Alkyl Nitrites ("Poppers") and ChemSex

"Alkyl nitrites are a chemical class of substances colloquially known as “poppers” (Rush, Bolt, Locker Room, Bullet, Aroma of Men, Dr. Bananas, Cum, Heart-On), whose basic pharmacological action of the nitrites is relaxation of vascular smooth muscles [39]. The route of administration is inhalation of the vapour of the volatilized organic liquid. Indeed, for their rapid onset, short-acting potent vasodilators, disinhibiting effect, poppers have been consumed in recreational and sexual settings since the 1970s [40].

"In the 1990s the popularity of alkyl nitrites significantly increased for both heterosexual and homosexual sexual intercourses. Interestingly, among the “chemsex” drugs, these ones are frequently used by youngsters too, for the misperception of the products harmlessness. Nitrites have been reported by many women to be useful for abandonment to a full sexual experience. Furthermore, anal penetration becomes easier, probably from a combination of nitrites actions on the anal sphincter and decreased pain perception [40]. These two actions plus mild hallucinatory sensations (e.g. “visions of bright colours, often containing symbolic representations of the sexual moment”) made the products highly popular in gay discos to enjoy at most music, lights, other drugs and social-sexual excitement [40].

"Among poppers, the most common sold are: amyl nitrite (isoamyl nitrite, isopentyl nitrite), but also cyclohexyl nitrite, isobutyl nitrite (2-methylpropyl nitrite), isopropyl nitrite (2-propyl nitrite), and less frequently butyl nitrite.

"Pharmacologically, alkyl nitrites act inducing relaxation of vascular smooth muscles, with an indirect effect on heart, by systemic arterioles relaxation resulting in a decrease of blood pressure, reflex tachycardia and a drop in the activity of the left ventricle. The peak action in blood pressure occurs in 30 seconds, with an average increase of 30 mm of systolic pressure, returning to normal within two minutes. When using these substances individuals feel different sensations like warmth, dizziness and an altered heartbeat and facial blush. This response can range from high pleasure to moderate nausea and headaches according to the scenario and the expectations [40]."