What are poppers? Are they safe?

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Nitrites are drugs sometimes used to treat heart conditions—but when used recreationally, they are called “poppers,” and they serve a different purpose. So what are poppers, what are they used for, and—most importantly—are they safe? Read on to learn more. 

What are poppers?

“Poppers” is a slang term for a group of recreational drugs called alkyl nitrites or nitrite inhalants. Recreational use of poppers has been around in the United States since the 1970s. Poppers may contain amyl nitrite, butyl nitrite, or isobutyl nitrites. They are called poppers because they were originally sold in small bottles. You squeeze or “pop” these vials between your fingers to release the vapor, which you inhaled to get a euphoric, head rush, or “high” sensation (Le, 2020). 

Amyl nitrite is a prescription medication sometimes used by medical professionals to treat heart disease by increasing blood flow to the heart. This should not be confused with amyl nitrate, which is a different compound.

Butyl nitrite and isobutyl nitrites are available over-the-counter and in sex shops. They are often marketed as “room deodorizers,” “liquid incense,” and “leather cleaners.” You may see them under brand names like Rush, Jungle Juice, Liquid Gold, and many others. Poppers are liquid at room temperature but produce vapors that can be inhaled and are commonly described as having an unpleasant fruity odor (Zhang, 2017)

Alkyl nitrites are vasodilators, meaning they work by widening the blood vessels. This increases blood flow and causes a rush of euphoria, making them a popular club drug.

What are poppers used for?

Poppers can be used by anyone looking for a temporary “high.” They are sometimes used by men who have sex with other men (MSM) to relax the muscles around the anus and facilitate anal sex. One study estimates that over 30% of MSM have used poppers at some point. Some people use poppers because they act as aphrodisiacs and enhance sexual pleasure (Le, 2020).

Poppers open up blood vessels (vasodilation), allowing more blood to reach the brain quickly. This can cause lightheadedness, dizziness, decreased inhibitions, and a warm sensation. They also have a relaxation effect on the anal sphincter. Their use as an illicit club drug is mainly due to their ability to relax smooth muscle, including the anal sphincter, making anal sex easier (Le, 2020).

Side effects of poppers

While most people using poppers are looking for the relaxing, euphoric aftereffects, there are many negative side effects of poppers, including (UpToDate, n.d.):

• Headaches
• Lightheadedness/dizziness
• Low blood pressure
• Trouble breathing
• Fast heart rate
• Blurry vision
• Allergic reactions
• Skin irritation or chemical burns

Risks of poppers 

Poppers can cause serious side effects and even death. 

One risk of using poppers is developing methemoglobinemia, a life-threatening blood disorder in which oxygen isn’t delivered properly to the cells. Methemoglobinemia may cause a bluish tinge to the skin, fatigue, altered mental state, giddiness, headache, and shortness of breath (Ludlow, 2020), 

Poppers may also cause severe heart palpitations, blurred vision, erectile dysfunction, confusion, ringing in the ears, and vomiting (Zhang, 2017). 

Serious allergic reactions that include skin irritation, inflammation of the throat, wheezing, and itching are also risks of using poppers (UptoDate, n.d.).

Some people combine poppers with erectile dysfunction medications, which can be dangerous. Both amyl nitrite and ED medications (like Viagra and other PDE5 inhibitors) increase blood flow by widening blood vessels. Taking them together may cause dangerously low blood pressure (hypotension), resulting in dizziness, loss of consciousness, and even death (Le, 2020).

Poppers can lead to eye damage, called retinopathy or maculopathy, which may cause temporary or permanent vision loss (Docherty, 2018).

Amyl nitrites should only be used if prescribed by a medical professional. The FDA currently approves them to treat cyanide poisoning. While amyl nitrite is available as a prescription treatment for relieving chest pain associated with coronary artery disease, an alternative medication class known as nitrates (which come as tabs that patients put under their tongues) is the preferred method for treatment as their effects are longer-lasting (FDA, 2020).

References

1. Docherty, G., Eslami, M., & O’Donnell, H. (2018). “Poppers Maculopathy”: a case report and literature review. Canadian Journal of Ophthalmology, 53(4), e154–e156. doi: 10.1016/j.jcjo.2017.10.036. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30119813/
2. Food and Drug Administration (FDA). (2020, Apr). CFR – Code of Federal Regulations Title 21. Retrieved Aug 4 from https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=250
3. Le, A., Yockey, A., & Palamar, J. J. (2020). Use of “Poppers” among Adults in the United States, 2015-2017. Journal of Psychoactive Drugs, 52(5), 433–439. doi: 10.1080/02791072.2020.1791373. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32669067/
4. Ludlow JT, Wilkerson RG, Nappe TM. (2020). Methemoglobinemia. In: StatPearls [Internet]. Retrieved from 
   https://www.ncbi.nlm.nih.gov/books/NBK537317/
5. UptoDate. (n.d.). Amyl nitrite: drug information. Retrieved on Aug 4, 2021 from https://www.uptodate.com/contents/amyl-nitrite-drug-information
6. Zhang, Z., Zhang, L., Zhou, F., Li, Z., & Yang, J. (2017). Knowledge, attitude, and status of nitrite inhalant use among men who have sex with men in Tianjin, China. BMC Public Health, 17(1), 690. doi: 10.1186/s12889-017-4696-7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5584038/

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