Alkyl Nitrites (Poppers)
Alkyl nitrites, commonly known as poppers, are potent, short-acting, rapid onset inhalants that produce a brief warm sensation, head rush, relaxation of smooth muscle tissue, and euphoria. The first alkyl nitrite to be developed, amyl nitrite, was prescribed therapeutically for the management of chest pains, in the 1860’s. They became popular in the 1970’s disco scene, starting the more widespread use of the drug. Nowadays they are mainly used in the context of sexual encounters, but sometimes also in social settings, dance clubs, and music festivals.
There are different types of alkyl nitrites. When the first produced type of alkyl nitrite, amyl nitrite, started being used in the party scene, the FDA reinstated the original prescription requirement in 1969. This led to the proliferation of non-regulated chemicals butyl and isobutyl nitrite. After these were also banned, dealers began selling other alkyl nitrites, like isopropyl nitrites. Compositions of poppers vary, usually containing one or more of the mentioned nitrites.
Poppers come in a liquid form in small bottles (10 - 40 millilitre), often with colourful wrappers showing brand names, like “Rush” or “Jungle Juice.” In many countries, they are legal to purchase under the guise of nail polish remover, cleaners, or room odorizers.
Poppers are usually inhaled into the nose, by directly sniffing closely above the bottle. Sometimes they are administered through different methods, like bagging (inhaling fumes from inside a plastic or paper bag) or huffing (from an inhalant-soaked rag stuffed in the mouth).
The exact mechanism of how alkyl nitrites work in the body and brain is unknown. What is known is that poppers release nitric oxide in the body, which relaxes smooth muscles, dilates blood vessels in the brain and periphery, and increases blood flow to the heart. The temporary increased blood flow may cause a short-lasting lightheadedness, headrush or euphoria, which are some of the desired effects of poppers.
The loosening of smooth muscle surrounding blood vessels is why alkyl nitrites cause a drop in blood pressure. The effect on blood pressure and blood vessels in the brain could also explain some of the effects of alkyl nitrites: light-headedness, dizziness, and thumping sensations in the head.
Amyl nitrite, which is a type of alkyl nitrite, used to be prescribed therapeutically for the management of angina, which is characterised by chest pain, pressure, and discomfort. By increasing the action of the heart and relaxing narrowed blood vessels, amyl nitrite could relieve angina symptoms. Later, amyl nitrite was replaced by nitroglycerin, because this is easier to administrate and has a longer duration of action.
Amyl nitrite is also used as an antidote for cyanide, which is a metabolic poison. The antidotal properties of amyl nitrites are attributed to the release of nitric oxide causing vasodilation.
When the vapour of alkyl nitrites is inhaled, it rapidly enters the bloodstream, with the onset of effects being in the order of seconds. The nitrites are also rapidly metabolised by the liver and other organs, causing the effects to only last a few minutes.
Alkyl nitrites are vasodilatory substances, which means that they widen the blood vessels. 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 also make the skin flush.
Since alkyl nitrites also relax smooth muscle tissue in the vagina and anus, they can facilitate sex by making it more comfortable for the receptive partner and potentially reducing pain and tearing. Anecdotal reports state that poppers enhance sexual experiences by increasing intensity and lengthening orgasms. Users report that poppers create feelings of wellbeing and increase sex drive. Some users also report an occasional loss of erection.
Adverse effects of alkyl nitrites include mainly headaches and skin irritation. Frequent use can lead to crusty skin lesions and in some cases sinusitis.
Poppers should never be swallowed, as this can lead to an overdose, causing blood poisoning (methemoglobinemia). When someone does drink poppers, it is important to get them to the hospital, as leaving methemoglobinemia untreated can cause loss of consciousness and potentially organ failure, blindness, brain damage, and in the most severe cases death. An overdose can also be caused by inhaling large quantities of poppers, but this is very rare.
Another risk related to poppers is both sexual and physical assault. Poppers are often used within a sexual context, and as using a lot of it in combination with alcohol and other drugs, could make you lose consciousness, this could lead to dangerous situations. It is important to use them in a safe environment with people you trust, so that the risk of being sexually or physically assaulted is minimised.
Frequent use of alkyl nitrites can cause crusty skin lesions with a distinctive yellow tint around exposure areas (nose, mouth, lips, and face). These usually resolve within 7 - 10 days after someone stops using alkyl nitrites.
Alkyl nitrites are flammable and explosive and should never be heated or placed near an open flame. Direct contact with the skin should also be avoided at all times, as alkyl nitrites cause skin corrosion or burn.
As alkyl nitrites cause the blood vessels to widen, they can lead to a sudden drop in blood pressure. This could be riskier for people with heart conditions or abnormal blood pressure.
It is not advised to combine alkyl nitrites with other drugs. As alkyl nitrites cause a sudden drop in blood pressure, it is especially dangerous to combine them with drugs that affect blood pressure. This includes several erectile dysfunction drugs like Viagra, but also alcohol. The interaction of alkyl nitrites with such drugs can dangerously affect blood pressure and heart rate, which can lead to fainting, heart attack or stroke.
When you do combine poppers with other drugs, it is important to be aware of the fact that using stimulants and poppers (depressants) together could make it harder to judge the effect each drug is having. You might take more of each drug than you meant to, and they will still affect your body. When using depressants and poppers together, it is important to be aware of the fact that this increases the risk of overdose as well as lowering the blood pressure and heart rate dangerously much.
Alkyl nitrites are not known to be physically addictive. Nitrites can cause tachyphylaxis, which means that the body quickly becomes desensitised to the effects of the substance. Even though the dose stays the same, the effects on the body diminishes. This can lead to someone inhaling progressively increased amounts of the poppers to experience the same desired effect.
There have been some reports of people feeling psychologically dependent on poppers to perform sexually or have fulfilling sexual experiences. Avoiding the use of the drug for a while should allow for normal sexual response to return.
When using poppers, it is important to avoid direct contact with the skin, as this causes skin corrosion or burn. It is also important to not heat the poppers or place them near an open flame, as they are flammable and explosive.
Poppers should never be swallowed, as this can cause poisoning, which can result in death. It is also not advised to combine poppers with other substances, as this can negatively influence blood pressure and heart rate.
When someone does drink poppers or seems to lose consciousness due to mixing with other drugs, it is important to get them to the hospital.
Finally, it is important to use poppers in a safe environment. To avoid sexual and physical assault, it is advised to use poppers with people you feel safe with and in places you are safe.
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