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For other uses, see Popper (disambiguation).
A selection of poppers

Poppers is a slang term given boldly to the chemical class called alkyl nitrites, that are inhaled for recreational purposes, including as club drugs used at dance clubs, and that are sometimes associated with preparation for sexual encounters.[1] As a pharmacologically active agent, they are subject to interactions with other drugs, prescribed or otherwise (e.g., vasodilators such as Viagra-class agents, with potential for stroke or heart attack), and their use has been associated with fatalities due to misadministration, and with serious maculopathy (eye damage). As well, their use correlates with risky sexual behaviour, and as such, with risk of sexually transmitted disease, including AIDS.

Poppers were part of club culture from the 1970s disco scene to the 1980s, and the 1990s rave scene made their use popular.[2] Most widely sold products include the original amyl nitrite (isoamyl nitrite, isopentyl nitrite), but also cyclohexyl nitrite, isobutyl nitrite (2-methylpropyl nitrite), isopropyl nitrite (2-propyl nitrite, increasingly, after EU ban of the isobutyl form), and, more rarely, butyl nitrite; however, as unregulated products, compositions and the implications of altered formulations on user health can change without notice.

History

In 1844, the French chemist Antoine Jérôme Balard synthesized amyl nitrite. Scottish physician Sir Thomas Lauder Brunton (1844–1916) famously pioneered the use of amyl nitrite to treat angina pectoris (now treated with nitroglycerin). He was inspired by earlier work with the same reagent by Arthur Gamgee and Benjamin Ward Richardson. Brunton reasoned that the pain and discomfort of angina could be reduced by administering amyl nitrite to dilate the coronary arteries of patients, thus improving blood flow to the heart muscle.[citation needed]

Time and the Wall Street Journal reported that popper use among homosexual men began as a way to enhance sexual pleasure, but "quickly spread to avant-garde heterosexuals" as a result of aggressive marketing. A series of interviews conducted in the late 1970s revealed a wide spectrum of users.[3]

Pharmacology and physiology

Inhaling nitrites relaxes smooth muscles throughout the body, including the sphincter muscles of the anus and the vagina.[4] As of 1998, it was unclear if there is a direct effect on the brain.[5][needs update] 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.[6][better source needed] When these vessels dilate, a further result is an immediate decrease in blood pressure.[clarification needed][citation needed]

Chemistry

Composition

Generally speaking, poppers have historically contained a class of chemicals called alkyl nitrites, chemical compounds of structure R–ONO; formally, they are alkyl esters of nitrous acid.[citation needed] However, as unregulated products, compositions and the implications of altered formulations on user health can change without notice.[7][better source needed]

Tp the extent that poppers products contain alkyl nitrites, the following applies. Ignored here are methyl nitrite and ethyl nitrite, which are gaseous at room temperature and pressure.[citation needed] Proceding from these, the next few members of the alkyl nitrites—those still of lowest molecular weight—are volatile liquids.[citation needed] The whole of the family are Organic nitrites, and are prepared from alcohols and sodium nitrite in sulfuric acid solution.[citation needed]

Alkyl nitrites decompose slowly on standing, the decomposition products being oxides of nitrogen, water, the parent alcohol, and polymerization products of the corresponding aldehyde.[citation needed]

Alkyl nitrite properties

Main article: Alkyl nitrites

The following table, derived from Sutton (1963,[full citation needed] for amyl, butyl, and isobutyl nitrites) and other sources[clarification needed] summarizes alkyl nitrite chemical and physical properties, including chemical structure:

Alkyl nitrite CAS Formula Molecular weight (g·mol−1) Physical state Boiling point (°C)
Amyl nitrite (isoamyl nitrite, isopentyl nitrite) 110-46-3 (CH3)2CHCH2CH2ONO 117.15 Transparent liquid 97–99
Butyl nitrite 544-16-1 CH3(CH2)2CH2ONO 103.12 Oily liquid 78.2
Cyclohexyl nitrite[citation needed] 5156-40-1 C6H11ONO
Isobutyl nitrite (2-methylpropyl nitrite) 542-56-3 (CH3)2CHCH2ONO 103.12 Colorless liquid 67
Isopropyl nitrite (2-propyl nitrite)[citation needed] 541-42-4 (CH3)2CHONO 89.09 Clear pale yellow oil 39
Pentyl nitrite[citation needed] 463-04-7 C5H11NO2

Use

Administration

The only route of administration without the direst of consequences, for the pharmacologically active agent or agents contained in products used as poppers, is inhalation of the vapor of the volatilized organic liquid (where swallowing or aspirating the liquid can prove fatal, see below).[8][9][needs update]

Contexts

Alkyl nitrites are often used as a club drug, or to enhance a sexual experience.[1]

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.[10][needs update] 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.[11][needs update]

Health issues

Health issues associated with the chemical exposure inherent to the use of poppers include its interaction with other medications and pharmacologic agents that the user might have in their system, its side effects (as are expected for any pharmacologically active agent), fatal toxicity from misadministration (e.g., ingestion) and serious damage to user vision, and an association with risky sexual behaviour and its correlates in sexually transmitted disease.

Interactions

Alkyl nitrites interact with other vasodilators such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) to cause a serious decrease in blood pressure, that can lead to fainting, stroke, or heart attack.[12][needs update]

Side effects

Common side effects of popper use include headaches,[13][needs update] excessive perspiration,[citation needed] and temporary erectile problems.[citation needed]

Toxicity concerns

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 prior to 2007 on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs,[14][needs update] serious harm to users, including fatalities, are associated with common occurrences that take place during their recreational use.

Swallowing or aspirating the organic liquid contained in popper products (rather than inhalation) can prove fatal.[8][9][needs update] Overdose via ingestion may result in cyanosis, unconsciousness, coma, and even death. Methemoglobinemia is a consequence associated with popper use, and includes several reports of fatalities.[4][8][15][16][17][full citation needed][needs update] Accidental aspiration of amyl or butyl nitrites may lead to the development of lipoid pneumonia.[9][needs update]

As well, poppers associated with maculopathy (eye damage), based on case reports from the UK, France, and elsewhere, beginning in the mid 2000s.[18] 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,[full citation needed] an ophthalmologist described four cases in which recreational users of poppers experienced temporary changes in vision.[19][full citation needed] Foveal (center-of-gaze) damage has also been described, in six habitual users of poppers.[20][full citation needed] In 2014, optometrists and ophthalmologists reported having noticed an increase in vision loss in chronic poppers users in the UK associated with isopropyl nitrite being substituted for isobutyl nitrite in 2006.[21][22]

Early in the AIDS crisis, widespread use of poppers among those afflicted by AIDS led to the hypothesis that poppers contributed to the development of Kaposi's sarcoma, a rare form of cancer that occurs in AIDS patients.[23][24] Modest, short-term reductions in immune function were observed in animal studies,[citation needed] but direct support for a role of nitrites in development of AIDS-associated diseases has yet to find broad agreement.[25][needs update][better source needed] However, associations of drug use, including poppers, with risky sexual behaviour, a known correlate with HIV transmission, supports an indirect association between popper use and subsequent infection with sexually transmitted diseases.[26]

Other risks

Further associated risk of popper use include burns, if spilled on skin.[citation needed]

Canada

The sale of poppers in any formulation has been banned in Canada. Although not considered a narcotic and not illegal to possess or use, they are considered a drug. Sales that are not authorized can now be punished with fines and prison.[27]

European Union

Since 2007, reformulated poppers containing isopropyl nitrite are sold in Europe; isobutyl nitrite is prohibited.[28]

France

In France, the sale of products containing butyl nitrite, pentyl nitrite, or isomers thereof, has been prohibited since 1990 on grounds of danger to consumers.[29] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.[30] 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.[31]

United Kingdom

In the United Kingdom, poppers are sold in clubs/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, and in order to bypass this, they are usually sold as odorizers. Those containing amyl nitrite are "very unlikely" to be sold as that compound is regulated as a medicine. 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".[32] 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.[33] On the 20th January 2016 a motion to exempt poppers (Alkyl nitrites) from this legislation was defeated.[34] 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. However, Policing Minister Mike Penning pointed out that poppers had been mentioned on 20 death certificates since 1993.[35] [36] [37] 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.[38]

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 safety record. This requirement was reinstated in 1969, after observation of an increase in recreational use. However, it is speculated that this was probably fueled by homophobia, and not by a genuine public health concern — gay men comprised the vast majority of recreational amyl nitrite users.

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 to mean 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.[39] The law came into effect in 1990.

Substances containing alkyl nitrites other than amyl nitrite are readily available at many retailers – typically, sex shops and head shops – in the United States and may be purchased legally. In retail formulations, they are labeled as video head cleaners, nail polish removers, or room odorizers.

See also

Further reading

  • Gremore, Graham (2015). "Sudden Sniffing Death" Is Now A Thing Thanks To The New Gay Poppers". Queerty (January 28). Retrieved 2016-01-11. {{cite journal}}: Cite has empty unknown parameter: |vo;ume= (help)

References

  1. ^ a b c Porter, Robert S.; et al., eds. (November 2005). "Volatile Nitrites". The Merck Manual Online. Merck & Co. Retrieved 2007-03-16.
  2. ^ "Nitrites". Drugscope. Archived from the original on 2007-04-05. Retrieved 2007-04-24.
  3. ^ "Rushing to a New High". Time. 1978-07-17. Retrieved 2007-04-29.
  4. ^ a b "Amyl Nitrite". Medsafe. New Zealand Medicines and Medical Devices Safety Authority. 2000-05-18. Archived from the original on 2006-11-11. Retrieved 2007-03-15.
  5. ^ Balster, RL. (1998). "Neural basis of inhalant abuse". Drug Alcohol Depend. 51 (1–2, Jun–Jul): 207–214. doi:10.1016/S0376-8716(98)00078-7. PMID 9716942.
  6. ^ "Amyl Nitrite (Professional Patient Advice) - Drugs.com". drugs.com. Retrieved 29 June 2016.
  7. ^ Gremore, Graham (2015). "Sudden Sniffing Death" Is Now A Thing Thanks To The New Gay Poppers". Queerty (January 28). Retrieved 2016-01-11. {{cite journal}}: Cite has empty unknown parameter: |vo;ume= (help)
  8. ^ a b c Dixon, DS.; Reisch, RF.; Santinga, PH. (Jul 1981). "Fatal methemoglobinemia resulting from ingestion of isobutyl nitrite, a "room odorizer" widely used for recreational purposes". J Forensic Sci. 26 (3): 587–93. PMID 7252472.
  9. ^ a b c Hagan, IG.; Burney, K. (Jul–Aug 2007). "Radiology of recreational drug abuse". Radiographics. 27 (4): 919–40. doi:10.1148/rg.274065103. PMID 17620459.
  10. ^ Nickerson, Mark, John Parker, Thomas Lowry, and Edward Swenson.Isobutyl Nitrite and Related Compounds; chapter on "Sociology and Behavioral Effects" . 1st ed. San Francisco: Pharmex, Ltd, 1979.[full citation needed]
  11. ^ Kennedy, Edward, U.S. Senate, Chair Committee on Labor and Human Resources. "Report of the Committee on Labor and Human Resources."Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments of 1988. Section 4015. 1988.
  12. ^ Romanelli, F.; Smith, KM. (Jun 2004). "Recreational use of sildenafil by HIV-positive and -negative homosexual/bisexual males". Ann Pharmacother. 38 (6): 1024–30. doi:10.1345/aph.1D571. PMID 15113986.
  13. ^ Wood, Ronald W. (1989). The Acute Toxicity of Nitrite Inhalants (PDF). National Institute on Drug Abuse. pp. 28–29. Retrieved 2007-03-15.
  14. ^ Nutt, D.; King, LA.; Saulsbury, W.; Blakemore, C. (Mar 2007). "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet. 369 (9566): 1047–53. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831.
  15. ^ Pruijm, MT.; de Meijer, PH. (Dec 2002). "[Methemoglobinemia due to ingestion of isobutyl nitrite ('poppers')]". Ned Tijdschr Geneeskd. 146 (49): 2370–3. PMID 12510403.
  16. ^ Stalnikowicz, R.; Amitai, Y.; Bentur, Y. (2004). "Aphrodisiac drug-induced hemolysis". J Toxicol Clin Toxicol. 42 (3): 313–6. doi:10.1081/clt-120037435. PMID 15362601.
  17. ^ Emergency Medicine: Principles and Practice. Harper & Collins, 2nd edition. 2008. pp. 42–51.[full citation needed]
  18. ^ Davies, A. J.; Kelly, S. P.; Bhatt, P. R. (2012-03-09). "'Poppers maculopathy'—an emerging ophthalmic reaction to recreational substance abuse". Eye (correspondence). 26 (888): 1479–86. doi:10.1038/eye.2012.37. Retrieved 2016-01-11.
  19. ^ The New York Times: "Vision: A Quick High for Sex May Damage Vision"[full citation needed]
  20. ^ "Foveal damage in habitual poppers users. - PubMed - NCBI". Ncbi.nlm.nih.gov. 2015-09-28. Retrieved 2016-01-11.[full citation needed]
  21. ^ Krystnell Storr (2014-07-08). "More evidence 'poppers' may damage eyesight". Reuters Health.
  22. ^ Gruener, A. M.; Jeffries, M. A.; El Housseini, Z; Whitefield, L (2014). "Poppers maculopathy". Lancet. 384: 1606. doi:10.1016/S0140-6736(14)60887-4. PMID 24954683.
  23. ^ Duesberg P et al., "The chemical bases of the various AIDS epidemics: recreational drugs, anti-viral chemotherapy and malnutrition", J Biosci 28(4):383-412, 2003.
  24. ^ Schechter MT et al., "HIV-1 and the aetiology of AIDS", Lancet 341:658-659, 1993.
  25. ^ NAM [National AIDS Manual], "Poppers", http://www.aidsmap.com/Poppers/page/1322957/, retrieved 29 October 2014.
  26. ^ "Adaptation and National Dissemination of a Brief, Evidence-Based, HIV Prevention Intervention for High-Risk Men Who Have Sex with Men". Morbidity and Mortality Weekly Reports (Supplements). 65 (1, February 12). Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health & Human Services: 42–50. 2016. Retrieved 29 June 2016. National survey data suggest that many MSM consume alcohol and other drugs that can impair judgment and increase risky behavior… Among MSM populations, methamphetamine, amyl nitrate (poppers), cocaine, and heavy alcohol use (i.e., binge drinking) are the substances most consistently associated with risky sexual behavior... and increased HIV risk… {{cite journal}}: Unknown parameter |authors= ignored (help)
  27. ^ Rob Salerno (Jun 25, 2013). "Health Canada cracks down on poppers". Canada: Pink Triangle Press.
  28. ^ "DIRECTIVE 2005/90/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL". Official Journal of the Europe. 18 January 2006.
  29. ^ "Decree 90–274 of 26 March 1990" (in French). Legifrance.gouv.fr. 2009-05-15. Retrieved 2012-07-26.
  30. ^ "Decree 2007-1636 of 20 November 2007" (in French). Legifrance.gouv.fr. Retrieved 2012-07-26.
  31. ^ "Conseil d'État, 10ème et 9ème sous-sections réunies, 15/05/2009, 312449, Publié au recueil Lebon". Legifrance.gouv.fr (in French). 2009-05-15. Retrieved 2016-01-11.
  32. ^ "Consideration of the Novel Psychoactive Substances ('Legal Highs')" (PDF). Advisory Council on the Misuse of Drugs. pp. 52–54.
  33. ^ http://www.publications.parliament.uk/pa/bills/lbill/2015-2016/0002/16002.pdf
  34. ^ "House of Commons Hansard Debates for 20 Jan 2016 (pt 0003)". parliament.uk. Retrieved 29 June 2016.
  35. ^ Connolly, Nancy. "Bath MP Ben Howlett speaks out against banning so-called legal high, Poppers". Bath Chronicle.
  36. ^ Sutcliffe, Robert. "UK's biggest poppers manufacturer vows to fight legal high ban on product he's made for 35 years". Mirror.
  37. ^ Tayag, Yasmin. "The UK is at war with synthetic drugs and brain boosters are in the crossfire".
  38. ^ "The Government thought it had banned Poppers but actually accidentally didn't". The Independent. Retrieved 2016-03-16.
  39. ^ Anti-Drug Abuse Act of 1988 (Public Law 1QO-690,section 2404) (15 U.S.C. 2d57a(e)(2)).
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