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Poppers

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For other uses, see Popper (disambiguation).
A selection of 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 was also used until it was banned by the European Union. In some countries, to evade anti-drug laws, poppers are labelled or packaged as room deodorizers, leather polish, or tape head cleaner.

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] initially within the gay community.[4] As Dr. Lucy Robinson at Sussex University said:

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.[5]

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.[6][7]

History

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19th-century discovery

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The French chemist Antoine Jérôme Balard synthesized amyl nitrite in 1844.[8] 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.[9] Brunton was inspired by earlier work with the same agent, performed by Arthur Gamgee and Benjamin Ward Richardson.[9] 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.[9]

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; this was followed up 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 of 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.[10][11]

20th-century presence in 1960s disco and 1970s gay culture

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Although amyl nitrite is known for its practical therapeutic applications, the first documented case of recreational use was in 1964[12] during the disco era.[13] The poppers "craze" began in the early 1970s in the LGBT community in gay bars, discothèques and bathhouses,[14] marking its prominent presence in gay culture.[15] 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.[14] 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.[14]

In the late 1970s Time magazine[16] and The Wall Street Journal[17] 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.[16]

Chemistry

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Main article: Alkyl nitrites

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:[18]

Alkyl nitrite CAS Formula Molecular weight (g·mol−1) Physical state Boiling 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

Administration and effects

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A selection of poppers

Administration

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Poppers are inhaled. This is typically done through the nasal cavities, commonly directly from the bottle or by the help of small inhalators.

Principal effect

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Inhaling nitrites relaxes smooth muscles throughout the body, as well as sphincter muscles of the anus and the vagina.[19] 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.[20][21] When these vessels dilate, a further result is an immediate decrease in blood pressure.[22]

Interactions

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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 fainting.[23]. Side effects of popper abuse includes tachycardia, headaches, migraines, dizziness and fainting.[24]

Toxicity

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The Merck Manual of Diagnosis and Therapy reports insignificant hazard associated with inhalation of alkyl nitrites,[25] and British governmental guidance on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs.[26]

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.[19][27][28][29][30]Template:Full citation needed Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia.[31]

Isopropyl nitrite poppers may be a cause of maculopathy (eye damage), as reported in France and the United Kingdom.[32] 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,Template:Full citation needed an ophthalmologist described four cases in which recreational users of poppers suffered temporary changes in vision.[33]Template:Full citation needed Foveal (center-of-gaze) damage has also been described, in six habitual users of poppers.[34]

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).[35][36] 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.[37]

[edit]

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.[38][39] Modest, short-term reductions in immune function were observed in animal studies.[40][41]

Cyanide treatment

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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.[42][43] Amyl nitrites were discontinued in 2012 in standard cyanide kits.[44] Cyanide kits now use hydroxocobalamin.[45]

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Australia

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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.[46]

History of poppers legislation in Australia

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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).[47] This was met by criticism from the LGBTIQ community for being discriminatory and further evidence was demanded and further consultation sought.[48]

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[49] and that use of amyl nitrites has been stable over the past decade with very little evidence of harm despite use by a high proportion of gay men over a long period of time.

A final decision was pushed back from November 29, 2018 to late January or early February 2019 for further consultation with the public.[50]

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.[51] 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.[52]

In June 2019 Australia decided not to ban poppers.[53]

Europe

[edit]

Since 2007, reformulated poppers containing isopropyl nitrite are sold in Europe; isobutyl nitrite is prohibited.[54]

In France, the sale of products containing butyl nitrite has been prohibited since 1990 on grounds of danger to consumers.[55] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.[56] 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.[57]

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.[58][59]

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".[60] The Psychoactive Substances Act 2016, scheduled to be enacted April 1, 2016, was initially claimed to impose a blanket ban on the production, import and distribution of all poppers.[61] On January 20, 2016 a motion to exempt poppers (alkyl nitrites) from this legislation was defeated.[62] 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.[63][64] 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.[65]

North America

[edit]

Since 2013, Health Canada has banned all distribution and sales of poppers.[66]

In the US, 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 safety record. This requirement was reinstated in 1969, after observation of 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.[9]

Butyl nitrites were outlawed in 1988 by the Anti-Drug Abuse Act of 1988.[67] This prompted distributors to sell other alkyl nitrites not yet banned, like isopropyl nitrites.[9] In 1990, isopropyl nitrites and other nitrites not yet banned were outlawed by the Crime Control Act of 1990.[68] 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.[69]

See also

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References

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  2. ^ Schmidt AJ, Bourne A, Weatherburn P, Reid D, Marcus U, Hickson F (December 2016). "Illicit drug use among gay and bisexual men in 44 cities: Findings from the European MSM Internet Survey (EMIS)". The International Journal on Drug Policy. 38: 4–12. doi:10.1016/j.drugpo.2016.09.007. PMID 27788450.
  3. ^ Sex and Poppers (28 November 2017). Archived 26 December 2019 at the Wayback Machine
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  5. ^ Quine, Oscar (2016-01-22). Poppers: How gay culture bottled a formula that has broken down boundaries (en).
  6. ^ Nitrites. Drugscope. Archived 2007-04-05 at the Wayback Machine
  7. ^ Nickerson, Mark (1979). Isobutyl nitrite and related compounds. Pharmex. OCLC 4790673.Template:Pn
  8. ^ Fischer, János; Ganellin, C. Robin (2006). "Chapter 10 : Development of Organic Nitrates for Coronary Heart Disease". Analogue-based Drug Discovery. United States: John Wiley & Sons. pp. 247, 248. ISBN 978-3-527-60749-5. {{cite book}}: Unknown parameter |name-list-format= ignored (|name-list-style= suggested) (help)
  9. ^ a b c d e Fye, W B (August 1986). "T. Lauder Brunton and amyl nitrite: a Victorian vasodilator". Circulation. 74 (2): 222–229. doi:10.1161/01.cir.74.2.222. PMID 3524895.
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  11. ^ Brunton, Thomas Lauder (1898). Lectures on the Action of Medicines: Being the Course of Lectures on Pharmacology and Therapeutics Delivered at St. Bartholomew's Hospital During the Summer Session of 1896. Macmillan. pp. 332–339. Brunton, T.L Lectures on the actions of medicines.
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  18. ^ Sutton (1963) Template:Full citation needed
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  33. ^ "A quick high for sex may damage vision". Template:Full citation needed
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  35. ^ Storr, Krystnell. "More evidence 'poppers' may damage eyesight", Reuters Health, 2014-07-08.  Archived 2015-11-10 at the Wayback Machine
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  37. ^ Pahlitzsch M, Mai C, Joussen AM, Bergholz R (2016). "Poppers Maculopathy: Complete Restitution of Macular Changes in OCT after Drug Abstinence". Seminars in Ophthalmology. 31 (5): 479–84. doi:10.3109/08820538.2014.962175. PMID 25398125.
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  44. ^ cyanide antidote kit (sodium thiosulfate, sodium nitrite, & amyl nitrite) dosing, indications, interactions, adverse effects, and more. Archived 2019-12-26 at the Wayback Machine
  45. ^ Research, Center for Drug Evaluation and (2019-08-14). "Products Approved for Chemical Emergencies". FDA.
  46. ^ "You'll Soon Be Allowed to Buy Amyl in Australian Pharmacies—But There's A Catch", Vice, 7 June 2019. 
  47. ^ Administration, Australian Government Department of Health Therapeutic Goods (7 June 2018). Consultation: Proposed amendments to the Poisons Standard being referred to the June 2018 meetings of the ACCS, ACMS and Joint ACCS/ACMS.
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  66. ^ Poppers sold across Canada pose serious risks.
  67. ^ 15 U.S. Code § 2057a - Banning of butyl nitrite.
  68. ^ 15 U.S. Code § 2057b - Banning of isopropal nitrite and other nitrites.
  69. ^ Anti-Drug Abuse Act of 1988 (Public Law 1QO-690, section 2404) (15 U.S.C. 2d57a(e)(2)).

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