#27: Poppers!
COMMUNITY VOICE: Eric Hassan | HEALTHCARE EXPERTS: Aaron Bola, MD; Greg Katz, MD | COMMUNITY REVIEWER: Andrew Trimmer
SHOW NOTES
“Poppers are fun. They are not without their risks” (says our community voice Eric). That is basically the short and sweet of it!
Feeling the Rush: A Poppers Overview
Poppers are a chemical known as amyl nitrite, an inhalant (read: you breathe it in through the nose)
They create a short-lived high that create a sense of euphoria and dissociation, and can relax smooth muscle in the body (like, say, that of the anus)
How do they do all that?
Poppers turn into nitric oxide when inhaled
Nitric oxide then acts on blood vessels to cause them to dilate (or expand).
The increased blood flow is what causes poppers' effects, including smooth muscle dilation (often desired) as well as some undesired side effects (more on this below)
Where and how you might encounter poppers
They are often sold in bodegas or gas stations in small colorful vials; also sex stores or gay underwear stores
You may see them advertised as room deodorizers or leather cleaners (they don’t work for either of those purposes)
Poppers are Sexual!
Eric talked about how, growing up, poppers were clearly connected to gay subcultures and sexual dynamics (poppers coaches, poppers trainers - Eric gets into this more in the episode!)
How might people use them?
“There's no right or wrong way or time to use poppers when you're having sex.”
People often use them during sex to enhance bottoming. Eric noted that it isn’t a shortcut to bottoming, but many folks describe how it helped them relax the smooth muscle sphincters of their butt during sex.
People use them while masturbating, alone or with a partner
What Poppers Aren’t
Poppers are never medically prescribed.
Which means poppers are not medically regulated or medical grade - ever.
They are not approved for human consumption
Potential Side Effects
Note: This is not medical advice! If you are concerned you have a symptom you should seek emergency medical attention.
Heart-related
Mainly: increased heart rate and decreased blood pressure. Also, irregular heart beats, particularly for those who might be pre-disposed to this (or in Dr. Katz’s words, have “ticklish” hearts).
Any of those, alone or in combination, could lead to passing out or light-headedness.
Using poppers with other drugs can increase the potential for dangerous changes in blood pressure and dangerous heart rhythms.
Erection (boners) can be hard to get and maintain when using poppers
Poppers can trigger headaches or migraines due to the way they dilate brain vessels in addition to other blood vessels
Amplifying medication effects
Using poppers with other medications that lower blood pressure, specifically (but not only) erection medications like Viagra and Cialis - can cause sharp drops in blood pressure
This is because of how each drug works, it can be a 1+1=5 situation.
Skin changes
Poppers rash – which is a chemical burn
Blue skin - a danger sign!
Poppers can cause methemoglobinemia - when our red blood cells cannot move oxygen around
This can show us as blue lips or skin (or skin looking grayer or ashen).
It can also show up by harming organs in a way someone cannot feel, so if you don’t
What if I accidentally drink poppers? Dr. Bola: “Even a tiny amount [of poppers ingestion] is risky. I would suggest going to an emergency room.”
The Poppers Rumor Mill
Bottom (hehe) line:
Poppers do not cause HIV. Poppers do not cause AIDS.
Rumors about poppers' role in the HIV/AIDS epidemic are not scientifically supported!
Where did this come from?
Poppers have been tied up in HIV/AIDS disinformation narratives from both the 80s and more recently.
What may have seemed like a historical and outdated mode of thinking has played out in recent news, with federal officials alleged to have instigated raids on poppers factories based on long standing myths about the (debunked) link between poppers causing AIDS.
Harm Reduction (or: Using Poppers Less Unsafely)
Don’t use alone (due to fainting risk!)
Reminder: not for human consumption (meant to sniffed, not drunk)
Consider using some vaseline to prevent a chemical burn
Look out for signs of contamination or “bad batches”
Like geting really bad headaches
Can often be identified by a fruity smell – which, FYI, isn’t the classic poppers smell
The Poison Center is your friend!
NYC Poison Control Center: 212 POISONS (212-764-7667)
Outside NYC: 1 800 222 1222. That will direct you to your region’s poison center
TRANSCRIPT
Eric Hasan: Poppers are fun. They're great. They are not without their risks, but it's entirely possible to get an idea about what those risks are, learn how to mitigate them and have a great life without getting into any trouble with poppers. They're fun. Like life is way too short to not have some fun. And given all of the number of things that you could inhale or inject or swallow or smoke. Like poppers, they're kind of low on the risk scale.
[QHP THEME MUSIC BEGINS]
Gaby: Welcome to Queer Health Pod!
Richard: Poppers are fun. They're not without their risks. Should we just stop the episode now?
Sam: We have too many popper sound effects to stop here and now, but that summary is an excellent start.
Gaby: And I'll keep us going. This is Queer Health Pod and today's queer health topic is poppers.
Richard: Yes, despite media allegations that straight people have discovered poppers, we are confident that poppers maintain shall we say a gay lifestyle?
Sam: By that, do you mean the Hell's Kitchen dance floor at 2am when you inevitably get a whiff of, well, someone cleaning their VCR or deodorizing their locker rooms?
Richard: Who are we when we're not in Hell's Kitchen at 2 AM?
Sam: We are rested and we are not in our 20s.
Gaby: Or we're a lesbian ...at ANY age.
Sam: True. But then as now, I'm Sam, I use he/him pronouns, and I am a primary care doctor in New York.
Gaby: I'm Gaby, she/her pronouns and same job title.
Richard: And I'm Richard. I use he and him pronouns, and I have been a primary care doctor in the LGBTQ+ community for the last 20 years.
Gaby: And you are listening to Queer Health Pod season three, episode eight: Poppers!
[QHP THEME MUSIC ENDS]
Gaby: This episode is about poppers, known by her name out of drag as amyl nitrite, poppers are an inhalant or a substance that is used by breathing it in, usually almost always through the nose.
Richard: We already established that poppers are kinda gay. to be more to the point, poppers create an intense but short lived high that is also thought to relax some smooth muscle.
Sam: Oh, smooth muscles. I thought we said not to bring up my 20s again.
Richard: Well, Sam, many of our listeners already know that oftentimes people use poppers to help them bottom, that is, to get the muscles of their anal sphincter more relaxed to help with sex, and sometimes folks use them as part of a solo or not so solo encounter with emphasis on masturbation.
Sam: Sounds gay to me. Okay, so now I'm less worried about poppers being straight appropriated, but let's get to some history.
The name poppers comes from the 19th century, when amyl nitrite was manufactured in small glass vials that had to be crushed or popped. The liquid would be exposed to the air and become a fume for people to (Large, exaggerated glassing breaking noise) inhale.
Richard: Sam, you don't have to break a window pane to use poppers. (Medium glass breaking noise)
Richard: Sam, this isn't a bar fight. One more time.(Medium glass breaking noise)
Richard: There you go.
Gaby: I'm actually not sure if that was a bar fight or a bunch of Jewish weddings breaking the glass, but mazel tov either way. And I think folks get the point about the origin of the name Poppers very clearly.
Sam: Nowadays, they come in small glass bottles, often marketed to look like energy drinks, which is an issue we'll come back to when we talk about the risks of poppers.
Richard: Before that, we will talk about the cultural place of poppers in the queer world, something that our community voice, Eric, will guide us through.
Gaby: And after that we will dive into the medical things and we'll hear from a cardiologist and a toxicologist about the way poppers work and how they can sometimes harm people.
Sam: Alright, let's clear the air, or I guess maybe not if we're talking about poppers, but at least we'll explain who we heard from at the top of the episode, our poppers politician, our huffing host, our wise whiffer.
Gaby: Sam, you wanna put the lid back on that bottle?
Eric Hasan: My name is Eric Hassan. My pronouns are he, him, and I'm known as the guy who started poppers coaching. And I run a bator porn website and I'm pretty heavily involved in the poppers community.
Richard: We will come back to the idea of poppers coaching and bator porn because, uh, I mean, how could we not do that? But first, more about poppers proper.
Gaby: We asked Eric to tell us about the first time that he used poppers
Eric H: Oh, I was like, "Poppers!. Yes. Bring it on!" like, I was so excited about sex. I was open. It's all good. I didn't have any sort of negative information in my head about poppers. I don't think I really knew what they were, but as soon as I found out that they could make sex, like really fucking awesome, I was all about it. I remember being like super turned on and it enhanced everything that I was doing. And it was the first substance where I understood that you might want to keep going, right? I, as a kid, especially growing up in the, the drug wars of the 80s, you did a little bit of something and then that was it. Because if you do too much, you can get addicted. But poppers was just something that you could kind of keep going with. And as I did, I felt less inhibited. I felt, um, like I kind of just wanted to keep going.
Gaby: We wanted Eric to rewind and tell us about actually buying the poppers. And just for reference poppers, you can find them in sex shops, in gay underwear stores, or if you live like us in New York City in bodegas, like honestly, where you might get your lunch, usually behind glass, and they're in these short, small, colorful bottles. And honestly, they really look like five hour energy bottles.
Eric H: I was not at all scared. I didn't understand the legality of them. So I thought it was kind of funny that they were sold as like leather cleaner or video head cleaner or room odorizer. Who wants their room to smell like that? Like when you're not having sex. So I don't think I had enough information to Be scared or even to be cautious
Richard: Eric is referencing the reality that still exists where poppers have no use as a commercial product. So contrary to rumors, no one actually cleans leather with them. In fact, it will ruin your leather and no one is, or was when it was a thing cleaning their VCR tapes with them.
Gaby: Poppers are also sometimes marketed as room deodorizers, but for those of you who have not smelled them before, they are definitely not giving lavender febreeze.
Richard: If you've ever spilled a bottle of poppers, you know that it's not a smell that you want in your room. But for many of us who are older, it does evoke a very specific memory of the 70s, 80s, and 90s.
Sam: Poppers’ informal, or should we really say, not exactly legal marketing aside, Eric told us about the ways that poppers and the queer community have melded together.
Eric H: The narrative in my head in the nineties. It was like condoms and sex isn't safe and like all of that. And poppers were a way to feel like you were getting away with something that you should be doing, but that weren't going to give you HIV. Like it wasn't bare backing. It was like, I got to put this condom on, but these poppers make it feel better.
And also for me, having grown up without a father figure or any sort of male role models, the closest I had was anybody who was gay, right? That's what I was looking for once I figured out what was going on with me. So having poppers and having people explain to me why they were called poppers and the connection to like the dance floors in the seventies and anal and all that stuff. I was like, "Yeah. I want to be a part of this. I want to be connected to ssomething." And I grew up in a small town where there was, there was no gay life at all. The idea that there was a gay world out there that had been going on longer than I had been alive. It was so exciting. I wanted to connect to that. Poppers were a conduit for that.
Gaby: when you start exploring poppers like Eric did, one of the first things you're gonna find is the poppers community, and you'll probably find the subcultures that are built within that community.
Eric H: There's the Bator community. It's B-A-T-O-R as in masturbator. And I mentioned I make bator porn, so I'm definitely a part of this community and I do my work for this community. And it's guys who enjoy masturbation either in place of sex with somebody else, or as a large part of their sex life.
Richard: And because we're spelling things out, it's M A S T U R- bator.
Sam: And if you forget the spelling of masturbator, just google it, but do so carefully. Another point we wanted to make is that poppers are deeply ingrained in some subcultures within the queer community, and poppers often play a specific role in sexual encounters that aim to include them.
Gaby: To be a little more specific, let's clarify the difference between a poppers coach and a popper's trainer and how all of this relates to Eric's category of porn, which is Bator porn.
Richard: Before we get into this quote, I think it's important to note that Eric describes a very specific way in a specific subculture that may not be for everyone and that in fact could be dangerous for some people. But for those who are experienced, this is a particular type of subculture that works for them.
Eric H: There's a difference between poppers coaching and poppers trainers. And I think what you're talking about are poppers trainers. That's maybe there's porn, maybe centered around a theme, and there's like cues about when to have the poppers, when to huff the poppers, that's poppers training. Poppers coaching is like a coach for a sport. It's somebody Who is actually there guiding you through the experience. So it's a live person. Many people will do it without taking the poppers. I do the poppers. That's my signatures. I do the poppers with the people as I coach them. So it's, I'm not just telling you what to do. And, and I don't have any clue what's going on. I'm, I'm doing it with you. So as a poppers coach, sometimes it's a little more of a, "you're going to huff because I fucking told you to huff" and "you're going to huff because I'm the boss here." so you can play with dynamics a lot, but it's really about. My connection with the person and we're both using poppers at the same time.
Gaby: Okay, so is the vibe kind of like, put me in coach.
Sam: Gaby, does it make me a little homophobic if I can't decide if you're more of a soccer team or basketball kind of gal?
Gaby: It it does. But to be honest, I've been sort of shooting at least aesthetically for more of a 1940 softball vibe. Sort of a la League of Her Own. Also may, that show rest in peace. It was killed far before its time.
Sam: Well, let's do one of those sports things where they take a break to deodorize the locker room with poppers.
[TRANSITION MUSIC STARTS]
Sam: And when we are back, we will talk about how poppers are used and get more into the physiology or biology of them.
[TRANSITION MUSIC ENDS]
Richard: Were y'all having thoughts of a QHP locker room? A multimedia installation?
Gaby: Eaux, de QHP locker room, a scent currently, and never to be on sale.
Sam: Our lost merchandising opportunities aside, let's get back to poppers and specifically, how to use them.
Eric H: So how do you use them in general? It's pretty straightforward. You open the bottle and you sniff. I make a couple of recommendations. One of those is not touching the bottle all the way to your nose. Poppers are a volatile liquid. That means they're going to give off fumes easily. If you put the bottle all the way to your nose, you're going to suck the fumes out, which is great. But if you leave a little bit of distance, you'll get some air rushing over that. You'll get actually more fumes. There's no right or wrong way or time to use poppers when you're having sex. It's something that you need to explore on your own. For some people, they like to have poppers through the entire session. Other people prefer to save it for maybe the end. Sometimes when people are bottoming, they like to have poppers as the guy is starting to penetrate. I've been with guys where like we start using the poppers the moment we're making out and other times where maybe one or two hits somewhere through things, there isn't really a prescriptive time to use them, but really you've got to play around a little bit and see what feels right to you and also recognize that it's not going to be the same every time. Sometimes you might feel like using more poppers. Sometimes you might feel like using less poppers.
Richard: We'll come back to the frequency of popper use and things to know and look out for if you're taking multiple huffs, but back to Eric for another tidbit.
Eric H: The other great thing about poppers is they're relatively short lasting, right? If you smoke a joint, you're going to be high for a couple of hours. If you do a line of Coke, you're going to be buzzing for an hour. You do some poppers and you got a few minutes of feeling kind of high, and then it starts to come down. So it's very easy to control the experience. And because it's so automatic, because it's so instant. You really have an idea of how much you've taken pretty quickly. We've all heard the stories of people having nightmares with the edibles. And then after an hour that doesn't hasn't kicked in. So they take more and then they're like loopy for three days. Poppers are not like that.
Richard: On the other side of the how to use poppers coin, Eric wanted to speak to the misconception that poppers are a fast track to bottoming with ease.
Eric H: The thing is poppers are not a magic elixir that are all of a sudden, just going to open up your butthole and you can take anything, right? You still need to prepare. You still need to be psychologically in a state where you're ready for that. So start using the poppers as soon as you feel ready, but go ahead and do that as soon as you start feeling the guy's hand on your butt. Maybe he's using some fingers or a toy at first. That's a great time to use poppers. Absolutely.
Sam: With that psychological guidepost, let's get to the physical. The medical explanation of how poppers work is that they cause blood vessel dilation.
As a result, more blood can get to the smooth muscle of the anal sphincters, which can help them to relax. But, poppers can only do so much, as Eric pointed out, and it's not always the shortcut to bottoming some people will hope it is.
Gaby: So that's the effect people want from poppers. But what are the risks? And to answer that, we will bring in our first guest.
Dr. Bola: My name is Aaron Bola and my pronouns are he/him. I'm an emergency medicine doctor, and I'm also currently doing subspecialty training in medical toxicology, AKA poison.
Richard: We asked Dr. Bola how a toxicologist would define poppers.
Gaby: As a heads up in his quote, Dr. Bola refers to alkyl nitrites. This is just the parent family of amyl Nitrites. And all of that today means the same thing, which is poppers.
Dr. Bola: Poppers are liquids that fall under a class of chemicals we refer to as alkyl nitrites. Alkyl nitrites are a group of chemicals with a variety of uses. In medicine, for example, historically alkyl nitrites have been used for relief of chest pain as well as treatment for a different kind of poisoning, for cyanide poisoning.
Sam: As Eric has made clear, vivid even, folks using poppers will cover one nostril and breathe in deep, at which point the fumes go into your lungs and are rapidly absorbed into your bloodstream.
Dr. Bola: The poppers, the alkyl nitrites, they're their own class. And they have a established but not very well described mechanism as to how they cause the high and also how they cause their side effects. Other inhalants like toluene, difluoroethane, nitrous oxide, they all produce that similar sense of euphoria and dissociation, but again, they all have different mechanisms as to how they affect the body and how they produce this high.
Sam: Ok, so not paint thinner, not whippets, not keyboard cleaner. Poppers really are, looking at you Gaby, in a league of their own.
Gaby: So for the sake of medical clarity, can you please tell me if you're referencing the original with Geena Davis or the new reboot with Abbi Jacobson?
Richard: She's giving Kate Berlant. So for that reason, the reboot.
Sam: I would love to be able to give Kate Berlant.
Gaby: Honestly, me too. And like Sam's knowledge of lesbian pop, cultural references, poppers are fleeting. Quick on and quick off, so there's no leftover effects. This means that the concept of a poppers hangover or a come down isn't really a thing
Sam: This rapid on and off of poppers is explained by the physiology.
Gaby: So the amyl nitrite, again, that's the popper's chemical, gets inhaled, it goes to the lungs, gets into the blood that way, And then once that's in the blood, amyl nitrite is broken down into this other compound called nitric oxide. Once that is in the blood, a few things happen.
Richard: And to explain those details, let's introduce our last guest.
Dr. Katz: My name is Greg Katz. My pronouns are he him. I am a cardiologist at NYU Langone Health. My specialty, what I focus on really is prevention and treatment of atherosclerotic cardiovascular disease. So I see a lot of patients who have established heart disease, post heart attack, post stroke.
Richard: Dr. Katz explained the way that poppers and similarly functioning heart medications have a role in the way the heart functions.
Dr. Katz: Amyl nitrite colloquially known as poppers comes from a class of medications that increase nitric oxide. And so anything that increases nitric oxide makes your blood vessels expand and it increases blood flow. And so if somebody has a blockage in blood flow to an artery in their heart, giving them a medicine that increases blood flow will often help to relieve symptoms. And so many people have seen like in pop culture, somebody popping a nitroglycerin pill under their tongue. Nitroglycerin is a pretty short acting medication, but it's a longer acting medication than amyl nitrite. And so Poppers are the most absolutely short lived version of nitroglycerin, which is a common cardiovascular medication for relief of chest pain. And so what a medicine that that works like a popper does is it dilates a blood vessel and it takes a narrowing and makes it a little bit less likely to cause a significant obstruction of blood flow. And the reason it relieves chest pain is because it leads to blood vessels opening up.
Sam: So, our little nitric oxide drag queen tells the muscles in the blood vessels to chill out, they relax or dilate, and now the tube through which the blood is running is bigger.
Gaby: And this in turn, can relieve symptoms like chest pain that can come from low blood flow.
Richard: The explanation for why amyl nitrate helps relieve chest pain also explains some of its side effects, namely low blood pressure and high heart rate.
Dr. Katz: Poppers lower blood pressure because they dilate blood vessels. And so if you dilate a blood vessel, the pressure inside that blood vessel goes down. The reason that it raises heart rate is a reflex response to the drop in blood pressure. And so the heart rate response that you get from poppers is related to the fact that it dilates blood vessels and drops blood pressure.
Sam: In addition to heart rate going up as a reflexive response to lower blood pressure, the drug itself also has the potential to impact the heart's electrical activity.
Dr. Katz: Anything that lowers your blood pressure is going to cause a reflex in adrenergic tone. Your catecholamines, your adrenaline they're going to go up. When that stuff goes up, it causes potential in folks who have the way I describe it as a ticklish heart to have an irregular heartbeat. Anything that raises your heart rate which is done through raising adrenaline levels has the potential to cause an irregular heartbeat. I have no ability to quantify what that risk is. And I have no idea for a person who develops an irregular heartbeat after taking poppers, whether it's because of the drug itself or because it's something else that was in the drug. That just goes to the sort of, like hand waviness of what we would assume to be in there and whether or not it's actually what's in there.
Sam: So despite all the potential ways that poppers can impact heart biology and functioning, they do not have a role in modern medicine.
Dr. Katz: When you're treating somebody who has cardiovascular disease, you don't want a drug that is super short acting. You want something that's going to be a little bit more reliable in terms of a durable therapy. And so amyl nitrite has no contemporary role in the management of cardiovascular disease, zero.
Sam: To connect the dots another way, whatever you're buying is not meeting a pharmaceutical standard in the U. S., or any other country, because it's not regulated like a prescribed substance. Because it's not a prescribed substance.
Richard: Like most of what one can buy from behind the counter in a bodega in New York City, the FDA is probably not too involved.
Sam: Something that all of our guests spoke to and many listeners likely have questions about are the interactions between poppers, erections, and erectile dysfunction medications, like Cialis or Viagra to use the brand names.
Eric H: One thing to know is they can kind of kill your boner. Like I've learned to know when I'm hard enough that poppers are not going to immediately kill my boner and how much I can use without losing it.
Sam: An erection is caused by the blood vessels inside the penis tissue dilating, so more blood flows into those tissues, and then the penis gets bigger or erect. When you dilate all of the blood vessels in your body, there's just less blood that's gonna flow into those specific tissues inside the penis. That's why during popper use, it can be harder to get or maintain an erection.
Richard: so, asking for a friend, but like if poppers can kill your boner, why not take meds to help get and maintain erections.
Dr. Katz: There's a gigantic concern of using poppers along with a medication like Viagra or Cialis. What those medications do is they potentiate the effect of, of nitroglycerin by blocking the degradation of the sort of like intracellular pathway of blood vessel dilation. And so those dilate your blood vessels. And that's why they work to treat erectile dysfunction. And if you add on another medication that dilates blood vessels in the same pathway, but at a slightly different place in that pathway, you create a ton of potential for having super low blood pressure. And that can lead to passing out that could potentially even lead to a life threatening situation.
Gaby: And that life-threatening situation is because poppers and erection meds both lower blood pressure but in these two different ways. And when you use them at the same time, you can lower your blood pressure so much that your brain and your other organs just don't see enough blood.
Sam: We asked our experts about the medical risk of mixing poppers and another class of drug called stimulants, things like cocaine, meth, or other uppers.
Dr. Bola: So ecstasy, speed, cocaine, and meth, they're all stimulants, which all have similar effects of having a more activated state that causes a faster heart rate, high blood pressure, and even a higher body temperature. So taking poppers while on these drugs increases that state of euphoria that these drugs induce on their own. But if we hone in on that faster heart rate that they cause, poppers also increase your heart rate. So taken together, you might get to a point where your heart is beating so fast, it's causing a strain to your heart. And that may lead to abnormal life threatening heart rhythms as well.
Sam: We're going to move on to other types of medical risks of poppers, but we wanted to pause here and summarize. One of the biggest risks of poppers is the large, rapidly occurring change in someone's blood pressure, especially when also using erectile dysfunction medications at the same time.
Gaby: Which you might imagine will be a likely visit to the er. We asked Dr. Bola what kinds of poppers related ER visits he's seen.
Dr. Bola: There's a spectrum of side effects that lead to the ER. The more minor presentations, they come with lightheadedness or headaches, as well as, Not as common, but I still see skin irritation from direct exposure to the liquid. Some people end up with like little red spots on their skin or on their nose, especially if their nose directly comes into contact with the top of the bottle, which has the liquid on it. The more severe cases, however, that I've seen were people brought in by ambulance and they're anywhere from confused to completely unconscious and cyanotic, meaning they're blue to their face or their extremities. I do want to clarify though, that those extreme cases do not occur with just one sniff. They typically occur in cases of excessive inhalation or for some folks unfortunately accidentally ingesting or drinking the poppers themselves.
Richard: Let's zoom in on what excessive inhalation means.
Dr. Bola: There's no exact definition for what excessive inhalation means. But going by severe cases we've taken care of who come in with severe side effects, they tended to be people who've had over dozens of inhalations within minutes. So a very short period of time If I were to put a number, maybe a dozen or two inhalations within five minutes would be what I would call excessive.
Gaby: The boundaries of what's considered excessive proper use are blurry, and I think that in part is why providers and clinicians have trouble counseling on poppers. Like a few uses are probably safe, but then like Dr. Bola pointed out, dozens of inhalations within minutes may put too much stress on someone's heart or their blood pressure. And so finding that safe zone can be really tricky when we're counseling people,
Richard: and like Dr. Katz pointed out, it's hard to know how the poppers as a drug and someone's baseline physiology are going to interact.
Gaby: Two more side effects left to mention. One migraines, which are thought to be triggered by poppers because they dilate vessels in the brain. And then two, a chemical burn, or as Eric calls it, a poppers burn.
Eric H: Popper's burn is a chemical burn that you get from the liquid touching your skin. People will often have that around their nostrils. It will look kind of red. There's a few things that you can do to avoid it. The first thing to know is it's possible that not every formula is going to do that to you. So you might want to try some different varieties and find something That maybe doesn't do that to you. Another thing that I recommend to people is putting some kind of a barrier on your skin before using poppers. So that can be like a little bit of Vaseline or Neosporin or something like that. Another thing that you can do, I talked about this at the beginning was don't hold a bottle right to your nose. You'll actually get a better hit if you have a little bit of a gap and can allow some airflow. And that will also prevent some chemical burns. And then the last thing is when you're done, wash your face, wash your nose. If there's any chemical residue, you might be able to avoid the burns if you can wash it off.
Gaby: And Dr. Bola has seen people come into the emergency room with skin changes from poppers.
Dr. Bola: It doesn't concern me as much as the other side effects of poppers, but it is technically a chemical burn that we want to make sure that patients know about and that they don't apply certain remedies that may actually worsen the rash itself rather than help it get better. Typically within days, a week or so, the rash itself goes away like any superficial burn would, but again, it's a chemical burn and It's important for patients to know to just not apply whatever which home remedies that they would think to do so.
Sam: Here's a classic poppers question, which is an anxious text I've gotten more than one time in my life. What happens if you spill poppers into your mouth, if you accidentally drink some, or you're just not sure if it got into your mouth at all? We want to note that many people know how to use poppers, but sometimes people get it mixed up with 5 hour energy, or they're just not sure and didn't Google it first, so they end up drinking it. Here's Dr. Bola.
Dr. Bola: Even a tiny amount of ingesting poppers is risky, and I would suggest going to an emergency room to be seen by a physician to make sure that you don't develop more severe symptoms. Because as you can imagine, these bottles are small and the people who ingest the full bottle get really sick. So if you have even a little bit of that that is of concern to emergency doctors and to toxicologists. There's also been studies looking at where poppers are placed in certain corner stores or bodegas and the confusion that comes with them being next to energy drinks that are the same size bottle and kind of the same graphic design as them that people actually mistake them for energy drinks or shots and overdo them for the first time or even drink them, which is really dangerous.
Sam: If you think you may have spilled a small drop in your mouth, or you're not sure, you can wait and see if you're not feeling any side effects and nothing looks blue or red, like we've been talking about up to this point. If you full on drank poppers and you got a big amount into your body, we definitely recommend getting urgent medical attention right away
Gaby: Another side effect beyond skin are concerns about immune system changes. And let us preface this by saying that these are concerns which are not borne out in fact. So these aren't true
Dr. Bola: There's a historical component to this belief that's really been tied to the early years of the HIV AIDS epidemic. Researchers looked into behaviors other than sexual activity in the community to see if there's correlations between them and HIV risk. The use of poppers was initially implicated in the development of Kaposi's sarcoma, but that's been refuted. There's been a lot of studies that describe poppers lowering the immune system of rats and mice, and there's some studies that have also used human cells to link poppers exposure and changes to the immune system, but to my knowledge and As far as I've looked, I didn't see any studies that have translated this to sufficient human studies. So, I don't think that we can definitively say that poppers impact the immune system.
Sam: To state it another way, Poppers are not known to have negative side effects on the human immune system function.
Richard: the one potential side effect of poppers that is well known and well documented is something called Methemoglobinemia.
Dr. Bola: Methemoglobinemia is a condition where our red blood cells cannot bind or deliver oxygen to our organs. So, in our blood we have a protein called hemoglobin that binds the oxygen we breathe in and delivers that same oxygen to the rest of the body. Poppers cause hemoglobin to be converted to methemoglobin, so methemoglobinemia.
So methemoglobin does not bind and deliver oxygen as well. So you can imagine excessive poppers use over a short period of time can lead to more methemoglobin than hemoglobin, and that's a problem because oxygen is important in our organs functioning, so this can be very serious. Some symptoms include headache, nausea, confusion, shortness of breath, and on the more severe spectrum, loss of consciousness or cyanosis with patient's skin looking blue due to lack of oxygen. It's life threatening to not be able to deliver and use the oxygen to our organs. So I would say this is high up there for the thing, the bad things that poppers cause.
Gaby: When it comes to methemoglobinemia, it's really important to know the symptoms,
Dr. Bola: They might feel a headache that doesn't just go away right away, and is getting more severe. They can feel short of breath and generally weak or fatigued, even if they're not really doing anything. Some patients also experience confusion. Some patients actually lose consciousness and pass out. And Some patients, in addition to being passed out, will also appear blue because at that point, they're really lacking oxygen.
Gaby: And this is what Eric added on for things to look for.
Eric H: Your lips turn blue, your nose turns blue, your fingers turn blue, because they're quite literally starving of oxygen. And if that happens, that's absolutely a time to stop using poppers.
Gaby: I wanna highlight, Eric says, lips turning blue. This is the place to look in addition to looking under the fingernails at the tips of the fingers, that's where you will see these color changes happen the earliest, and so it's most reliable to look there if you're not sure
Sam: We asked about a situation where someone is looking blue or ashy or has some skin color changes after popper use, but otherwise feels okay. Spoiler alert, any blue is please seek medical attention blue.
Dr. Bola: Take seriously when someone says that you look blue or you're not looking like your normal self, especially after a significant amount of poppers use. Because that could mean that you're developing methemoglobinemia, if not already there. And while you may feel better now, symptoms can quickly become severe.
Sam: Just because you don't feel short of breath doesn't mean that your kidney, liver, and other vital organs are not actively being damaged from a lack of oxygen. And if that's the case, those results of those organs not getting enough oxygen could take hours to days to fully show up.
Richard: So any signs of not having enough oxygen, even if someone doesn't have severe symptoms, should be treated as an emergency.
Gaby: Eric also brought up that poppers have been implicated in eye damage
Eric H: Poppers do something to the fovea, the sort of central part of the retina, and can cause damage that usually resolves if you stop using poppers, but in some people it has not resolved. That's been tied to a certain formula that is now not used. But you can still experience some temporary vision changes.
Gaby: This quote, certain formula that is now not used was found to be this chemical called isopropyl nitrite, which sounds similar to amyl nitrite, but is quite different and much more harmful.
Richard: The extent we can say that it's not used is again hampered by the fact that poppers are not regulated, but Dr. Bola had some thoughts on this.
Dr. Bola: There's been a few case studies and case series describing patients who develop retinopathy and changes in their vision, particularly their central vision after chronic popper's use. Again, I want to emphasize that this is not something that happens after one sniff. In these patients, they describe having difficulty, particularly in their central field of vision, and The data isn't all very clear and points to one formulation or the other. There's data that suggests that it's primarily isopropyl nitrite, one kind of popper. And then there's some papers that say poppers in general. So there's a lot of conflicting information there. But what is true is while it's rare, it does happen that some patients develop visual changes after chronic poppers use.
Sam: So poppers, generally speaking, are not considered a high risk drug, however, there are clearly a few situations where things can go very wrong, and it can be a very risky situation.
Gaby: As Dr. Katz summarized for folks with heart issues or who are using other drugs that impact their heart and blood pressure, the risk of poppers is gonna be higher due to its impact on lowering blood pressure
Richard: Methemoglobinemia is basically when you can't get enough oxygen, a very risky situation that should prompt medical evaluation even if you don't feel short of breath.
Gaby: And yes, visual changes are possible, but extremely rare and likely attributed to a specific not popper chemical that got into the popper supply.
Richard: And to say it again, one of the biggest risk of poppers is large and sudden drops in your blood pressure, particularly when using erectile dysfunction medications at the same time.
[TRANSITION MUSIC]
Sam: Before wrapping up, we wanted to share some thoughts on risk reduction and chemsex. If those are new phrases to you, we highly encourage you to check out our Club Drugs episode, as well as our Meth 1 and Meth 2. But, in brief, I'm going to let Gaby define these.
Gaby: Chemsex is a big topic and I really recommend the club drugs episode, but what we're talking about is using chemical substances to heighten or alter the experience of sex, and the goal there is to facilitate more enjoyable or more intense sexual pleasure.
And then risk reduction refers to the idea that there may be a risk in say, taking poppers, but instead of our goal being to eliminate the risk completely, we're trying to make things safer without achieving like 0% risk. So you might also hear this called harm reduction.
Richard: Our hope is that knowing the potential health risks of using poppers can help folks navigate their decisions about how and when to use poppers, if at all, Dr. Bola had some great general advice to start us off.
Dr. Bola: I think that not using poppers alone is really good practice, and if you are able, moderate your use and avoid mixing with other drugs or medications. But should you find yourself needing care in relation to any other substances you use, my one plug here is, it's very important to be forthcoming to your doctors about your use history and whatever substances you use.
Sam: Eric had some advice about how to make sure you are in fact using the poppers that you want to be using.
Eric H: When it comes to street smarts, like you can't just walk into a store and pick up a bottle and like count on it being good. You could do that 25 years ago. You can't anymore. And part of that is poppers exist in a legal gray area. They can legally be sold as commercial products, but they're not for personal use. So what that means is there's no obligation for companies to post an ingredient list. So sometimes you just get a bottle and you don't know what's in it and there's nothing on it that tells you what's in it. So it's kind of the wild West, but there are some things that you can do. First of all, look at the bottles. If you're going someplace, look at the bottles and read what it says. If it says something like contains nitrites or contains pentyl nitrite, it might name the nitrite. You could be pretty sure that's probably what you're looking for. If it says it contains alcohol, don't buy it. If it doesn't say anything, don't buy it because you can't be sure about what's in there. And I don't think that you're going to come across anything. That's going to be incredibly harmful, but you're certainly not going to be getting poppers. If you get a bottle home and something doesn't seem right about it, throw it away. Don't use it, that's totally fine, no harm, no foul.
Richard: Eric was clear that none of this is ever guaranteed and had some more advice on getting closer to certainty that you have the right genie and the right amber poppers bottle.
Eric H: They don't have an expiration date, but because they're volatile, the moment that you expose them to air and or light, they start degrading. And you can tell that they're no good because they'll smell funky. They smell kind of, they'll smell kind of like fruity suntan oil, not like gym locker room feet. And believe it or not, gym locker room feet is the smell that you want, and fruity suntan is the smell you don't want. That smell is usually so objectionable that you'll like, you'll open the bottle and be like, I don't want to use those. Your experience with poppers will vary. If you have something like a headache, you have those kinds of symptoms, changing formulas is usually a great way to resolve that issue. You just need to find. The particular formula or concentration that works best for you and doesn't give you a headache.
Richard: So where does all this leave medical providers and their ability to give concrete and informed counseling around poppers?
Dr. Katz: I look at a drug like poppers, similar to how I look at a drug like cocaine. Like these are young person's drugs. And if you're older and you have any sort of chronic medical conditions, you are putting yourself at a different level of risk than a person who's otherwise young and healthy.
Gaby: Dr. Bola, as a toxicologist, wanted to make sure if people knew how to contact their nearest poison control center.
Dr. Bola: If you are in New York, the number for the Poison Center is 212-POISONS. It's very easy to remember. Phone numbers do vary nationwide for different city or state poison control centers, but there is a central 1 800 number that you can call. That's 1-800-222-1222, and you will be directed to your region's poison center.
Gaby: So that's a little bit on harm reduction. And now let's talk a little bit about poppers and chemsex.
Eric H: The very short answer that I have to the question of whether or not Poppers falls under the umbrella of chemsex is, I don't know, and I don't think it matters. And here's why. So I'm looking at anything from people who use meth so that they can bottom for hours at a time. Cause they don't really think they're good bottoms to people who use Viagra for maintaining a hard on, right? It can be very easy to think that chem sex is using some kind of hard drug and going for sex all night, right? Cause that's a classic example, but what about two guys who get together once a year for like the holidays and they do a few grams of cocaine and jerk off and fuck all weekend. And then after that they go off and live their lives. No harm, no foul. Was that chem sex? Was that harmful?
Sam: Eric makes a point that using poppers in a way where you're informed about their risks and their benefits, and you have an understanding of what they will and won't do for you in a way that refelcts the sexual reality, can be an empowering experience.
Richard: The other part of the summary that we want to make sure that people hear is not use these medications alone and to think about taking care of each other and pay attention when people are using poppers, just in case something goes wrong, even though the risks can be quite small.
Sam: So if you want to hear anything again, all you need to do is hit rewind and we summarized the medical risk earlier this episode, but before you hit rewind, here's Eric with the last word.
Eric H: Poppers can be really compelling, but it's important to know poppers don't make you cool. They don't make you better than somebody else. You're not like a better partner because you use poppers. You're not a better fuck because you can use more than somebody else. Poppers are great, but like anything else, it's really important that people make their own decisions about whether or not they want to use them, when, and how.
[QHP THEME MUSIC STARTS]
Richard: QHP is a power sharing project that puts community stories in conversation with health care expertise to expand autonomy for sexual and gender minority folks.
Sam: Thank you to our community voice, Eric Hassan, who has a healthy internet presence if you want to continue to engage with him. And as always, thank you to our healthcare experts, Dr. Aaron Bola and Dr. Greg Katz.
Richard: We would also like to thank our community reviewer Andrew Trimmer.
Gaby: For more information on this episode's topic, check out our website, www.queerhealthpod.com.
Richard: Help others find this information by leaving a review and subscribing on Spotify or Apple Podcasts.
Gaby: We are on social media. Our handle everywhere is at Queer Health Pod, so reach out to us.
Sam: Thank you to Lonnie Ginsberg, who composed our theme music, and thank you to the Josiah Macy Jr. Foundation, who supported some of the tech we use to produce these episodes.
[QHP THEME MUSIC ENDS]
Richard: Opinions in this podcast are our own and do not represent the opinions of any of our affiliated institutions, and even though we're doctors, please don't use this podcast as medical advice, and instead, consult with your own healthcare provider.
Gaby: That's where you will see these color changes happen the earliest. (laughter) And yes, blue is the warmest color.
Sam: A controversial but cinematic movie. I was having an intense flashback to when and where I watched that movie, and then the song, (singing) I, I, follow, I -, because that's what it's in. Anyway, okay –
Gaby: Ah, the Lykke Li remix. I love that song. We played it at my wedding. It was one of our must plays.
Sam (giggling): Blue IS the warmest color (peals of laughter).
[QHP THEME MUSIC REPRISE (BRIEF)]