Poppers

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

Poppers is a slang term given broadly 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] Poppers are drugs, and they interact with other drugs: for example, combined with vasodilators, such as Viagra, poppers can cause strokes and heart attacks. Use of poppers has caused eye damage and has killed people who have taken them.

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, 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.

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 suffer'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[3] and the Wall Street Journal[4] 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.[5] As of 1998, it was unclear if there is a direct effect on the brain.[6] 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.[7] When these vessels dilate, a further result is an immediate decrease in blood pressure.[8]

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. 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.[9]

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

Main article: Alkyl nitrites

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

Alkyl nitriteCASFormulaMolecular weight (g·mol−1)Physical stateBoiling 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 5156-40-1 C6H11ONO
Isobutyl nitrite (2-methylpropyl nitrite) 542-56-3 (CH3)2CHCH2ONO 103.12 Colorless liquid 67
Isopropyl nitrite (2-propyl nitrite) 541-42-4 (CH3)2CHONO 89.09 Clear pale yellow oil 39
Pentyl nitrite 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).[10][11]

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.[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]

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.[14]

Side effects

Common side effects of popper use include headaches,[15] 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,[1] and British governmental guidance before 2007 on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs,[16] 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.[10][11] Overdose via ingestion may cause cyanosis, unconsciousness, coma, and death. Methemoglobinemia is a consequence of popper use, and has killed several users.[5][10][17][18][19] Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia.[11]

Poppers cause maculopathy (eye damage), as reported in France, the United Kingdom, and other countries.[20] 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.[21] Foveal (center-of-gaze) damage has also been described, in six habitual users of poppers.[22] 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.[23][24]

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.[25][26] 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.[27] 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.[28]

Burns

On contact with skin, poppers can cause burns.

Legal status

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.[29]

European Union

Since 2007, reformulated poppers containing isopropyl nitrite are sold in Europe; isobutyl nitrite is prohibited.[30]

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.[31] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.[32] 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.[33]

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".[34] 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.[35] On the 20th January 2016 a motion to exempt poppers (Alkyl nitrites) from this legislation was defeated.[36] 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.[37] [38] [39] 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.[40]

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.[41] 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.

See also

Further reading

References

  1. 1 2 3 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. 1 2 "Rushing to a New High". Time. 1978-07-17. Retrieved 2007-04-29.
  4. ↑ Sansweet, Stephen J. (October 10, 1977). "wall street journal - A new way to glow and giggle, and get a headache. "Poppers, legally sniffable, becoming a big business; The FDA isn't interested". Wall Street Journal October 10, 1977 Stephen J. Sansweet. Retrieved October 10, 2016 – via http://virusmythpoppersmyth.org/.
  5. 1 2 "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.
  6. ↑ 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.
  7. ↑ "Amyl Nitrite (Professional Patient Advice) - Drugs.com". drugs.com. Retrieved 29 June 2016.
  8. ↑ Iversen, Les (March 16, 2016). "ACMD review of alkyl nitrites ("poppers")" (PDF). gov.uk. www.gov.uk. Retrieved October 10, 2016.
  9. ↑ Gremore, Graham (2015). "Sudden Sniffing Death" Is Now A Thing Thanks To The New Gay Poppers". Queerty (January 28). Retrieved 2016-01-11.
  10. 1 2 3 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.
  11. 1 2 3 Hagan, IG.; Burney, K. (Jul–Aug 2007). "Radiology of recreational drug abuse.". Radiographics. 27 (4): 919–40. doi:10.1148/rg.274065103. PMID 17620459.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ Wood, Ronald W. (1989). The Acute Toxicity of Nitrite Inhalants (PDF). National Institute on Drug Abuse. pp. 28–29. Retrieved 2007-03-15.
  16. ↑ 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.
  17. ↑ Pruijm, MT.; de Meijer, PH. (Dec 2002). "[Methemoglobinemia due to ingestion of isobutyl nitrite ('poppers')]". Ned Tijdschr Geneeskd. 146 (49): 2370–3. PMID 12510403.
  18. ↑ 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.
  19. ↑ Emergency Medicine: Principles and Practice. Harper & Collins, 2nd edition. 2008. pp. 42–51.
  20. ↑ 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.
  21. ↑ The New York Times: "Vision: A Quick High for Sex May Damage Vision"
  22. ↑ "Foveal damage in habitual poppers users. - PubMed - NCBI". Ncbi.nlm.nih.gov. 2015-09-28. Retrieved 2016-01-11.
  23. ↑ Krystnell Storr (2014-07-08). "More evidence 'poppers' may damage eyesight". Reuters Health.
  24. ↑ 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.
  25. ↑ 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.
  26. ↑ Schechter MT et al., "HIV-1 and the aetiology of AIDS", Lancet 341:658-659, 1993.
  27. ↑ NAM [National AIDS Manual], "Poppers", http://www.aidsmap.com/Poppers/page/1322957/, retrieved 29 October 2014.
  28. ↑ Jeffrey H. Herbst, Jerris L. Raiford, Monique G. Carry, Aisha L. Wilkes, Renata D. Ellington, David K. Whittier (2016). "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). Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health & Human Services. 65 (1, February 12): 42–50. 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…
  29. ↑ Rob Salerno (Jun 25, 2013). "Health Canada cracks down on poppers". Canada: Pink Triangle Press.
  30. ↑ "DIRECTIVE 2005/90/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL". Official Journal of the Europe. 18 January 2006.
  31. ↑ "Decree 90–274 of 26 March 1990" (in French). Legifrance.gouv.fr. 2009-05-15. Retrieved 2012-07-26.
  32. ↑ "Decree 2007-1636 of 20 November 2007" (in French). Legifrance.gouv.fr. Retrieved 2012-07-26.
  33. ↑ "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.
  34. ↑ "Consideration of the Novel Psychoactive Substances ('Legal Highs')" (PDF). Advisory Council on the Misuse of Drugs. pp. 52–54.
  35. ↑ http://www.publications.parliament.uk/pa/bills/lbill/2015-2016/0002/16002.pdf
  36. ↑ "House of Commons Hansard Debates for 20 Jan 2016 (pt 0003)". parliament.uk. Retrieved 29 June 2016.
  37. ↑ Connolly, Nancy. "Bath MP Ben Howlett speaks out against banning so-called legal high, Poppers". Bath Chronicle.
  38. ↑ Sutcliffe, Robert. "UK's biggest poppers manufacturer vows to fight legal high ban on product he's made for 35 years". Mirror.
  39. ↑ Tayag, Yasmin. "The UK is at war with synthetic drugs and brain boosters are in the crossfire.".
  40. ↑ "The Government thought it had banned Poppers but actually accidentally didn't". The Independent. Retrieved 2016-03-16.
  41. ↑ Anti-Drug Abuse Act of 1988 (Public Law 1QO-690,section 2404) (15 U.S.C. 2d57a(e)(2)).
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