Poppers is a slang term for various alkyl nitrites inhaled for recreational purposes, especially for enhancing sexual pleasure.^[1] . Today poppers are mainly sold in cap vials but historically received the names "poppers", "boppers", and "snappers"^[2] from the sound of snapping off the neck of glass ampoules to release their vapors.

Widely sold concentrated products are isobutyl nitrite (2-methylpropyl nitrite) and isopropyl nitrite (2-propyl nitrite). isopropyl nitrite went popular due to ban of isobutyl nitrite in EU 2007 but are for the moment investigated for concern of lasting eye damage. More rarely sold are butyl nitrite, and least sold are amyl nitrite (isoamyl nitrite, isopentyl nitrite), and cyclohexyl nitrite.

Alkyl nitrites, are also are present in products such as air freshener, video head cleaner^[3] and finger nail polish remover^[4], which has been exploited in order to bypass to sell them advertised for "human consumption" which is regulated by laws like Medicines Act 1968 in the UK.

Poppers have also been part of the club culture from the 1970s disco scene to the 1980s and 1990s rave scene.^[5] Poppers have a long history of use due to the rush of warm sensations and dizziness experienced when the vapours are inhaled.

Sir Thomas Lauder Brunton
Known for	Treatment of angina pectoris

In 1844, the French chemist Antoine Jérôme Balard synthesized amyl nitrite. Sir Thomas Lauder Brunton (March 14, 1844–September 16, 1916), a Scottish physician, famously pioneered the use of amyl nitrite to treat angina pectoris (now treated with nitroglycerin). Brunton's clinical use of amyl nitrite to treat angina was inspired by earlier work with the same reagent by Arthur Gamgee and Benjamin Ward Richardson. Brunton reasoned that the pain and discomfort of angina could be reduced by administering amyl nitrite to dilate the coronary arteries of patients, thus improving blood flow to the heart muscle.

Amyl nitrite, manufactured by Burroughs Wellcome (now GlaxoSmithKline) and Eli Lilly and Company, was originally sold in small glass ampoules that were crushed to release their vapors, and received the name "poppers" and "snappers" as a result of the popping sound made by crushing the ampoule.^[6]

Time and the Wall Street Journal reported that the popper fad began among homosexual men as a way to enhance sexual pleasure, but "quickly spread to avant-garde heterosexuals" as a result of aggressive marketing. A series of interviews conducted in the late 1970s revealed a wide spectrum of users, including construction workers, a "trendy East Side NYC couple" at a "chic NYC nightclub", a Los Angeles businesswoman "in the middle of a particularly hectic public-relations job" (who confided to the reporter that "I could really use a popper now"), and frenetic disco dancers amid "flashing strobe lights and the pulsating beat of music in discos across the country."^[7] Additionally, Scott Thorson - Liberace's former live-in lover and author of Behind the Candelabra: My Life With Liberace - reported on Larry King Live: "He was into amylnitrate. I don't know if you know what that is, but basically it's a popper. You use it for sex."^[8]

The light alkyl nitrites cause the formation of methemoglobin wherein, as an effective antidote to cyanide poisoning, the methemoglobin combines with the cyanide to form nontoxic cyanmethemoglobin.^[9] First responders typically carry a cyanide poison kit containing amyl nitrite, such as the popular Taylor Pharmaceutical Cyanide Antidote Kit.^[10]

Amyl nitrite is used medically as an antidote to cyanide poisoning,^[11] but the term "poppers" refers specifically to recreational use.

Not particular mentioned but of public interest; a typical nasal inhalation hit normally for an average sized adult with normal lung capacity is around 100 µL (0.1 mL) from a vial with an opening of 2 cm which gives a mild to moderate high. Users may repeat inhalation for prolonged and intensified effect.

The dose consumed can easily be checked with good accuracy by subtracting the vials weight before inhalation with its weight after inhalation on a precision pocket scales (0.01 g). 2 cm vial openings now being more common, are broad enough to cover the nostrils, smaller vial necks distributes lower doses.

Inhaling nitrites relaxes smooth muscles throughout the body, including the sphincter muscles of the anus and the vagina.^[11] It is unclear if there is a direct effect on the brain. Smooth muscle surrounds the body's blood vessels and when relaxed causes these vessels to dilate resulting in an immediate decrease in blood pressure, producing a sensation of heat and excitement that usually lasts for a couple of minutes.^[12]

Alkyl nitrites are often used as a club drug or to enhance a sexual experience.^[1] The head rush, euphoria, and other sensations that result from the increased heart rate are often felt to increase sexual arousal and desire.^[1]

User surveys are hard to come by, but a 1988 study found that 69% of men who had sex with men in the Baltimore/Washington DC area reported they had used poppers, with 21% having done so in the prior year. The survey also found that 11% of recreational drug users in the area reported using poppers, increasing to 22% among "heavy abusers," with an average age of first use of 25.6 years old. Both survey groups used poppers to "get high," but the men who had sex with men were more likely to use them during sex. It was reported that this group reduced usage following the AIDS epidemic, while the drug-users had not.^[13] A 1987 study commissioned by the US Senate and conducted by the Department of Health and Human Services found that less than 3% of the overall population had ever used poppers.^[14]

Use by minors is historically minimal due, in part, to the ban on sales to minors by major manufacturers for public relations reasons and because some jurisdictions regulate sales to minors by statute.^[15] A paper published in 2005 examined use of poppers self-reported by adolescents aged 12–17 in the (American) 2000 and 2001 National Household Surveys on Drug Abuse. In all, 1.5% of the respondents in this age group reported having used poppers. This figure rose to 1.8% in those over 14. Living in nonmetropolitan areas, having used mental health services in the past year (for purposes unconnected with substance use treatment), the presence of delinquent behaviours, past year alcohol and drug abuse and dependence, and multi-drug use were all associated with reporting the use of poppers.^[16] In contrast to these low rates, a survey in the North West of England found a rate of 20% self-reported use of poppers among 16-year-olds.^[5]

The Merck Manual of Diagnosis and Therapy reports that there is little evidence of significant hazard associated with inhalation of alkyl nitrites.^[1] A study and ranking of drugs for harmfulness devised by British-government advisers and based upon scientific evidence of harm to both individuals and society showed that poppers pose little potential harm to individuals or to society when compared to other recreational drugs including alcohol and tobacco.^[18] A 1983 U. S. Consumer Product Safety Commission investigation Briefing Package stated that "Available injury data did not indicate a significant risk of personal injury or illness from room odorizer abuse."^{[citation needed]}

Alkyl nitrites are interactive with other vasodilators like sildenafil (Viagra), to cause a serious decrease in blood pressure, leading to fainting, stroke, or heart attack.^[19][20][21]

Swallowing or aspirating the liquid can prove fatal.^[22][23]

An overdose via ingestion (rather than inhalation) may result in cyanosis, unconsciousness, coma and even death. Methylene blue is a treatment for methemoglobinemia associated with popper use.^{[11][22][24][25][26]} Accidental aspiration of amyl or butyl nitrites may lead to the development of lipoid pneumonia.^[23]

Irritated throat may cause breathing by mouth (but not by nose) harder. Probably increased risk for throat cancer if cancer if prevalent.^{[citation needed]}

Common side-effects of popper use include headaches,^[27] and in some cases temporary erectile problems. Other risks include burns if spilled on skin.

Rarely, the use of poppers can cause methemoglobinemia and hemolysis^{[citation needed]}, especially in individuals predisposed towards such a condition or in overdose. Hemolytic anemia (or haemolytic anaemia), a form of anemia due to hemolysis, may break out consistently.

More rarely, acute use of poppers has been associated with asphyxia, arrhythmias, cardiovascular depression, carbon monoxide poisoning, hepatorenal toxicity, mucosal, pulmonary, skin irritation and facial dermatitis.

Although, according to at least one analysis, poppers have a lower risk of harm to society and the individual than do certain other recreational drugs,^[18] other cases have shown that serious adverse effects can occur. In a letter to the New England Journal of Medicine, an ophthalmologist described four cases in which recreational users of poppers experienced temporary changes in vision.^[28] There is some evidence to indicate that even occasional use of poppers may affect vision.^[29]

Poppers can also increase intraocular pressure, and so should be avoided by people who have glaucoma.^[30][31] In reference to vision loss, a published case concluded "To present a case of blinding bilateral acute optic nerve disease in a 15-year-old male apparently induced by inhalation of amyl nitrite. No similar cases have been described in the more than 100-year history of pharmacological use of amyl nitrite for angina pectoris, and pharmacologically it is hard to point out a rationale behind the sequential visual loss."^[32][33]

Poppers are a cause of concern of damage to the macula (centre portion of retina) in recent case reports from UK and France.^[34] One study points out, "Although poppers have been in use for several decades, in 2007, following legislative changes, there was a change in the most commonly used compound from isobutyl nitrite to isopropyl nitrite. There were no reports of 'poppers maculopathy' before this."^[35]

It has been incorrectly suggested that poppers have been related to AIDS, HIV infection, and the AIDS-related cancer Kaposi's sarcoma.^[36] Initially poppers were considered as a hypothesis for the then-burgeoning AIDS epidemic, and the idea has persisted in large part due to the activities of AIDS denialists as a pseudoscientific rationalization for the presence of AIDS in homosexual males.^[37]

Poppers are a class of chemicals called alkyl nitrites. These are chemical compounds of structure R–ONO. In more formal terms, they are alkyl esters of nitrous acid.

The first few members of the series are volatile liquids; methyl nitrite and ethyl nitrite are gaseous at room temperature and pressure. Organic nitrites are prepared from alcohols and sodium nitrite in sulfuric acid solution. They decompose slowly on standing, the decomposition products being oxides of nitrogen, water, the alcohol, and polymerization products of the aldehyde.

(Sutton, 1963 for butyl nitrite, isobutyl nitrite, and amyl nitrite):

Today, reformulated poppers containing isopropyl nitrite in Europe (because isobutyl is prohibited^[38]), isobutyl nitrite in the US and amyl nitrite in Canada.

Since 2007, reformulated poppers containing isopropyl nitrite in Europe because isobutyl is prohibited.^[39]

In France, the sale of products containing butyl nitrites, pentyl^{[citation needed]} nitrites, or isomers thereof, has been prohibited since 1990 on grounds of danger to consumers.^[40] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.^[41] After litigation by sex shop owners, this extension was quashed by the Council of State on the grounds that the government had failed to justify such a blanket prohibition: according to the court, the risks cited, concerning rare accidents often following abnormal usage, rather justified compulsory warnings on the packaging.^[42]

In the United Kingdom, poppers are widely available and frequently (legally^[43]) sold in gay clubs/bars, sex shops, drug paraphernalia head shops, over the Internet and on markets.^[44] It is illegal under Medicines Act 1968 to sell them advertised for human consumption, and in order to bypass this, they are usually sold as odorizers.^[45]

In the U.S., originally marketed as a prescription drug in 1937, amyl nitrite remained so until 1960, when the Food and Drug Administration removed the prescription requirement due to its safety record. This requirement was reinstated in 1969, after observation of an increase in recreational use.

Other alkyl nitrites were outlawed in the U.S. by Congress through the Anti-Drug Abuse Act of 1988. The law includes an exception for commercial purposes. The term commercial purpose is defined to mean any use other than for the production of consumer products containing volatile alkyl nitrites meant for inhaling or otherwise introducing volatile alkyl nitrites into the human body for euphoric or physical effects.^[46] The law came into effect in 1990. Visits to retail outlets selling these products reveal that some manufacturers have since reformulated their products to abide by the regulations, through the use of the legal cyclohexyl nitrite as the primary ingredient in their products, which are sold as video head cleaners, polish removers, or room odorants.

• Alcohol and sex
• Sex and drugs
• Blue Velvet, a 1986 David Lynch film prominently featuring amyl nitrite inhalation, or Frank Booth, the character who uses it, played by Dennis Hopper