Ask LSOP #29 - Pills & Poppers - What you need to know about "Legal Highs"

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  • By Eli Caelum
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Ask LSOP #29 - Pills & Poppers - What you need to know about "Legal Highs"

While discussing which question to answer this month we came across one that gets asked a lot in our stores: "Why don't you sell poppers?" The answer is a short one (because they're illegal, next question), but the reasons they're illegal aren't often understood- which can be dangerous. Lucky for us, one of our staff was up to the challenge of doing the research and laying out the facts.

Fig 1: An assortment of brightly coloured bottles with consumer labels know as

Fig 1: An assortment of brightly coloured bottles with consumer labels know as "poppers".
Photo Source: Wikimedia Commons (gov.uk)

 

Have you ever heard of "poppers"? If you have, it is likely you have noticed their disappearance off the shelves of various retailers across Canada. A few years ago, you could walk into nearly any "head shop" or adult store and find a rainbow of brightly coloured bottles and single packaged pills at the counter. They may have piqued your curiosity, tempting you with "A RUSH of Euphoria" or inviting you to "Make Your Pussycat Purrrrr" and go "All Night Long" with buzzwords like "Size! Stamina! Maximum Arousal!". With such bold claims, you'd swear the late Billy Mays was making a late-night infomercial for Viagra.

 

What are poppers?

You may have heard poppers marketed as consumer products such as liquid incense, room [de]odorizers, tape head cleaner, or leather cleaner. Firstly, no leather-lover in their right mind would ever use alkyl nitrites on their leather. Proper leather care requires mild soaps and natural oils, not solvents. Secondly, who even owns a VCR anymore? Why would you need tape head cleaner? Lastly, you should never leave a bottle of poppers open in a room, whether or not you hope to deodorize it (it won't do a good job, I promise).

 

Poppers are an inhalant drug that belong to the alkyl nitrite family of chemical solvents. This clear and highly flammable liquid produces vapours which are inhaled. Descriptions of the scent range from "sweet and fruity" to smelling like "old gym socks". The most common form is amyl nitrite, but poppers may contain isobutyl nitrite, isopropyl nitrite or other nitrites. Amyl Nitrite is classed as a Schedule I drug on Canada's Prescription Drug List as of 2013, which is when we pulled them from our shelves.

 

Who uses poppers?

What could one possibly gain out of huffing something that smells like old gym socks? Well, amyl nitrite was first synthesized in 1844 by French chemist Antoine Balard and has been used as a medical treatment around the world since the 1860's. Alkyl nitrites are vasodilators, and the nitric oxide signals smooth muscles to relax, including those of the blood vessel walls, allowing blood (and oxygen) to flow more freely to the heart. If you suffer from angina (chest pains) due to cardiovascular disease, inhalation of the vapours will ease the crushing feeling in your chest, but they are rarely prescribed for this condition today.

 

Believe it or not, poppers are actually a part of the antidote kit for cyanide poisoning in combination with other drugs. (Bear with me here, this part is a little dry... so lube up!) The nitrites ability to oxidize some of the hemoglobin's iron in our blood and convert it to methemoglobin allows the cyanide to bind to methemoglobin, which protects the healthy hemoglobin needed to carry oxygen around our system. Whew, okay. Hope I eased you in enough, because amyl nitrites recreational use was discovered by the gay community in the 1960's and the recreational use of poppers continues to pervade the party scene today.

 

So… butt stuff?

A secondary effect of nitrites is relaxing the involuntary muscles of the internal and external sphincters of the anus. This is why the use of poppers started to become quite popular amongst gay men and trans individuals to help facilitate anal sex. Amyl nitrite use just on its own isn't inherently dangerous when monitored under a physician's care. However, there are some pretty nasty side effects and interactions when poppers are mixed with other drugs because of the low blood pressure vasodilators cause, including legal ones like NSAIDS (Ibuprofin or Naproxin), alcohol, cigarettes,  diuretics like caffeine or even just being too dehydrated (and we all know how important hydration, especially the squirters out there!)

 

Ever wonder why they call it Rush? Well, it does certainly get your blood flowing, which can result in some pretty wicked headaches, flushing, dizziness and fainting. Other side effects of overdose include hypoventilation (shallow breathing) which will basically result in suffocation. Remember the methemoglobin necessary in treating cyanide poisoning? Well methemoglobin is absolutely useless for carrying oxygen, and if you overdose on nitrites with prolonged recreational use you can cause kidney and liver damage, gangrene organ failure, which could also lead to death.

 

 

Fig 2: Popper Maculopothy (vision loss)
Photo source: The Lancet

 

A) Colour fundus photography of the left eye showing subtle yellow foveal spots (arrow).

(B) Left high-resolution spectral domain optical coherence tomography showing disrupted foveal photoreceptor inner segment–outer segment layer (arrow).

 

People with certain health conditions, taking certain medications, or even with specific gene mutations can also suffer way more if amyl nitrites are used recreationally. Amyl nitrites also cause pressure to build in the skull and intraocular (eyeball) fluid, so people with glaucoma or recent head injury can cause serious damage. It can even cause partial or total vision loss in some people which may or may not return.

 

One of the greatest risks comes with mixing alkyl nitrites with drugs prescribed to treat erectile disfunction, including those "magic pills" that have been sold in sex stores. They aren't magic. A lot of those pills have been tested by Health Canada and found to contain one or more untested pharmaceutical drugs, some of which are not approved for use at all in Canada. These drugs also lower blood pressure, and if your blood pressure gets too low, you can faint or lose consciousness, give yourself angina, cause irregular heartbeat, a heart attack or... your heart can just stop beating.

 

Health Canada is responsible for ensuring that our prescription, non-prescription, and natural health products are safe, effective, and high quality. Health claims must be backed by scientific evidence, demonstrate their effectiveness, and any adverse reactions, side effects, and health risks associated are reported and evaluated. Health Canada also takes an active role in harm reduction at the border to prevent unmonitored access of undeclared drugs, for the safety of everyone in mind. We are quite lucky to have these regulatory practices and "rigorous licensing process" in place for the manufacturing, sale, and distribution to these drugs, and anything that does not have an 8-digit Natural Product Number (NPN), homeopathic medicine number (DIN-HM), or Drug Identification Number (DIN), it has either not been assessed for use, or it has and been deemed not fit for consumption without a doctor's prescription. If you have concerns regarding erectile disfunction, please talk to your doctor and get the good stuff!

 

Sources

 

Health Canada: Recalls & Safety Alerts

Natural Health Product Advisory, ID#: RA-65132 (2017, Nov 17)

Unauthorized products may pose serious health risks (November 17, 2017 to May 23, 2018)

Posting Date: 2018, May 23.   Date Accessed: 2018, July 24

http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2017/65132a-eng.php

 

Health Canada: Recalls & Safety Alerts

Drug Information Update, ID#: RA-34343 (2013, Jun 27 - Archived)

Poppers sold across Canada pose serious health risks

Posting Date: 2017, Jun 30.   Date Accessed: 2018, July 24

http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2013/34343a-eng.php?_ga=2.58646826.1260830709.1513001089-1165639816.1500047287

 

Health Canada: Recalls & Safety Alerts

Drug Advisory, ID#: RA-29269 (2013, May 16 - Archived)

Marketed leather cleaners and liquid incense are being used to get high: Poses serious dangers to Canadians

Posting Date: 2013, May 16.   Date Accessed: 2018, July 24

http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2013/29269a-eng.php

 

Health Canada: Recalls & Safety Alerts

Drug Recall, ID#: RA-29125 (2013, Apr 19 - Archived)

Rush

Posting Date: 2013, May 9.   Date Accessed: 2018, July 24

http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2013/29125r-eng.php

 

Government of Canada

Adulteration of Natural Health Products

https://www.canada.ca/en/health-canada/services/healthy-living/your-health/medical-information/adulteration-natural-health-products.html

 

National Association of Pharmacy Regulatory Authorities (NAPRA)

National Drug Schedules

http://napra.ca/national-drug-schedules

Date Accessed: 2018, July 24

 

Drug Science – Independent Scientific Committee on Drugs

Alkyl Nitrites (Poppers)

http://www.drugscience.org.uk/drugs/dissociatives/alkyl-nitrates

Date Accessed: 2018, July 24

 

Global Information Network About Drugs (GINAD)

Amyl Nitrite

http://www.ginad.org/en/drugs/narcotics/324/amyl-nitrite

Date Accessed: 2018, July 24

 

The Lancet

Written by Dr Anna M Gruener, FRCOphth, Megan A R Jeffries, MB, Zine El Housseini, MRCS(Ed), Laurence Whitefield, FRCOphth

Poppers maculopothy

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60887-4/fulltext?rss%3Dyes

 

VeryWell Mind

Written by Elizabeth Hartney, PhD. Reviewed by Steven Gans, MD.

What Are Poppers? An Often Poorly Understood Inhalent Drug

https://www.verywellmind.com/what-are-poppers-22094

Date Accessed: 2018, July 24

 

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