Chemistry:Poppers

From HandWiki
Short description: Class of recreational drug
A selection of poppers

Popper is a slang term given broadly to recreational drug of the chemical class called alkyl nitrites that are inhaled. They act on the body as vasodilators. Most widely sold products include the original isoamyl nitrite, isopentyl nitrite, and isopropyl nitrite. Isobutyl nitrite is also widely used but is banned in the European Union. In some countries, poppers are labeled or packaged as room deodorizers, leather polish, nail polish remover, or videotape head cleaner to evade anti-drug laws.

Popper use has a relaxation effect on involuntary smooth muscles, such as those in the throat and anus.[1][2] It is used for practical purposes to facilitate anal sex by increasing blood flow and relaxing sphincter muscles.[3] The drug is also used for recreational purposes, typically for the "high" or "rush" that the drug can create, and to enhance sexual pleasure in general.

In popular culture, poppers have been part of club culture from the mid-1970s disco scene and surged in popularity in the 1980s and 1990s rave scene.[4][5]

History

19th-century discovery

The French chemist Antoine Jérôme Balard synthesized amyl nitrite in 1844.[6] Sir Thomas Lauder Brunton, a Scottish physician born in the year of amyl nitrite's first synthesis, documented its clinical use to treat angina pectoris in 1867 when patients experiencing chest pains would experience complete relief after inhalation.[7] Brunton was inspired by earlier work with the same agent, performed by Arthur Gamgee and Benjamin Ward Richardson.[7] Brunton reasoned that the angina sufferer's pain and discomfort could be reduced by administering amyl nitrite—to dilate the coronary arteries of patients, thus improving blood flow to the heart muscle.[7]

Amyl nitrites were originally enclosed in a glass mesh called "pearls". The usual administration of these pearls was done by crushing them between the fingers, followed by a popping sound. This administration process seems to be the origin of the slang term "poppers". It was then administered via direct inhalation of the vapors or inhalation through silk that covered the capsule.

Brunton found that amyl nitrites had effects of dilating blood vessels and flushing of the face. Butyl nitrites were also documented around the late 1890s by Brunton and despite being found to have generally the same effects as amyl nitrites, they were never used as a clinical alternative to amyl nitrates. Brunton also found that propyl nitrites had the same effects as well.[8][9]

20th-century use

Although amyl nitrite is known for its practical therapeutic applications, the first documented case of recreational use was in 1964.[10][11] The poppers "craze" began in the early 1970s in the gay male community in bars, discothèques and bathhouses.[12][13] It was packaged and sold pharmaceutically in fragile glass ampoules wrapped in cloth sleeves which, when crushed or "popped" in the fingers, released the amyl nitrite for inhalation, hence the colloquialism poppers.[12] The term extended to the drug in any form as well as to other drugs with similar effects, e.g. butyl nitrite which is packaged under a variety of trade names in small bottles.[12]

In the late 1970s Time (magazine) magazine[14] and The Wall Street Journal [15] reported that popper use among gay men began as a way to enhance sexual pleasure, but "quickly spread to avant-garde heterosexuals". A series of interviews conducted in the late 1970s revealed a wide spectrum of users.[14]

Chemistry

Main page: Chemistry:Alkyl nitrites

Poppers contain a class of chemicals called alkyl nitrites. To the extent that poppers products contain alkyl nitrites, the following applies.

The following table summarizes alkyl nitrite chemical and physical properties, including chemical structure:[16]

Alkyl nitrite CAS Formula Molecular weight (g·mol−1) Physical state Boiling point (°C)
Amyl nitrite (isoamyl nitrite, isopentyl nitrite) 110-46-3 (CH3)2CH(CH2)2ONO 117.15 Transparent liquid 97–99
Pentyl nitrite (n-pentyl nitrite) 463-04-7 CH3(CH2)4ONO 117.15 Yellow liquid 104
Butyl nitrite (n-butyl nitrite) 544-16-1 CH3(CH2)3ONO 103.12 Oily liquid 78.2
Isobutyl nitrite (2-methylpropyl nitrite) 542-56-3 (CH3)2CHCH2ONO 103.12 Colourless liquid 67
Isopropyl nitrite (2-propyl nitrite) 541-42-4 (CH3)2CHONO 89.09 Clear pale yellow oil 39
Hexyl nitrite 638-51-7 CH3(CH2)5ONO 131.17 Clear liquid 130

Administration and effects

A selection of poppers

Administration

Poppers come in liquid form, but this liquid is not directly consumed. When the bottle is opened, the vapors are inhaled, rather than the liquid. This is typically done through the nasal cavities, commonly directly from the bottle (avoiding touching the bottle to the skin) or with the help of small inhalers.

Physiological effect

Inhaling nitrites produces a fast-acting, short-lived and non-specific relaxation of smooth muscles (along with the sphincter muscles of the anus and the vagina).[17] Blood vessels are surrounded by smooth musculature, which directly influences blood pressure by increasing or decreasing its inward pressure on the blood vessels.

With relaxation of the smooth muscles, the 'inward' pressure on the blood vessels decreases and they dilate, resulting in a drop in blood pressure and an immediate (compensatory) increase in heart rate (reflex tachycardia). Vasodilation may cause giddiness, dizziness, headache, nausea, vomiting and flushing, and may produce a sensation of heat and excitement. Maximum vasodilatory effect is usually reached within 30 seconds, with (secondary) physiological effects lasting for 5 to 10 minutes .[18][19][20][21]

Interactions

Alkyl nitrites interact with other vasodilators, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis), to cause a serious decrease in blood pressure, which can cause strokes, and low blood pressure leading to people fainting.[22] Side effects of popper abuse include tachycardia, headaches, migraines, dizziness and fainting.[23]

Toxicity

The Merck Manual of Diagnosis and Therapy reports insignificant hazard associated with inhalation of alkyl nitrites,[24] and British governmental guidance on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs.[25]

Swallowing poppers (rather than inhaling the vapour) may cause cyanosis, methemoglobinemia, unconsciousness, coma, and complications leading to death.[17][26][27][28][29][full citation needed] Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia.[30]

Isopropyl nitrite poppers may be a cause of maculopathy (eye damage), as reported in France and the United Kingdom.[31] Some studies have concluded that there may be increased risk for at least temporary retinal damage with habitual popper use in certain users; in a letter to the New England Journal of Medicine,[32] an ophthalmologist described four cases in which recreational users of isopropyl nitrite poppers suffered temporary changes in vision.[33]

Foveal (center-of-gaze) damage has also been described, in six habitual users of isopropyl nitrite poppers.[34] Furthermore, in June 2014, optometrists and ophthalmologists reported having noticed an increase in vision loss in chronic popper users in the United Kingdom associated with isopropyl nitrite (substitute for isobutyl nitrite which was banned in 2007).[35][36]

In November 2014, it was observed maculopathy is a rare complication of isopropyl nitrite abuse. A full recovery of visual acuity in longterm abuse could be demonstrated after drug abstinence.[37] Studies have shown that poppers users who have HIV and/or use Sildenafil in combination with poppers are at an increased risk of developing poppers‐associated maculopathy.[38]

A working group in 2019 from the International Agency for Research on Cancer determined there to be "sufficient evidence" to suggest carcionogenic properties of isobutyl nitrite on experimental animals, and because they could not find any sufficient studies regarding its carcinogenic effects on humans, they determined that isobutyl nitrite is "possibly carcinogenic to humans". The group primarily looked at 2 studies on animals, one on rats and one on mice. Both of these involved the administration of doses of isobutyl nitrite at seemingly low doses (0, 37.5, 75, or 150 ppm) 6 hours a day, 5 days a week, for a total of 103 weeks.[39] This is different from the relatively brief exposure to alkyl nitrites that inhaling poppers recreationally usually provides. Nonetheless, in the studies there was shown to be no increase in death rates for the animals exposed to isobutyl nitrite, but there was shown to be an increase in tumors in the lungs of the males and females of both species in the groups exposed, as well as in the thyroids of the male mice exposed.[39]

Treatment

Isobutyl nitrite toxicity

Isobutyl nitrite is known to cause methemoglobinemia.[40] Severe methemoglobinemia may be treated with methylene blue.[41]

Refuted link with HIV/AIDS

Early in the AIDS crisis, widespread use of poppers among AIDS patients led to the later disproved hypothesis that poppers contributed to the development of Kaposi's sarcoma, a rare form of cancer that occurs in AIDS patients.[42][43] Modest, short-term reductions in immune function were observed in animal studies, but not replicated in human studies.[44][45]

Cyanide treatment

Amyl nitrites were part of some kits used to treat cyanide poisoning, containing amyl nitrite, sodium nitrite, and sodium thiosulfate. The nitrites were administered to produce methemoglobin and induce vasodilation.[46][47] Amyl nitrites were discontinued in 2012 in standard cyanide kits.[48] Cyanide kits now use hydroxocobalamin.[49]

Legal status

Australia

Poppers are legal in Australia, and from 2020, poppers can also be purchased as a schedule 3 substance from pharmacies, or a schedule 4 substance with a prescription.[50]

History of poppers legislation in Australia

In June 2018, the Therapeutic Goods Administration (TGA) motioned to reschedule alkyl nitrites to be in the same category as heroin and cocaine (Schedule 9).[51] This was met by criticism from the LGBTQI community for being discriminatory and further evidence was demanded and further consultation sought.[52]

In October 2018, the Australian Federation of AIDS Organisations (AFAO) pointed out the lack of quality evidence provided by the TGA to justify the rescheduling[53] and that use of amyl nitrites has been stable over the past decade with very little evidence of harm and has been in use by a high proportion of gay men over a long period.

A final decision was pushed back from 29 November 2018 to late January or early February 2019 for further consultation with the public.[54]

As of March 2019, two public meetings have taken place in Sydney and Melbourne with The Kirby Institute and the Australian Research Centre in Sex, Health and Society (ARCSHS). Along with 70 written public proposals, there was significant opposition to alkyl nitrites rescheduling.[55] Banning alkyl nitrites was not considered acceptable as their use was said to help reduce harms such as anal injury and blood-borne disease transmission during anal sex.[56]

In June 2019, Australia decided not to ban poppers.[57]

However the new arrangements brought in from February 2020 onward, have brought some changes in local availability. As of February 2020, most poppers available in Australia are now based on the formula base of Pentyl nitrite. Currently, the most common brand of poppers in Australia are being imported from the Canadian firm, Locker Room. These products include Jungle Juice Black, Jungle Juice Platinum, Jungle Juice Triple Distilled, Iron Horse, Amsterdam Special and Blue Boy. All these, if not before, are now fully Pentyl nitrite based, confusing some consumers with their now relatively weak strength, as compared to before 2020.

In addition to the regular adult stores in Australia, a number of online platforms that are now selling poppers, for Australian only domestic supply. These platforms include a bigger variety and include poppers based on the stronger amyl nitrite, based formula.

Canada

Since 2013, Health Canada has banned all distribution and sales of poppers.[58]

Continental Europe

Since 2007, reformulated poppers containing isopropyl nitrite are sold in the EU; isobutyl nitrite is prohibited.[59]

In France , the sale of products containing butyl nitrite has been prohibited since 1990 on grounds of danger to consumers.[60] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sale as drugs.[61] 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.[62]

The possession in Germany , Austria and Switzerland is not subject to any regulations regarding anesthetic drugs and is therefore legal; however, the purchase, sale or trade of amyl nitrite without permission violates the drug laws of the corresponding countries. Occasionally, poppers were seized from sex shops, when sold there illegally.[63][64]

United Kingdom

Poppers are sold in nightclubs, bars, sex shops, drug paraphernalia head shops, over the Internet and in markets. It is illegal under Medicines Act 1968 to sell them advertised for human consumption. The Advisory Council on the Misuse of Drugs noted in 2011 that poppers, rather than being psychoactive substance or legal high, "appear to fall within the scope of The Intoxicating Substances (Supply) Act 1985".[65]

The Psychoactive Substances Act 2016, scheduled to be enacted 1 April 2016, was initially claimed to impose a blanket ban on the production, import and distribution of all poppers.[66] On 20 January 2016 a motion to exempt poppers (alkyl nitrites) from this legislation was defeated.[67] This was opposed by Conservative MP Ben Howlett. Howlett's fellow Conservative MP Crispin Blunt declared that he has used and currently uses poppers. Manufacturers expressed concern over loss of business and potential unemployment.[68][69]

In March 2016, the Advisory Council on the Misuse of Drugs stated that, because alkyl nitrites do not directly stimulate or depress the central nervous system, poppers do not fall within the scope of the Psychoactive Substances Act 2016.[70]

United States

Amyl nitrite was originally marketed as a prescription drug in 1937. It 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 observing an increase in recreational use. There was a huge increase in the number of brands for butyl nitrites after the FDA put in the prescription requirement again in 1969.[7]

Butyl nitrites were outlawed in 1988 by the Anti-Drug Abuse Act of 1988.[71] This prompted distributors to sell other alkyl nitrites not yet banned, like isopropyl nitrite. In 1990, isopropyl nitrites and other nitrites not yet banned were outlawed by the Crime Control Act of 1990.[72] Both of these laws include an exception for commercial purpose, defined as 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.[73]

See also

References

  1. "Recreational Drug Use among Chinese MSM and Transgender Individuals: Results from a National Online Cross-Sectional Study". PLOS ONE 12 (1): e0170024. 2017-01-20. doi:10.1371/journal.pone.0170024. PMID 28107391. Bibcode2017PLoSO..1270024Z. 
  2. "Illicit drug use among gay and bisexual men in 44 cities: Findings from the European MSM Internet Survey (EMIS)". The International Journal on Drug Policy 38: 4–12. December 2016. doi:10.1016/j.drugpo.2016.09.007. PMID 27788450. 
  3. "Sex and Poppers". 28 November 2017. https://sexinfo.soc.ucsb.edu/article/sex-and-poppers. 
  4. "Nitrites". Drugscope. http://www.drugscope.org.uk/druginfo/drugsearch/ds_results.asp?file=%5Cwip%5C11%5C1%5C1%5Cnitrites.html. 
  5. Nickerson, Mark (1979). Isobutyl nitrite and related compounds. Pharmex. OCLC 4790673. [page needed]
  6. Fischer, János; Ganellin, C. Robin (2006). "Chapter 10 : Development of Organic Nitrates for Coronary Heart Disease". Analogue-based Drug Discovery. United States: John Wiley & Sons. pp. 247, 248. ISBN 978-3-527-60749-5. https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA247. 
  7. 7.0 7.1 7.2 7.3 Fye, W B (August 1986). "T. Lauder Brunton and amyl nitrite: a Victorian vasodilator.". Circulation 74 (2): 222–229. doi:10.1161/01.cir.74.2.222. PMID 3524895. 
  8. Newell, GR; Spitz, MR; Wilson, MB (1988). "Nitrite inhalants: historical perspective". NIDA Research Monograph 83: 1–14. PMID 3140018.  Also published as: Newell, Guy R.; Spitz, Margaret R.; Wilson, Michael B. (1988). "Nitrite Inhalants: Historical Perspective". in Haverkos, Harry W.; Dougherty, John A.. Health Hazards of Nitrite Inhalants. U.S. Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse. pp. 1–14. OCLC 18456297. https://books.google.com/books?id=NQmWSoooPaYC&pg=PA1. 
  9. Brunton, Thomas Lauder (1898). Lectures on the Action of Medicines: Being the Course of Lectures on Pharmacology and Therapeutics Delivered at St. Bartholomew's Hospital During the Summer Session of 1896. Macmillan. pp. 332–339. https://archive.org/details/lecturesonactio00brungoog. "Brunton, T.L Lectures on the actions of medicines." 
  10. Lubell, I. Correspondence with Burroughs Wellcome Co., 1964, U.S. Food and Drug Administration, 1967.
  11. "How gay culture bottled a formula that has broken down boundaries". 2016-01-22. http://www.independent.co.uk/life-style/poppers-how-gay-culture-bottled-a-formula-that-has-broken-down-boundaries-a6828466.html. 
  12. 12.0 12.1 12.2 "Poppers, a new recreational drug craze". Canadian Psychiatric Association Journal 23 (7): 493–5. November 1978. doi:10.1177/070674377802300711. PMID 709498. 
  13. "A Qualitative Study of the Social Contextual Use of Alkyl Nitrites (Poppers) among Targeted Groups". Journal of Drug Issues 28 (1): 57–76. 1998-01-01. doi:10.1177/002204269802800104. ISSN 0022-0426. 
  14. 14.0 14.1 "Rushing to a new high". Time. 1978-07-17. http://content.time.com/time/magazine/article/0,9171,916269,00.html. Retrieved 2020-09-08. 
  15. Sansweet, Stephen J. (October 10, 1977). "wall street journal - A new way to glow and giggle, and get a headache. "Poppers, legally sniffable, becoming a big business; The FDA isn't interested". Wall Street Journal October 10, 1977 Stephen J. Sansweet. http://virusmythpoppersmyth.org/wall-street-journal/. [yes|permanent dead link|dead link}}]
  16. Sutton (1963) [full citation needed]
  17. 17.0 17.1 "Amyl Nitrite". Medsafe. New Zealand Medicines and Medical Devices Safety Authority. May 18, 2000. http://www.medsafe.govt.nz/Profs/datasheet/a/Amylnitrateinh.htm. 
  18. "Amyl Nitrite (Professional Patient Advice) - Drugs.com". drugs.com. https://www.drugs.com/ppa/amyl-nitrite.html. 
  19. "ADF - Drug Facts - Amyl Nitrite". ADF - Alcohol & Drug Foundation. https://adf.org.au/drug-facts/adf-drug-facts-amyl-nitrite/. 
  20. Iversen, Les (March 16, 2016). "ACMD review of alkyl nitrites ("poppers")". www.gov.uk. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/508179/Poppersadvice.pdf. 
  21. Dutch Poisons Information Center (November 25, 2022). "Poppers - Vergiftigingen.info". www.vergiftigingen.info. https://www.vergiftigingen.info/f?p=300:STOFMONOGRAFIE:9676941181930:::RP,1210,1040::. 
  22. "Recreational Use of Erectile Dysfunction Medications in Undergraduate Men in the United States: Characteristics and Associated Risk Factors". Archives of Sexual Behavior 40 (3): 597–606. June 2011. doi:10.1007/s10508-010-9619-y. PMID 20358273. 
  23. Wood, Ronald W. (1989). "The acute toxicity of nitrite inhalants". NIDA Research Monograph (National Institute on Drug Abuse) 83: 28–29. PMID 3140020. 
  24. O'Malley, Gerald F.; O'Malley, Rika (January 2016). "Volatile Nitrites". in Porter, Robert S.. The Merck Manual Online. Merck & Co.. http://www.msdmanuals.com/en-gb/professional/special-subjects/recreational-drugs-and-intoxicants/volatile-nitrites. Retrieved 2017-09-16. 
  25. "Development of a rational scale to assess the harm of drugs of potential misuse". Lancet 369 (9566): 1047–53. March 2007. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831. 
  26. "Fatal methemoglobinemia resulting from ingestion of isobutyl nitrite, a "room odorizer" widely used for recreational purposes". Journal of Forensic Sciences 26 (3): 587–93. July 1981. doi:10.1520/JFS11404J. PMID 7252472. 
  27. "[Methemoglobinemia due to ingestion of isobutyl nitrite ('poppers')]". Nederlands Tijdschrift voor Geneeskunde 146 (49): 2370–3. December 2002. PMID 12510403. 
  28. "Aphrodisiac drug-induced hemolysis". Journal of Toxicology. Clinical Toxicology 42 (3): 313–6. 2004. doi:10.1081/clt-120037435. PMID 15362601. 
  29. Emergency Medicine: Principles and Practice. Harper & Collins, 2nd edition. 2008. pp. 42–51.[full citation needed]
  30. "Radiology of recreational drug abuse". Radiographics 27 (4): 919–40. July–August 2007. doi:10.1148/rg.274065103. PMID 17620459. 
  31. "'Poppers maculopathy'--an emerging ophthalmic reaction to recreational substance abuse". Eye 26 (6): 888. June 2012. doi:10.1038/eye.2012.37. PMID 22402700. 
  32. Vignal-Clermont, Catherine; Audo, Isabelle; Sahel, José-Alain; Paques, Michel (2010-10-14). "Poppers-Associated Retinal Toxicity". New England Journal of Medicine 363 (16): 1583–1585. doi:10.1056/NEJMc1005118. ISSN 0028-4793. PMID 20942681. 
  33. Rabin, Roni Caryn (2010-10-18). "Vision: A Quick High for Sex May Damage Vision" (in en-US). The New York Times. ISSN 0362-4331. https://www.nytimes.com/2010/10/19/health/research/19vision.html. 
  34. Audo, Isabelle; El Sanharawi, Mohamed; Vignal-Clermont, Catherine; Villa, Antoine; Morin, Annie; Conrath, John; Fompeydie, Dominique; Sahel, Jose´-Alain et al. (13 June 2011). "Foveal Damage in Habitual Poppers Users". Archives of Ophthalmology 129 (6): 703–708. doi:10.1001/archophthalmol.2011.6. PMID 21320953. 
  35. Storr, Krystnell (2014-07-08). "More evidence 'poppers' may damage eyesight". Reuters Health. http://in.reuters.com/article/us-proppers-eyesight-idINKBN0FD1ZD20140708. 
  36. "Poppers maculopathy". Lancet 384 (9954): 1606. November 2014. doi:10.1016/S0140-6736(14)60887-4. PMID 24954683. 
  37. "Poppers Maculopathy: Complete Restitution of Macular Changes in OCT after Drug Abstinence". Seminars in Ophthalmology 31 (5): 479–84. 2016. doi:10.3109/08820538.2014.962175. PMID 25398125. 
  38. Bral, Nathalie O. G.; Marinkovic, Marina; Leroy, Bart P.; Hoornaert, Kristien; van Lint, Michel; ten Tusscher, Marcel P. M. (February 2016). "Do not turn a blind eye to alkyl nitrite (poppers)!". Acta Ophthalmologica 94 (1): e82–e83. doi:10.1111/aos.12753. PMID 25975842. 
  39. 39.0 39.1 IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2019). Isobutyl Nitrite, β-Picoline, and Some Acrylates. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Lyon (FR): International Agency for Research on Cancer. pp. 33-60. ISBN 978-92-832-0160-1. http://www.ncbi.nlm.nih.gov/books/NBK558045/. 
  40. Taylor, Gregory M; Avera, Robert S; Strachan, Christian C; Briggs, Christian M; Medler, Jason P; Pafford, Carl M; Gant, Timothy B (1 February 2021). "Severe methemoglobinemia secondary to isobutyl nitrite toxicity: the case of the 'Gold Rush'". Oxford Medical Case Reports 2021 (2): omaa136. doi:10.1093/omcr/omaa136. PMID 33614047. 
  41. Modarai, B; Kapadia, YK; Kerins, M; Terris, J (May 2002). "Methylene blue: a treatment for severe methaemoglobinaemia secondary to misuse of amyl nitrite.". Emergency Medicine Journal 19 (3): 270–1. doi:10.1136/emj.19.3.270. PMID 11971852. 
  42. "The chemical bases of the various AIDS epidemics: recreational drugs, anti-viral chemotherapy and malnutrition". Journal of Biosciences 28 (4): 383–412. June 2003. doi:10.1007/BF02705115. PMID 12799487. 
  43. "HIV-1 and the aetiology of AIDS". Lancet 341 (8846): 658–9. March 1993. doi:10.1016/0140-6736(93)90421-c. PMID 8095571. 
  44. "Poppers: epidemiology and clinical management of inhaled nitrite abuse". Pharmacotherapy 24 (1): 69–78. January 2004. doi:10.1592/phco.24.1.69.34801. PMID 14740789. 
  45. "Poppers: large cancer increase and immune suppression in animal tests". AIDS Treatment News (317): 1–2. April 1999. PMID 11366993. 
  46. Johnson, W. S.; Hall, A. H.; Rumack, B. H. (July 1989). "Cyanide poisoning successfully treated without 'therapeutic methemoglobin levels'". The American Journal of Emergency Medicine 7 (4): 437–440. doi:10.1016/0735-6757(89)90057-0. ISSN 0735-6757. PMID 2567600. 
  47. Marraffa, Jeanna M.; Cohen, Victor; Howland, Mary Ann (2012-02-01). "Antidotes for toxicological emergencies: A practical review". American Journal of Health-System Pharmacy 69 (3): 199–212. doi:10.2146/ajhp110014. ISSN 1079-2082. PMID 22261941. 
  48. "cyanide antidote kit (sodium thiosulfate, sodium nitrite, & amyl nitrite) dosing, indications, interactions, adverse effects, and more". https://reference.medscape.com/drug/cyanide-antidote-kit-sodium-thiosulfate-sodium-nitrite-amyl-nitrite-343737. 
  49. Research, Center for Drug Evaluation and (2019-08-14). "Products Approved for Chemical Emergencies". FDA. https://www.fda.gov/drugs/bioterrorism-and-drug-preparedness/products-approved-chemical-emergencies. 
  50. Butler, Gavin (7 June 2019). "You'll Soon Be Allowed to Buy Amyl in Australian Pharmacies—But There's A Catch". Vice. https://www.vice.com/en_au/article/a3x4bp/youll-soon-be-allowed-to-buy-amyl-in-australian-pharmaciesbut-theres-a-catch. 
  51. Administration, Australian Government Department of Health Therapeutic Goods (7 June 2018). "Consultation: Proposed amendments to the Poisons Standard being referred to the June 2018 meetings of the ACCS, ACMS and Joint ACCS/ACMS". https://www.tga.gov.au/consultation-invitation/consultation-proposed-amendments-poisons-standard-being-referred-june-2018-meetings-accs-acms-and-joint-accsacms. 
  52. "LGBTIQ Health Experts Slam Proposed Government Ban On Poppers". 18 October 2018. https://www.qnews.com.au/lgbtiq-health-experts-slam-proposed-government-ban-on-poppers/. 
  53. "Submission to the Publication of interim decision proposing to amend, or not amend, the current Poisons Standard, September 2018". 11 October 2018. https://www.afao.org.au/wp-content/uploads/2018/10/Alkyl-Nitrite-Submission-AFAO-and-Alliance-10-October.pdf. 
  54. Administration, Australian Government Department of Health Therapeutic Goods (22 November 2018). "Further public consultation on appropriate access and safety controls (Poisons Standard schedule) for alkyl nitrites". https://www.tga.gov.au/media-release/further-public-consultation-appropriate-access-and-safety-controls-poisons-standard-schedule-alkyl-nitrites. 
  55. Butler, Gavin (25 April 2019). "It Looks Like the Australian Government Probably Won't Ban Amyl". Vice. https://www.vice.com/en_au/article/pajbmv/looks-like-australian-government-probably-wont-ban-amyl-poppers-illegal. 
  56. Administration, Australian Government Department of Health Therapeutic Goods (2019-03-07). "Public meeting communique: Regulatory options for appropriate access and safety controls for alkyl nitrites". https://www.tga.gov.au/public-meeting-communique-regulatory-options-appropriate-access-and-safety-controls-alkyl-nitrites. 
  57. Badge, Joshua (10 June 2019). "Australia's decision not to ban poppers is a win for sensible drug policy, but the stigma remains". The Guardian. https://www.theguardian.com/commentisfree/2019/jun/10/australias-decision-not-to-ban-poppers-is-a-win-for-sensible-drug-policy-but-the-stigma-remains. 
  58. "Poppers sold across Canada pose serious risks". http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2013/34343a-eng.php. 
  59. "Directive 2005/90/EC of the European Parliament and of the Council". Official Journal of the European Union. January 18, 2006. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ%3AL%3A2006%3A033%3A0028%3A0081%3Aen%3APDF. 
  60. "Decree 90–274 of 26 March 1990" (in fr). Legifrance.gouv.fr. May 15, 2009. http://www.legifrance.gouv.fr/affichTexte.do?dateTexte=20090901&cidTexte=JORFTEXT000000166136. 
  61. "Decree 2007-1636 of 20 November 2007" (in fr). Legifrance.gouv.fr. http://www.legifrance.gouv.fr/affichTexte.do?dateTexte=20090901&cidTexte=JORFTEXT000000341445. 
  62. "Conseil d'État, 10ème et 9ème sous-sections réunies, 15/05/2009, 312449, Publié au recueil Lebon" (in fr). May 15, 2009. http://www.legifrance.gouv.fr/affichJuriAdmin.do?oldAction=rechJuriAdmin&idTexte=CETATEXT000020868995. 
  63. "Sexdroge Poppers: Zur Ekstase geschnüffelt" (in de). http://www.news.de/reisen-und-leben/855244035/zur-ekstase-geschnueffelt/1/. 
  64. ""Poppers" sichergestellt. Polizei entdeckt 400 Flaschen des Schnüffelstoffs in Sex-Shop" (in de). Die Welt. 2005-12-08. https://www.welt.de/print-welt/article182967/Poppers-sichergestellt.html. 
  65. "Consideration of the Novel Psychoactive Substances ('Legal Highs')". Advisory Council on the Misuse of Drugs. pp. 52–54. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/119139/acmdnps2011.pdf. 
  66. "publications.parliament.uk". https://publications.parliament.uk/pa/bills/lbill/2015-2016/0002/16002.pdf. 
  67. "House of Commons Hansard Debates for 20 January 2016 (pt 0003)". parliament.uk. https://publications.parliament.uk/pa/cm201516/cmhansrd/cm160120/debtext/160120-0003.htm#16012033005245. 
  68. Sutcliffe, Robert. "UK's biggest poppers manufacturer vows to fight legal high ban on product he's made for 35 years". Mirror. https://www.mirror.co.uk/news/uk-news/uks-biggest-poppers-manufacturer-vows-7373648. 
  69. Tayag, Yasmin. "The UK is at war with synthetic drugs and brain boosters are in the crossfire". https://www.inverse.com/article/11351-england-s-psychoactive-substances-act-puts-nootropic-poppers-on-notice. 
  70. "The Government thought it had banned Poppers but actually accidentally didn't". 2016-03-16. https://www.independent.co.uk/news/uk/politics/poppers-are-so-harmless-they-dont-even-fall-under-the-governments-legal-highs-ban-acmd-says-a6934096.html. 
  71. "15 U.S. Code § 2057a - Banning of butyl nitrite". https://www.law.cornell.edu/uscode/text/15/2057a. 
  72. "15 U.S. Code § 2057b - Banning of isopropal nitrite and other nitrites". https://www.law.cornell.edu/uscode/text/15/2057b. 
  73. Anti-Drug Abuse Act of 1988 (Public Law 100-690, section 2404) (15 U.S.C. 2d57a(e)(2)).