Alkyl nitrites, commonly known as ‘poppers’, are liquid compounds which cause a headrush and smooth muscle relaxation when their vapour is inhaled. Amyl nitrite, the first alkyl nitrite to be developed, was synthesised in 1844 and was used from 1867 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 were developed. The main examples include isopropyl nitrite, isobutyl nitrite and butyl nitrite.

Poppers come in liquid form in small bottles, often with colourful wrappers. The contents evaporate into a breathable vapour at room temperature. They are often sold labelled as ‘room odourisers’ as it is illegal to sell them for human consumption.

The vapour can be inhaled into the nose or mouth directly from the bottle. If the liquid comes into contact with skin, this can cause a crusty rash to form. Contact with the nose and lips is a particular concern, as these areas may touch the rim of the bottle when vapour is being inhaled.

Some users dip the end of a cigarette into the liquid and use it to inhale the vapour without lighting it. The cigarette should not be lit after this, as it becomes dangerously flammable. This method could be risky if any of the liquid, rather than just its vapour, is breathed into the lungs.
Some users transfer a small amount of liquid onto a cloth, cotton wool or paper, and put this into another sealable bottle or container. The vapour is then inhaled from that container. This may minimise the risk of accidental skin contact with the liquid.

If poppers liquid is ever swallowed or aspirated, medical help must be sought immediately.

The exact mechanism of how alkyl nitrites work in the body to produce their effects is unknown. However, some of the effects experienced can be attributed to the relaxing of smooth muscle that poppers induce.

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 which effects of poppers are due to direct effects on the drug in the brain and which effects are due to the drop in blood pressure.

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.

When the vapour of poppers is inhaled, it very quickly enters the bloodstream via the mouth, throat and lungs, causing intense but short-lasting effects, typically 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 also make the skin flush.

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. It is also used to facilitate sex because it relaxes muscles in the anus and vagina. However, some people have also reported problems getting or maintaining an erection when using poppers.

The most common after-effect of the drug is headaches. Some have reported feeling nauseous after using poppers, and people may also feel very dizzy and can faint.

The risks of using poppers for healthy people are relatively low. However, there are still associated risks to be aware of.

Using poppers can lead to methemoglobinemia when an overdose is taken. Methemoglobinemia occurs when haemoglobin, which transports oxygen in the blood, is converted to methaemoglobin, which binds to oxygen but does not then release it to cells in the body. Severe methemoglobinemia leads to oxygen starvation. This can potentially lead to organ failure, blindness, brain damage and in the most severe cases, death. Overdose of alkyl nitrites can occur easily through accidental swallowing. Inhaling poppers in very large quantities can also lead to overdose.

However, an overdose of alkyl nitrites is rare, suggesting that ordinary use should not put someone in danger of overdose.

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 must go to a hospital by ambulance immediately. As well as the poisoning risk, swallowing poppers results in throat irritation, nausea, and vomiting.

It has been suggested that the use of poppers can negatively affect eye health. However, more research must be conducted to confirm this link.

Some people who use poppers heavily have developed crusty skin lesions around the nose, mouth, and lips. Poppers can cause a chemical burn if the liquid comes into contact with the skin and should be washed off immediately. Contact with the eyes is very painful and 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. Bottles of alkyl nitrite should never be heated or placed near an open flame. Burns could be obtained if a cigarette used to inhale poppers is later lit.

Poppers lower blood pressure and increase heart rate. It could be riskier for people with heart conditions or abnormal blood pressure. There could also be added risks for people with glaucoma or anaemia.

Poppers should not be mixed with other drugs.

Mixing poppers with drugs which affect blood pressure is particularly risky. This includes any blood pressure medication and erection-inducing drugs, such as sildenafil (Viagra). The interaction of poppers with such drugs can dangerously affect blood pressure and heart rate, and can lead to fainting, heart attack or stroke.

Poppers are not thought to be physically addictive.

After using poppers consistently to enhance sex, some people have reported feeling reliant on them in order to perform sexually. Avoiding the use of the drug for a while should allow for normal sexual response to return.

Care must be taken when using poppers to ensure that no skin contact occurs and that the liquid is kept away from open flames.

Under no circumstances should poppers liquid ever be swallowed, as this will lead to poisoning.

Poppers should not be mixed with other drugs, especially those which alter blood pressure.

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