mice. Both of these involved the administration of doses of isobutyl nitrite at seemingly low doses (0, 37.5, 75, or 150 ppm) 6 hours a day, 5 days a week, for a total of 103 weeks. [58] This is different from the relatively brief exposure to alkyl nitrites that inhaling poppers recreationally usually provides. Nonetheless, in the studies there was shown to be no increase in death rates for the animals exposed to isobutyl nitrite, but there was shown to be an increase in tumors in the lungs of the males and females of both species in the groups exposed, as well as in the thyroids of the male mice exposed. [58]

Treatment

Isobutyl nitrite toxicity

Isobutyl nitrite is known to cause methemoglobinemia. [59] Severe methemoglobinemia may be treated with methylene blue. [60]

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. [61] [62] Modest, short-term reductions in immune function were observed in animal studies, but not replicated in human studies. [63] [64]

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. [65] [66] Amyl nitrites were discontinued in 2012 in standard cyanide kits. [67] Cyanide kits now use hydroxocobalamin. [68]

Australia

Poppers are legal in Australia, and from 2020, poppers can also be purchased as a schedule 3 substance from pharmacies, or a schedule 4 substance with a prescription. [69]

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). [70] This was met by criticism from the LGBTQI community for being discriminatory and further evidence was demanded and further consultation sought. [71]

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 [72] 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. [73]

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. [74] 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. [75]

In June 2019, Australia decided not to ban poppers. [76]

However the new arrangements brought in from February 2020 onward, have brought some changes in local availability. As of February 2020, most poppers available in Australia are now based on the formula base of Pentyl nitrite. Currently, the most common brand of poppers in Australia are being imported from the Canadian firm, Locker Room. These products include Jungle Juice Black, Jungle Juice Platinum, Jungle Juice Triple Distilled, Iron Horse, Amsterdam Special and Blue Boy. All these, if not before, are now fully Pentyl nitrite based, confusing some consumers with their now relatively weak strength, as compared to before 2020.

In addition to the regular adult stores in Australia, a number of online platforms that are now selling poppers, for Australian only domestic supply. These platforms include a bigger variety and include poppers based on the stronger amyl nitrite, based formula.

Canada

Since 2013, Health Canada has banned all distribution and sales of poppers. [77]

Continental Europe

Since 2007, reformulated poppers containing isopropyl nitrite are sold in the EU; isobutyl nitrite is prohibited. [78]

In France, the sale of products containing butyl nitrite has been prohibited since 1990 on grounds of danger to consumers. [79] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs. [80] 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. [81]

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. [82] [83]

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". [84]

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. [85] On 20 January 2016 a motion to exempt poppers (alkyl nitrites) from this legislation was defeated. [86] 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. [87] [88]

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. [89]

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. [10]

Butyl nitrites were outlawed in 1988 by the Anti-Drug Abuse Act of 1988. [90] This prompted distributors to sell other alkyl nitrites not yet banned, like isopropyl nitrite. In 1990, isopropyl nitrites and other nitrites not yet banned were outlawed by the Crime Control Act of 1990. [91] 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. [92]

See also

Related Research Articles

<span class="mw-page-title-main">Amyl nitrite</span> Chemical compound

Amyl nitrite is a chemical compound with the formula C5H11ONO. A variety of isomers are known, but they all feature an amyl group attached to the nitrite functional group. The alkyl group is unreactive and the chemical and biological properties are mainly due to the nitrite group. Like other alkyl nitrites, amyl nitrite is bioactive in mammals, being a vasodilator, which is the basis of its use as a prescription medicine. As an inhalant, it also has a psychoactive effect, which has led to its recreational use, with its smell being described as that of old socks or dirty feet. It was first documented in 1844 and came into medical use in 1867.

<span class="mw-page-title-main">Inhalant</span> Chemical, often household, breathed in to cause intoxication

Inhalants are a broad range of household and industrial chemicals whose volatile vapors or pressurized gases can be concentrated and breathed in via the nose or mouth to produce intoxication, in a manner not intended by the manufacturer. They are inhaled at room temperature through volatilization or from a pressurized container, and do not include drugs that are sniffed after burning or heating. For example, amyl nitrite (poppers), gasoline, nitrous oxide and toluene – a solvent widely used in contact cement, permanent markers, and certain types of glue – are considered inhalants, but smoking tobacco, cannabis, and crack cocaine are not, even though these drugs are inhaled as smoke or vapor.

<span class="mw-page-title-main">Recreational drug use</span> Use of drugs with the primary intention to alter the state of consciousness

Recreational drug use is the use of one or more psychoactive drugs to induce an altered state of consciousness, either for pleasure or for some other casual purpose or pastime. When a psychoactive drug enters the user's body, it induces an intoxicating effect. Recreational drugs are commonly divided into three categories: depressants, stimulants, and hallucinogens.

<span class="mw-page-title-main">Club drug</span> Category of recreational drugs

Club drugs, also called rave drugs or party drugs, are a loosely defined category of recreational drugs which are associated with discothèques in the 1970s and nightclubs, dance clubs, electronic dance music (EDM) parties, and raves in the 1980s to today. Unlike many other categories, such as opiates and benzodiazepines, which are established according to pharmaceutical or chemical properties, club drugs are a "category of convenience", in which drugs are included due to the locations they are consumed and/or where the user goes while under the influence of the drugs. Club drugs are generally used by adolescents and young adults.

<span class="mw-page-title-main">Methylene blue</span> Blue dye also used as a medication

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<span class="mw-page-title-main">Ipratropium bromide</span> Type of anticholinergic

Ipratropium bromide, sold under the trade name Atrovent among others, is a type of anticholinergic medication which is applied by different routes: inhaler, nebulizer, or nasal spray, for different reasons.

<span class="mw-page-title-main">Methemoglobin</span> Type of hemoglobin

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<span class="mw-page-title-main">Butyl nitrite</span> Chemical compound

Butyl nitrite is the organic compound with the formula CH3(CH2)3ONO. It is an alkyl nitrite made from n-butanol. Butyl nitrite is used recreationally as poppers. Synonyms include 1-butyl nitrite, n-butyl nitrite and nitrous acid butyl ester.

<span class="mw-page-title-main">Isopropyl nitrite</span> Chemical compound

The chemical compound isopropyl nitrite is an alkyl nitrite made from isopropanol. It is a clear pale yellow oil that is insoluble in water.

<span class="mw-page-title-main">Cyclohexyl nitrite</span> Chemical compound

Cyclohexyl nitrite is an organic compound, with formula C6H11NO2. It is the ester of cyclohexanol and nitrous acid, i.e. it is an alkyl nitrite. Like amyl nitrite and butyl nitrite, it acts as an antianginal due to vasodilation. The compound is colorless, volatile liquid.

Isobutyl nitrite, C4H9NO2, is an alkyl nitrite, an ester of isobutanol and nitrous acid. Its chemical structure is (CH3)2CH-CH2-ONO.

Frank Booth (<i>Blue Velvet</i>) Fictional character

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<span class="mw-page-title-main">Alkyl nitrite</span> Organic compounds of the form R–O–N=O

In organic chemistry, alkyl nitrites are a group of organic compounds based upon the molecular structure R−O−N=O, where R represents an alkyl group. Formally they are alkyl esters of nitrous acid. They are distinct from nitro compounds.

Sex and drugs date back to ancient humans and have been interlocked throughout human history. Both legal and illegal, the consumption of drugs and their effects on the human body encompasses all aspects of sex, including desire, performance, pleasure, conception, gestation, and disease.

<span class="mw-page-title-main">Butyl nitrate</span> Chemical compound

Butyl nitrate is a colorless oil. It is often confused with butyl nitrite, which is sometimes used as a recreational inhalant.

Pentyl nitrite is a chemical compound with the molecular formula, classified as an alkyl nitrite, used as an antihypertensive medicine. It is also used to treat cyanide poisoning.

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Drug abuse retinopathy is damage to the retina of the eyes caused by chronic drug abuse. Types of retinopathy caused by drug abuse include maculopathy, Saturday night retinopathy, and talc retinopathy. Common symptoms include temporary and permanent vision loss, blurred vision, and night blindness. Substances commonly associated with this condition include poppers, heroin, cocaine, methamphetamine, tobacco, and alcohol.

Hexyl nitrite has the formula C6H13NO2 and is a nitrite and more specifically, an alkyl nitrite. It is an ester of hexanol and nitrous acid. It has the structural formula of: CH3(CH2)5ONO The CAS Registry Number is 638-51-7 and the European Community number 680-102-5. It is REACH and TSCA registered. It is also known as nitrous acid, hexyl ester. It is the aliphatic analogue of cyclohexyl nitrite.

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