As a person who uses isobutyl nitrite myself, I’ve been collecting various data sources to form my own evaluation on the safety of poppers for human consumption. I was always taught that “it’s not the poison, its the dose” and that there’s no such thing as a “riskless” anything. I’d like to examine where these products sit on the continuum of risk, similarly to how alcohol, cannabis, or tobacco products are viewed in the public sphere.
Cancer:
My main fear was the risk of developing cancer due to semi-regular use, so I’ll start there. Luckily, scientists have been interested in this in the past as well, and there’s a reputable paper from 2017 on the topic.
To summarize it, a cohort study was conducted on 3223 MSM (men who have sex with men) from 1996-2010 with daily to weekly use. In the findings, heavy popper use (daily or weekly use for at least a year) was not associated with increased risk of any individual cancers. My conclusion is that if poppers cause cancer, there would be a trend in a group of 3000+ people over 10+ years.
It is worth noting that in this group, there was an elevated risk of HPV, HHV-9, and EVB in HIV-uninfected participants leading to cancer. To clarify what this means…these diseases are already known to lead to cancer. People in this group getting cancer is because they had or contracted HPV, HHV-9, or EVB, not because they used poppers. The danger is that popper use is associated with high-risk sexual behavior which can lead to these diseases.
Toxicity:
At this point, I’m feeling pretty good that cancer directly from poppers isn’t particularly likely. But that leads me to other things, namely all my google searches that seem to indicate vision loss/retinal toxicity and methemoglobinemia (basically means that blood isn’t delivering oxygen to the body as it should leading to headaches/dizziness/fatigue/weakness…or the skin turning blue/gray).
I started with just looking for acute toxicity data. The current animal data on the topic seems to involve injecting mice in the stomach every day for a week and observing if they suffer memory or motor skill loss, so we’ll put that to the side for now.
However, Robert Gable had written a more helpful review in the Society for the Study of Addiction Journal that contains this table:
My take aways are similar to those made by Mr. Gable in his article. Firstly, there are very few reported lethal cases of poppers use. Secondly, when specifically looking at isobutyl nitrite, a usual lethal dose derived from “individual case studies as well as compilations that reported aggregated data” was 1.5mL of vaporized liquid and a usual effective dose is 0.2mL. Considering small and large bottles are usually 10ml and 30ml in size, this leads me to believe that there is certainly room in isobutyl nitrite market for delivery of smaller doses. They use this dosage information to calculate the “safety ratio” of a drug – the lethal dose/the effective dose. In this regard, isobutyl nitrite appears to be amongst the most toxic substances on this list. However, with an n=3 and not actual data on dosage consumed, this seems like a best wild guess.
It’s tough to get a straight answer, it doesn’t seem like we really know enough and investment in data collection is required.
Until then, here’s the seemingly four biggest concerns:
- Methemoglobinemia
- Eye issues
- Interactions with other drugs
- Addiction
Methemoglobinemia
No debate to be had here – this absolutely does happen – However, this is dosage based. The reports on the subject claim the real concern is drinking or ingesting butyl nitrite. Protip: don’t drink cleaning chemicals.
Eye issues
There is an article in JAMA from 2011 that states that there have been 2 case reports of vision loss following inhalation of poppers in 10 years. This seems to be exceedingly rare considering number of users. There are also 6 reported cases of progressive vision loss related to use of isopropyl nitrite. While the symptoms reversed when the users abstained, it seems like isopropyl nitrite is a bad idea. Of course, when users buy the product, they have little hope of knowing what is in the bottle outside of the label claim, which is a matter of trust.
A second source from BMJ Open Opthalmology written in 2017 provides a bit more insight on a larger population. 22,289 people were surveyed worldwide and 5152 reported using poppers in their lifetime. 1322 of these responders stated that they used them within the last year, and 2% of those users reported that poppers had affected their eyesight.
My conclusion is that this does happen rarely, and its likely dose or variant (ie isopropyl nitrite) related.
Interactions with other drugs
The most dangerous is mixing isobutyl nitrite solvent cleaners with erectile disfunction medication because the ED medication will lower blood pressure and so will inhaling poppers. This combined effect will expand blood vessels too much and could cause heart attack or stroke. Drinking alcohol can also lower blood pressure, so its important to be careful with this as well.
Addiction:
Finally, relating back to a statement I made earlier about “it’s not the poison its the dose”, I also took a look at the addictive potential of isobutyl nitrite. If there’s an addiction risk, dose would be higher, meaning all of these potentially negative outcomes would be amplified.
There was a cross sectional study of 836 Australian gay men 18-35 years old published in Drug and Alcohol Review in July 2019. From the group, high levels of lifetime (38%) and recent (24%) use were reported, but the analysis found the prevalence of dependency symptoms and risky consumption were low with WHO ASSIST scores for poppers. The data is demonstrating an overall low-risk of addiction in regards to poppers.
Conclusion.
The way most gay men use these products is unlikely to be of concern. The dangers come from using varied formats of these solvent cleaners that are likely on the market because they are lower in cost to produce (ie isopropyl nitrite), accidental ingestion, extremely heavy dosage, or interactions with other drugs.
Harm reduction strategies to address these concerns should be the focus, including dose control and awareness, education on the products, quality and chemical composition measurements, and preventing the ability for the product to be spilled down the nasal cavity or ingested.
This post is brought to you by Unspillables Solvent Cleaners. The brand, while obviously unaffiliated with poppers products and this blog, has a side interest in social studies on the LGBTQ community.
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