Poppers

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Sir Thomas Lauder Brunton
Brunton Thomas Lauder sig.jpg
Known forTreatment of angina pectoris
 
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A modern popper brand that declares 99% pure isobutyl nitrite.

Poppers is a slang term given to the chemical class called alkyl nitrites that are inhaled for recreational purposes, especially as an aphrodisiac.[1] Today poppers are mainly sold in cap vials but historically received the names "poppers", "boppers", and "snappers"[2] from the sound of snapping off the neck of glass ampoules to release their vapors.

Widely sold concentrated products are the pioneer amyl nitrite (isoamyl nitrite, isopentyl nitrite), cyclohexyl nitrite, isobutyl nitrite (2-methylpropyl nitrite), and isopropyl nitrite (2-propyl nitrite). Isopropyl nitrite went popular due to ban of isobutyl nitrite in EU 2007. More rarely sold are butyl nitrite.

Part of the club culture from the 1970s disco scene to the 1980s and 1990s rave scene.,[3]

Contents

Etymology

Amyl nitrite, manufactured by Burroughs Wellcome (now GlaxoSmithKline) and Eli Lilly and Company, was originally sold in small glass ampoules that were crushed to release their vapors, and received the name "poppers" and "snappers" as a result of the popping sound made by crushing the ampoule.[4]

History

Sir Thomas Lauder Brunton
Brunton Thomas Lauder sig.jpg
Known forTreatment of angina pectoris

In 1844, the French chemist Antoine Jérôme Balard synthesized amyl nitrite. Sir Thomas Lauder Brunton (March 14, 1844–September 16, 1916), a Scottish physician, famously pioneered the use of amyl nitrite to treat angina pectoris (now treated with nitroglycerin). Brunton's clinical use of amyl nitrite to treat angina 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.

Time and the Wall Street Journal reported that the popper fad began among homosexual men 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, including construction workers, a "trendy East Side NYC couple" at a "chic NYC nightclub", a Los Angeles businesswoman "in the middle of a particularly hectic public-relations job" (who confided to the reporter that "I could really use a popper now"), and frenetic disco dancers amid "flashing strobe lights and the pulsating beat of music in discos across the country."[5]

Chemistry

Poppers are a class of chemicals called alkyl nitrites. These are chemical compounds of structure R–ONO. In more formal terms, they are alkyl esters of nitrous acid.

The first few members of the series are volatile liquids; methyl nitrite and ethyl nitrite are gaseous at room temperature and pressure. Organic nitrites are prepared from alcohols and sodium nitrite in sulfuric acid solution. They decompose slowly on standing, the decomposition products being oxides of nitrogen, water, the alcohol, and polymerization products of the aldehyde.

Physical and chemical properties

(Sutton, 1963 for amyl nitrite, butyl nitrite, isobutyl nitrite):

Alkyl nitriteCASFormulaMolecular weight (g·mol−1)Physical stateBoiling point (°C)Specific gravity
Amyl nitrite (isoamyl nitrite, isopentyl nitrite)110-46-3(CH3)2CHCH2CH2ONO117.15Transparent liquid97–990.872
Butyl nitrite544-16-1CH3(CH2)2CH2ONO103.12Oily liquid78.20.9144 (0/4 °C)
Cyclohexyl nitrite5156-40-1
Isobutyl nitrite (2-methylpropyl nitrite)542-56-3(CH3)2CHCH2ONO103.12Colorless liquid670.8702 (20/20 °C)
Isopropyl nitrite (2-propyl nitrite)541-42-4(CH3)2CHONO89.09Clear pale yellow oil39 °C at 760 mmHg
Pentyl nitrite463-04-7C5H11NO2

Medical use

Antidote to cyanide poisoning

The light alkyl nitrites cause the formation of methemoglobin wherein, as an effective antidote to cyanide poisoning, the methemoglobin combines with the cyanide to form nontoxic cyanmethemoglobin. First responders typically carry a cyanide poison kit containing amyl nitrite, such as the popular Taylor Pharmaceutical Cyanide Antidote Kit.

Amyl nitrite is used medically as an antidote to cyanide poisoning,[6]

Recreational drug use

Myth about AIDS epidemic

It has been incorrectly suggested that poppers have been related to AIDS, HIV infection, and the AIDS-related cancer Kaposi's sarcoma.[7] Initially poppers were considered as a hypothesis for the then-burgeoning AIDS epidemic, and the idea has persisted in large part due to the activities of AIDS denialists as a pseudoscientific rationalization for the presence of AIDS in homosexual males.[8]

Dosage

The dose administered can easily be determined by subtracting the weight of a small vial after inhalation from its weight before inhalation, using an accurate scale. Two-cm vial openings, now being more common, are broad enough to cover the nostrils; smaller vial necks distribute lower doses.

Effects

[9]

Aphrodisiac

Inhaling nitrites relaxes smooth muscles throughout the body [6] Smooth muscle surrounds the body's blood vessels and when relaxed causes these vessels to dilate resulting in an immediate decrease in blood pressure.

Alkyl nitrites are often used as a club drug or to enhance a sexual experience.[1] The head rush, euphoria, and other sensations result from the increased heart rate.[1]

Popularity

User surveys are hard to come by, but a 1988 study found that 69% of men who had sex with men in the Baltimore/Washington DC area reported they had used poppers, with 21% having done so in the prior year. The survey also found that 11% of recreational drug users in the area reported using poppers, increasing to 22% among "heavy abusers," with an average age of first use of 25.6 years old. Both survey groups used poppers to "get high," but the men who had sex with men were more likely to use them during sex. It was reported that this group reduced usage following the AIDS epidemic, while the drug-users had not.[10] A 1987 study commissioned by the US 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]

Use by minors is historically minimal due, in part, 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 paper published in 2005 examined use of poppers self-reported by adolescents aged 12–17 in the (American) 2000 and 2001 National Household Surveys on Drug Abuse. In all, 1.5% of the respondents in this age group reported having used poppers. This figure rose to 1.8% in those over 14. Living in nonmetropolitan areas, having used mental health services in the past year (for purposes unconnected with substance use treatment), the presence of delinquent behaviours, past year alcohol and drug abuse and dependence, and multi-drug use were all associated with reporting the use of poppers.[13]

Health issues

The Merck Manual of Diagnosis and Therapy reports that there is little evidence of significant hazard associated with inhalation of alkyl nitrites.[1] A study and ranking of drugs for harmfulness devised by British-government advisers and based upon scientific evidence of harm to both individuals and society showed that poppers pose little potential harm to individuals or to society when compared to other recreational drugs including alcohol and tobacco.[14]

Contraindications

Absolute contraindications

Interactions
Other vasodilators

Alkyl nitrites are interactive with other vasodilators like sildenafil (Viagra), to cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.[15][16][17]

Route of administration
Ingestion

Swallowing or aspirating the liquid can prove fatal.[18][19]

An overdose via ingestion (rather than inhalation) may result in cyanosis, unconsciousness, coma and even death. Methylene blue is a treatment for methemoglobinemia associated with popper use.[6][18][20][21][22] Accidental aspiration of amyl or butyl nitrites may lead to the development of lipoid pneumonia.[19]

Relative contraindications

Habitual use and temporary symptoms

Maculopathy

Poppers are a possible and rare cause of concern of in a small number of cases of maculopathy (eye damage) in recent case reports from UK and France.[23] 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 experienced temporary changes in vision.[24] Another study described foveal (daylight vision) damage in six habitual poppers users.[25]

Route of administration

Side effects

Common side-effects of popper use include headaches,[26] and in some cases temporary erectile problems. Other risks include burns if spilled on skin.

Legal status

Today, it is legal to use reformulated poppers containing isopropyl nitrite in Europe (because isobutyl is prohibited[27]), isobutyl nitrite in the US and amyl nitrite in Canada.

European Union

Since 2007, reformulated poppers containing isopropyl nitrite in Europe because isobutyl is prohibited.[27]

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.[28] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.[29] 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.[30]

United Kingdom

In the United Kingdom, poppers are widely available and frequently (legally[31]) sold in gay clubs/bars, sex shops, drug paraphernalia head shops, over the Internet and on markets.[32] 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.[33]

United States

In the U.S., originally marketed as a prescription drug in 1937, amyl nitrite 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.

See also

References

  1. ^ a b c d Porter, Robert S., et al., ed. (November 2005). "Volatile Nitrites". The Merck Manual Online. Merck & Co.. Retrieved 2007-03-16. 
  2. ^ http://www.dancesafe.org/products/poppers-drug-info-cards-100
  3. ^ "Nitrites". Drugscope. Archived from the original on 2007-04-05. http://web.archive.org/web/20070405132026/http://www.drugscope.org.uk/druginfo/drugsearch/ds_results.asp?file=%5cwip%5c11%5c1%5c1%5cnitrites.html. Retrieved 2007-04-24.
  4. ^ "Poppers". homohealth.org. Lifelong AIDS Alliance. http://www.homohealth.org/mens_program/sexualhealth/poppers.htm. Retrieved 2007-03-18.
  5. ^ "Rushing to a New High". Time. 1978-07-17. Retrieved 2007-04-29. 
  6. ^ a b c "Amyl Nitrite". Medsafe. New Zealand Medicines and Medical Devices Safety Authority. 2000-05-18. Archived from the original on 2006-11-11. http://web.archive.org/web/20061111105814/http://www.medsafe.govt.nz/Profs/datasheet/a/Amylnitrateinh.htm. Retrieved 2007-03-15.
  7. ^ Drumright, LN.; Patterson, TL.; Strathdee, SA. (2006). "Club drugs as causal risk factors for HIV acquisition among men who have sex with men: a review.". Subst Use Misuse 41 (10–12): 1551–601. doi:10.1080/10826080600847894. PMID 17002993.
  8. ^ "Debunking denialist myths". AIDStruth.org. http://www.aidstruth.org/denialism/myths#m2. Retrieved 2010-08-02.
  9. ^ "Poppers: The effects, the risks, the law". TheSite.org. YouthNet UK. http://www.thesite.org/drinkanddrugs/drugsafety/drugsatoz/poppers. Retrieved 2007-03-14.
  10. ^ W.R. Lange, C.A. Haertzen and J.E. Hickey et al., Nitrite inhalants patterns of abuse in Baltimore and Washington, DC, Am J Drug Alcohol Abuse 14 (1988), pp. 29–39.
  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. ^ 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. [1]
  13. ^ Ringwalt CL, Schlenger WE. Wu L (2005) "Use of nitrite inhalants ("poppers") among American youth",Journal of Adolescent Health 37 (1) Jul 2005, pp.52–60.
  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. ^ 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.
  16. ^ "Viagra May Cause Heart Attack Deaths In Younger Men With No Heart Problems, Study Finds". PSA Rising. http://psa-rising.com/medicalpike/viagracardiodeaths031500.htm. Retrieved 2007-03-15.
  17. ^ "Experts See Dangerous Trend In Use Of Viagra With 'Party Pills'". Aetna InteliHealth. 2004-06-24. http://www.intelihealth.com/IH/ihtIH/WSIHW000/333/20789/351666.html. Retrieved 2007-03-18.
  18. ^ a b 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.
  19. ^ a b Hagan, IG.; Burney, K. (Jul–Aug 2007). "Radiology of recreational drug abuse.". Radiographics 27 (4): 919–40. doi:10.1148/rg.274065103. PMID 17620459. http://radiographics.rsna.org/content/27/4/919.long.
  20. ^ Pruijm, MT.; de Meijer, PH. (Dec 2002). "[Methemoglobinemia due to ingestion of isobutyl nitrite ('poppers')]". Ned Tijdschr Geneeskd 146 (49): 2370–3. PMID 12510403.
  21. ^ Stalnikowicz, R.; Amitai, Y.; Bentur, Y. (2004). "Aphrodisiac drug-induced hemolysis.". J Toxicol Clin Toxicol 42 (3): 313–6. PMID 15362601.
  22. ^ Emergency Medicine: Principles and Practice. Harper & Collins, 2nd edition. 2008. pp. 42–51.
  23. ^ http://www.nature.com/eye/journal/v26/n6/full/eye201237a.html
  24. ^ The New York Times: "Vision: A Quick High for Sex May Damage Vision"
  25. ^ [2]
  26. ^ Wood, Ronald W. (1989) (PDF). The Acute Toxicity of Nitrite Inhalants. National Institute on Drug Abuse. pp. 28–29. http://hdl.handle.net/1802/1150. Retrieved 2007-03-15.
  27. ^ a b http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ%3AL%3A2006%3A033%3A0028%3A0081%3Aen%3APDF
  28. ^ "Decree 90–274 of 26 March 1990" (in (French)). Legifrance.gouv.fr. 2009-05-15. http://www.legifrance.gouv.fr/affichTexte.do?dateTexte=20090901&cidTexte=JORFTEXT000000166136. Retrieved 2012-07-26.
  29. ^ "Decree 2007-1636 of 20 November 2007" (in (French)). Legifrance.gouv.fr. http://www.legifrance.gouv.fr/affichTexte.do?dateTexte=20090901&cidTexte=JORFTEXT000000341445. Retrieved 2012-07-26.
  30. ^ Council of State, Ruling 312449, 15 May 2009
  31. ^ "HIV & AIDS Information :: Poppers". Aidsmap.com. 2011-08-08. http://www.aidsmap.com/cms1045243.aspx. Retrieved 2012-07-26.
  32. ^ "Advice - Poppers". BBC. 1970-01-01. http://www.bbc.co.uk/switch/surgery/advice/drink_drugs/poppers/. Retrieved 2012-07-26.
  33. ^ "Poppers". DanceSafe.org. http://dancesafe.org/drug-information/poppers. Retrieved 12 September 2011.