What are alkyl nitrites (poppers)?
‘Poppers’ are short lasting drugs which cause a headrush and muscle relaxation. They appear as liquids that produce a vapour that can be inhaled. Poppers are chemicals called alkyl nitrites. The first, amyl nitrite, was made in 1844 and was used to help relieve angina (chest pains). Widespread recreational use of amyl nitrite is thought to have started in the 1960s. After consequent restrictions on its production and use, various other related alkyl nitrites appeared. The main examples include: isopropyl nitrite, isobutyl nitrite and butyl nitrite.
What are the different forms of alkyl nitrites?
Poppers are liquids in small bottles, often with a colourful wrapper. The contents evaporate into a breathable vapour at room temperature. Poppers are often sold labelled as ‘room odourisers’ as it can be illegal to sell them as a drug.
The vapour can be inhaled into the nose or mouth directly from the bottle, but this has some risks. If the liquid on the rim of the bottle touches the skin, or if it is spilt on skin, this can cause a crusty rash particularly around the nose and lips. Some users dip the end of a cigarette in poppers and inhale on it without lighting it (the cigarette should be thrown away after this as it becomes dangerously flammable). This method could be risky if any of the actual liquid gets aspirated (sucked into the lungs).
Some users transfer a little of the liquid onto cotton wool or paper in another closable bottle or container, and then inhale from that container. This may minimise the risk of accidental contact with the liquid. If you ever swallow or aspirate any poppers liquid you should get medical help as soon as possible.
How do alkyl nitrites work as a drug in the body and brain?
Poppers relax smooth muscle in the body. The loosening of smooth muscle surrounding blood vessels is why poppers cause a drop in blood pressure. The effect on blood pressure and blood vessels in the brain may be what causes some of the effects of poppers: light-headedness, dizziness and thumping sensations in the head. However, it is not known what effects of poppers are due to direct effects on the drug in the brain and what effects are due to the drop in blood pressure.
Do alkyl nitrites have any medical uses?
Amyl nitrite was originally used to treat angina, where poor blood flow to the heart causes pain. Poppers can alleviate angina by relaxing narrowed blood vessels, although now other more reliable medications are used for this, such as isosorbide dinitrate or nitro-glycerine, a chemical better known as an explosive.
Amyl nitrite is used in some countries for the treatment of cyanide poisoning.
Amyl nitrite may under rare circumstances be recommended to patients who engage in the risky sexual practice of asphyxiation, which kills more than 500 men in the United States per year. Poppers in this case serve as a harm reduction strategy; whilst not totally safe they offer a similar experience with lower risks of death.
What are effects of alkyl nitrites?
When the vapour of poppers is inhaled it very quickly enters the bloodstream through the mouth, throat and lungs, causing strong but short-lasting effects (typically lasting 2-5 minutes).
The ‘high’ can be described as a dizzying head rush, which can be euphoric, often accompanied with sensations of warmth and sometimes a thumping feeling in the head. The drug may make the skin flush.
People report that it enhances sexual experiences (increasing intensity and making orgasms last longer). Users report that poppers create feelings of wellbeing and increase sex drive. It is also used to facilitate sex because it relaxes muscles in the anus and vagina. However, some men have also reported problems getting or maintaining an erection when using poppers.
The most common after-effect of the drug is headaches. People have also reported feeling nauseous and sick after using poppers. People may also feel very dizzy and can faint.
What are the risks of using alkyl nitrites? Can the risks be avoided or reduced?
The health risks of using poppers for healthy people are considered relatively low. They are much lower than other inhaled volatile liquids, often called ‘solvents’. However, they are not always harmless.
Poppers can cause poisoning which can even occasionally be fatal if you get enough into the body. This can happen easily through accidental swallowing, but inhaling poppers in very large quantities can cause overdoses too. The reason is that the chemical converts the red haemoglobin in the blood into methemoglobin, turning the blood chocolate brown. Haemoglobin is needed to deliver oxygen round the body, so the result of severe ‘methemoglobinemia’ is oxygen starvation, potentially leading to organ failure, blindness, brain damage, or in the worse cases, death.
There is no advice available on the quantities likely to cause these serious problems. However, overdoses of alkyl nitrite are rare, suggesting that ordinary use should not put someone into the danger zone. If someone is continuously taking a lot of any alkyl nitrite and they experience shortness of breath, a lack of energy, tiredness and bluish colouring of the skin, they may be developing methemoglobinemia and should seek urgent medical help. If someone swallows poppers they should go to a hospital by ambulance as soon as possible. As well as the poisoning risk, swallowing poppers would likely result in throat irritation, nausea and vomiting. Visual loss associated with damage to the retina has been reported, but appears rare. This may resolve over several weeks. More research is needed to evaluate this risk.
People who use poppers heavily have developed crusty skin lesions around the nose, mouth and lips. Poppers can cause a chemical burn if it gets on the skin and should be washed off as fast as possible. When users get the liquid in their eye it is very painful. This requires prompt first aid of flushing with plenty of water. If discomfort continues, users should seek medical advice as soon as possible.
Poppers are also very flammable. You should never try to heat up a bottle of alkyl nitrite or have an open bottle near a flame or lit cigarette. People sometimes dip cigarettes in poppers to inhale through the unlit cigarette. Some have been burnt after mistakenly lighting the cigarette.
Are there health conditions that make using alkyl nitrites more dangerous?
Poppers lower blood pressure and increase heart rate. It could be more risky for people with heart conditions or abnormal blood pressure. There could also be added risks for people with glaucoma or anaemia.
Mixing alkyl nitrites with other drugs
Poppers taken with any drug that affects blood pressure could be risky. This includes any blood pressure medication and the erection inducing drugs such as sildenafil (Viagra). With poppers such drugs can dangerously affect blood pressure and heart rate causing a person to faint, or even have a heart attack or stroke.
How addictive are alkyl nitrites?
Poppers are not thought to be physically addictive in any way. After using poppers consistently to enhance sex, a few people have reported feeling reliant on them in order to perform sexually. If this happens, avoiding the drug for a while should allow normal sexual response to return.
Alkyl nitrite harm reduction advice
Most of the harms of poppers are associated with excessive use (e.g. overdose) or accidents (e.g. swallowing). Avoiding poppers or limiting your use is the most important step to minimise harm.
Drinking any alkyl nitrite may kill you
Drinking an alkyl nitrite can cause organ failure, blindness, brain damage or death.
If you or someone you know has drunk an alkyl nitrite they should get emergency hospital treatment.
Poppers are very flammable
You should keep all poppers away from flames, lit cigarettes, or anything which could ignite them.
Poppers cause chemical burns
Getting alkyl nitrite on your skin causes irritation and dermatitis. If you get it on your skin you should rinse it off with plenty of water.