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Poppers

A selection of poppers

Popper is a slang term given broadly to drugs of the chemical class called alkyl nitrites that are inhaled. It is used for practical purposes to facilitate anal sex by increasing blood flow and relaxing sphincter muscles[1] or for recreational drug purposes, typically for the "high" or "rush" that the drug can create. Poppers have also been historically used for sexual encounters, initially within the gay community.[2]

"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." - Dr. Lucy Robinson, Sussex University[2]

Poppers were part of club culture from the mid-1970s disco scene and returned to popularity in the 1980s and 1990s rave scene.[3]

Popper use has a relaxation effect on involuntary smooth muscles, such as those in the throat and anus.[4][5] 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.

Ethyl chloride, sometimes labelled as Maximum Impact and sold in aerosol cans, has also been misleadingly marketed as poppers, despite having no historical relation to poppers and not containing alkyl nitrites.[6]

History

19th-century discovery

The French chemist Antoine Jérôme Balard synthesized amyl nitrite in 1844.[7] 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.[8] Brunton was inspired by earlier work with the same agent, performed by Arthur Gamgee and Benjamin Ward Richardson.[8] 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.[8]

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

Although amyl nitrite is known for its practical therapeutic applications, the first documented case of recreational use was in 1964[9] during the disco era.[10] The poppers "craze" began in the early 1970s in the LGBT community in gay bars, discothèques and bathhouses,[11] marking its prominent presence in gay culture.[12] 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.[11] 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.[11]

In the late 1970s Time[13] and the Wall Street Journal[14] 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.[13]

Academic research on nitrites began around the 1970s but came to mixed conclusions over its correlation with AIDS, HIV and Kaposi's sarcoma.[15]

21st-century resurgence through New Media in queer subculture

Around mid-2010s, the resurgence of poppers is seen through amateur video compilations known as "popper trainers".[16][17] While most popper trainer compilation videos revolve around gay pornography, genres have expanded to subcultures based on sexuality and gender identities to more specialized fetishes such as BDSM and erotic hypnosis. Trainer makers such as PopperPiggy create compilations exploring themes of bear culture[16] while EmperorHypnos touches upon themes of erotic hypnosis and feminization. Elements using text, visuals, audio and music (using rave era music such as techno or trance to mainstream pop) are combined to give viewers an immersive (and sometimes narrative) experience.[18]

As stated by John Mercer, professor of gender and sexuality at the Birmingham City University:

"the practice of making collage 'popper training' videos by repurposing a range of found sources, from still images to amateur video and from webcam footage to extracts from commercial gay porn, with the express purpose of turning masturbation, fuelled by amyl nitrate use...this is a cultural practice and mode of production and consumption that can be framed within a wider set of debates around subjectivity and the state under neoliberalism."[19]

The act of masturbation and using poppers is an activity known as popperbating[19] and has created a subculture of gay men who identify as "popper pigs" who participate in the act.[19]

Pharmacology and physiology

Inhaling nitrites relaxes smooth muscles throughout the body, including the sphincter muscles of the anus and the vagina.[20] 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.[21][22] When these vessels dilate, a further result is an immediate decrease in blood pressure.[23]

Chemistry

Composition

Poppers contain a class of chemicals called alkyl nitrites.

To the extent that poppers products contain alkyl nitrites, the following applies.

Alkyl nitrite properties

The following table summarizes alkyl nitrite chemical and physical properties, including chemical structure:[24]

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

Use

Administration

Poppers are inhaled.

This is typically done through the nasal or oral cavities, and any conditions which adversely affect the use of the respiratory system should be taken into account before administration commences.

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.[25][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 three per cent of the overall population had ever used poppers.[26][needs update]

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 low blood pressure leading to potential heart attack.[27][needs update]

Side effects

Common side effects of popper abuse includes tachycardia, headaches, migraines, dizziness and fainting.[28][29][30]

Toxicity

The Merck Manual of Diagnosis and Therapy reports insignificant hazard associated with inhalation of alkyl nitrites,[31] and British governmental guidance on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs.[32]

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.[20][33][34][35][36][full citation needed] Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia.[37]

Maculopathy

Isopropyl nitrite poppers may be a cause of maculopathy (eye damage), as reported in France and the United Kingdom.[38] 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 suffered temporary changes in vision.[39][full citation needed] Foveal (center-of-gaze) damage has also been described, in six habitual users of poppers.[40][full citation needed]

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).[41][42]

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.[43]

Controversial link with HIV/AIDS

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.[44][45] Modest, short-term reductions in immune function were observed in animal studies.[46][47] A study examining men who have sex with men, and who also take recreational drugs, suggested poppers, when used in a pattern of recreational drug taking could be associated with increase in sexual risk-taking.[48] However, there was no evidence that nitrite use led directly to use of illicit drugs.[12]

Legal status

Australia

It is illegal to sell poppers as inhalants in Australia, although some, including amyl nitrite, are often sold in sex shops labeled as DVD or leather cleaner.[49]

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).[50] This was met by criticism from the LGBTIQ community for being discriminatory and further evidence was demanded and further consultation sought.[51]

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[52] 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.[53]

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.[54] 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.[55]

Publication of a final decision is anticipated in June 2019.

European Union

Since 2007, reformulated poppers containing isopropyl nitrite are sold in Europe; isobutyl nitrite is prohibited.[56]

France

In France, the sale of products containing butyl nitrite has been prohibited since 1990 on grounds of danger to consumers.[57] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.[58] 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.[59]

Germany, Austria, Switzerland

The possession in the German speaking countries 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.[60][61]

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. 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".[62] 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.[63] On January 20, 2016 a motion to exempt poppers (alkyl nitrites) from this legislation was defeated.[64] 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.[65][66] 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.[67]

Japan

Poppers are illegal in Japan.[68]

North America

Canada

As of June 2013, Health Canada has banned all distribution and sales of poppers.[69]

United States

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.

Other alkyl nitrites were outlawed in the US 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.[70] The law came into effect in 1990.

See also

References

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