Poppers

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 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.

Pharmacology and physiology

Inhaling nitrites relaxes smooth muscles throughout the body, including the sphincter muscles of the anus and the vagina. As of 1998, it was unclear if there is a direct effect on the brain. 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. When these vessels dilate, a further result is an immediate decrease in blood pressure.

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. However, to the extent that they remain unregulated or illicitly used products, compositions and the implications of altered formulations on user health can change without notice.

To 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. Proceeding from these, the next few members of the alkyl nitrites—those still of lowest molecular weight—are volatile liquids. The whole of the family are Organic nitrites, and are prepared from alcohols and sodium nitrite in sulfuric acid solution.

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

Alkyl nitrite properties

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

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).

Contexts

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

Popularity

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. 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.

Health problems

Health problems that are associated with the use of poppers include the following:

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 heart attack.

Side effects

Common side effects of popper use include headaches, excessive perspiration, respiratory congestion, and temporary erectile problems.

Toxicity

While an earlier edition of the 2005 Merck Manual of Diagnosis and Therapy reported insignificant hazard associated with inhalation of alkyl nitrites, and British governmental guidance before 2007 on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs, serious harm to users, including death, is commonly associated with their recreational use.

Swallowing or aspirating (rather than inhaling) the organic liquid in poppers also can be deadly. Overdose via ingestion may cause cyanosis, unconsciousness, coma, and death. Methemoglobinemia is a consequence of popper use, and has killed several users. Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia.

Poppers cause maculopathy (eye damage), as reported in France, the United Kingdom, and other countries. 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. Foveal (center-of-gaze) damage has also been described, in six habitual users of poppers. 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 for isobutyl nitrite.

Link with AIDS

Early in the AIDS crisis, widespread use of poppers among AIDS patients led to the hypothesis that poppers contributed to the development of Kaposi's sarcoma, a rare form of cancer, which occurs in AIDS patients. Modest, short-term reductions in immune function were observed in animal studies, but direct support for a role of nitrites in development of AIDS-associated diseases has not found broad agreement. However, because the recreational use of drugs, including poppers, is associated with increased sexual risk-taking, and because increased risk-taking is associated with HIV transmission, poppers may be indirectly associated with transmission of sexually transmitted diseases, including HIV and AIDS.

Burns

On contact with skin, poppers can cause burns.

Australia

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

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.

European Union

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

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. In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs. 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.

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, 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". 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. On the 20th January 2016 a motion to exempt poppers (Alkyl nitrites) from this legislation was defeated. 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. 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.

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: almost all recreational users of amyl nitrite were men who engaged in sexual activity with other men.

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. 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. In retail formulations, they are labeled as video-head cleaners, nail-polish removers, and room odorizers.