Safer Using – Poppers

About Poppers

Poppers (also known as alkyl nitrites) are a class of inhalant drugs used on the dance floor and during sex.^1,2 Poppers produce short-lasting psychoactive effects and a strong muscle-relaxant effect lasting around 3 minutes.¹ Due to their ability to relax smooth muscles, poppers are used to enhance anal intercourse primarily in the LGBTQ+ community.² A 2020 survey of 1745 gay and bisexual men in Australia found that two thirds of the participants had used poppers at least once, and almost half had used them in the last six months.² No drug-related harms were reported and popper use among these men was linked to reduced anxiety, increased social engagement with gay men, and improved sexual pleasure.²

Poppers are generally sold as small bottles contining an alkyl nitrite liquid, which is held under the nose so that the user can inhale its fumes.^1,3 The liquid in poppers is highly flammable and can result in chemical burns if spilled on the skin.¹ Alkyl nitrites are extremely toxic and potentially fatal when ingested orally.^1,3 Poppers are commonly found in adult stores, where they are sold for purposes such as “leather cleaner”, “room odoriser”, or “liquid incense”.^1-5 They are sometimes sold under the brand name “Jungle Juice” (a.k.a. “JJ”) among others.^2,3

There are multiple types of alkyl nitrites sold as poppers, but the most common are amyl nitrite (a.k.a. isoamyl nitrite or isopentyl nitrite), isopropyl nitrite, and isobutyl nitrite.^1,5 The immediate effects are very similar across alkyl nitrites, but some are experienced as more potent than others because the liquids are more volatile (that is, produce fumes at a greater rate).¹ Namely, isopropyl nitrite is more volatile than isobutyl nitrite, which in turn is more volatile than amyl nitrite.¹ Additionally, each alkyl nitrite has its own unique safety and toxicity.² For example, isopropyl nitrite has been shown to be toxic to the retina of the eye.^2,6 In 2019, the Australian Therapeutic Goods Administration (TGA) tested eight popper brands sold in Australia and found that they all contained isobutyl nitrite.⁵ They also tested ten popper brands from overseas and found that they either contained amyl nitrite or isopropyl nitrite.⁵

In 2018, the TGA attempted to ban alkyl nitrites, which caused a pushback from sections of the LGBTQ+ community.² In the following year, the TGA opted to keep alkyl nitrites in Schedule 4 (prescription only medicines), and to move amyl nitrite to Schedule 3, meaning that it can be sold in pharmacies without a prescription.^2,7 While alkyl nitrites can legally be sold in pharmacies, no medications containing them have been approved by the TGA.⁴ The lengthy manufacturing and testing process required to sell medications in Australia likely means that alkyl nitrites will not be sold at pharmacies in the near future.⁴

The use of poppers does not come without dangers. Poppers quickly lower blood pressure, so people with existing heart conditions should avoid using them.³ People with a genetic glucose-6-phosphate dehydrogenase (G6PD) deficiency should also avoid them.⁸ People who have accidentally or intentionally ingested the liquid found in poppers should seek emergency medical attention as soon as possible.³ More information regarding the overdose harms and toxicity of alkyl nitrites is presented below.

Poppers Effects

The most commonly reported effects experienced by people who use poppers are:^1,3

Euphoria.
Rushing sensation.
Lowered blood pressure (hypotension).
Increased heart rate (tachycardia).
Widening of blood vessels (vasodilation).
Headache.
Enhanced touch sensation.

The effects typically come on in about 15 seconds and can last a maximum of 3-5 minutes.^1,3

Poppers Dosing

It is always advised to start at a low dose and wait before redosing recreational drugs (start low and go slow).

The intensity of effects is generally greater when poppers are inhaled for a longer period of time. It is not recommended to inhale the fumes from poppers for more than five seconds.³

Some alkyl nitrites are more potent than others due to how volatile they are (how quickly they produce fumes).¹ The volatility (and thus potency) of alkyl nitrites is as follows: isopropyl nitrite > isobutyl nitrite > amyl nitrite.¹

Poppers Overdose

A high dose or repeatedly inhaling poppers can lead to unpleasurable side effects, inlcuding:⁹

Abnormal heart rhyhtm (palpitations).
Headache.
Disturbed vision.
Dizziness.
Nausea.
Fainting.

If someone is experiencing these symptoms, encourage them to sit down so they don’t injure themselves if they faint.

Extreme cases of popper overdose can cause a life-threatening condition known as methemoglobinemia. The symptoms of methemoglobinemia can include:⁹

Blue-greyish skin discolouration (cyanosis).
Loss of consciousness.
Slowed breathing (bradycardia).

Oral ingestion of poppers is more likely to cause methemoglobinemia, but prolonged inhalation of poppers has also resulted in multiple cases of methemoglobinemia.⁹

If someone is experiencing the symptoms of methomoglobinemia, seek emergency medical attention immediately.

Mixing drugs can have unpredictable and possibly dangerous effects. Mixing poppers with other vasodilators can cause an excessive drop in blood pressure and lead to fainting.¹ Examples of other vasodilators include sildenafil (Viagra/Kamagra), vardenafil, and tadalafil.¹

Poppers Toxicity

In the short-term, inhaling poppers can lead to skin irritation and inflammation (dermatitis) around the mouth and nostrils, which tends to resolve on its own.¹⁰ The long-term effects of popper use has not been widely studied in humans, but some alkyl nitrites appear to be more toxic than others. Of all the alkyl nitrites, amyl nitrite appears to be the least dangerous.

Isopropyl nitrite has been shown to cause toxicity to the centre (fovea) of the retina, resulting in partial or complete loss of central vision in one or both eyes.⁶ This has been called poppers maculopathy and, in severe cases, the disruption to vision took months to resolve.⁶ In two cases, people still experienced mild disturbance to their vision after 11 and 14 months respectively.⁶

Isobutyl nitrite was banned in the European Union in 2006 due to cancer risk, which led to an increase in the prevalence of isopropyl nitrite.⁶ A study from 1996 found that mice and rats that frequently inhaled large quantities of isobutyl nitrite were more likely to develop lung cancer.¹¹ The animals were exposed to isobutyl nitrite for 6 hours a day, 5 days a week over 103 weeks.¹¹

In a 2017 study of 3223 men who have sex with men, long-term heavy popper use (including but not limited to isobutyl nitrite) was not associated with any individual cancers but was linked to an increased risk of virus-associated cancers in older men.¹² It was speculated that poppers may suppress immune function and increase the risk of cancers caused by human papillomavirus (HPV), HHPV-8, and Epstein-Barr virus (EBV).¹²

If you are experiencing any concerning symptoms from short- or long-term popper use, consider seeing a non-judgemental medical professional, such as at the CAHMA clinic.