Alkyl nitrites (‘poppers’)

Description

Alkyl nitrites or ‘poppers’ are a group of liquid chemicals that act by allowing more blood into the heart and creating the feeling of a ‘rush’. The most common medical nitrite is amyl nitrite, but most poppers bought for recreational use in the UK are usually the less potent butyl nitrite.

Alkyl nitrites come in little bottles with screw or plug tops, under various trade names such as TNT, Rush, Raw and Liquid Gold. They are generally inhaled, after which the effects of the drug start after about 15 seconds and last for up to 3 minutes.

Pharmacology

Amyl nitrite is an antihypertensive (reduces blood pressure) medicine, through its vasodilatory (expanding blood vessels) action, which allows more blood to be delivered to the heart. Alkyl nitrites act as a source of nitric oxide (NO), a signalling molecule produced naturally in the body to relax smooth (involuntary) muscles and widen blood vessels. This is thought to be the main reason why it produces a euphoric effect and can facilitate easier penetration during sexual activity for some. It is also used to treat heart diseases such as angina and has been used to treat cyanide poisoning in the past (although they have been discontinued from most cyanide kits), due to its ability to increase levels of methemoglobin (a type of haemoglobin) in the blood.

Alkyl nitrites include:

• Amyl (isoamyl/isopentyl)
• Pentyl (n-pentyl)
• Butyl (n-butyl)
• Isobutyl (2-methylpropyl)
• Isopropyl (2-propyl)
• Hexyl nitrite

Different types of alkyl nitrites can carry different risks. Isopropyl nitrite is associated with eye damage (maculopathy and foveal damage). Isobutyl nitrite is suggested to be possibly carcinogenic to humans, and has been banned from sale as poppers in the EU and US.

Interactions

Taking alkyl nitrites alongside other vasodilators such as sildenafil (Viagra), tadalafil (Cialis) and nitroglycerin can increase the risk of strokes and fainting due to dangerously low blood pressure.

Harm Reduction

• If you swallow poppers, seek immediate medical attention. Oral use of the liquid can be potentially fatal
• Start low, go slow: Take a small amount and wait until you can feel the effects before taking more/anything else
• Alternate nostrils and avoid touching the liquid to reduce the risk of chemical burns
• Avoid smoking and open flames while taking or around poppers, as all alkyl nitrites are highly flammable
• Try not to use alone: If something goes wrong, someone is there to help or get help
• Be careful mixing: Mixing poppers with other drugs can increase unwanted side effects and risks – avoid if you can, otherwise take less, as they can increase effects and risks
• Psychological dependence: It’s possible to become psychologically dependent on the drug (feeling like you need it all the time). If you think this is happening, see your doctor as soon as possible

History

Amyl nitrite was first introduced in the 19th Century as a treatment for angina. Poppers became part of the club culture scene in the 70s to the 80s and again popularised in the 90s in the rave scene. In the following decade, its use dropped again, but it seems to have picked up in the 2010–20s.

Since their popularisation as a recreational drug, poppers have been associated with the gay community. A survey in the mid-to-late 2010s found that more than a third of US gay men had taken poppers at least once. Australian singer Troye Sivan’s 2023 song ‘Rush’ was partially inspired by the poppers brand.

Law

• Not controlled under the Misuse of Drugs Act 1971, therefore are not illegal to possess or supply under that legislation.
• However, some issues exist around the Medicines Act 1968, which may impact ability to supply. In 1999, the Medicines Control Agency said that they consider isobutyl nitrite a medicine and therefore it could be that only licensed shops, such as chemists, could sell them. It is therefore illegal to sell them as inhalants, as this is a form of medical use, however many vendors sell them as room odourisers in an attempt to circumvent the law.
• The Intoxicating Substances (Supply) Act 1985, which prohibited the supply of intoxicating substances to someone under the age of 18, has now been repealed.
• A recent Court of Appeal decision that considered whether Nitrous Oxide fell within the remit of the Psychoactive Substances Act 2016 (PSA 2016) may have affected the legal status of poppers. Parliament was clear when debating the PSA 2016 that poppers did not fall within the legislation as it was considered that alkyl nitrites did not have a direct effect on the central nervous system but rather an indirect effect, and so were practically exempt from the PSA 2016 as the definition of a ‘psychoactive substance’ was limited to substances that directly affected the system. However, the Court of Appeal decision widened the definition of a ‘psychoactive substance’ to include substances that had an indirect effect (as nitric oxide can act as a neurotransmitter, meaning increasing its concentrations in the brain means it could exert direct psychoactive effects). If this was the case, poppers could come within the remit of the PSA 2016.