Vapour and Mirrors: Poppers in the context of Canadian drug policy

In 2013, Health Canada cracked down on the sale of poppers, products known affectionately by gay, bi, and queer (GBQ) men for use in the bedroom and occasionally on the dancefloor.  Put simply, inhaling poppers relaxes smooth muscle, giving a quick head-rush and making anal sex easier. These products, containing alkyl nitrites, were used freely since the 1970s, but they are now considered illegal to sell in Canada. The real question is why.

Health Canada suggests there are risks to using poppers with certain medications and there is a possibility for overdose. Presumably this would mean the crackdown was made with the health of GBQ guys in mind. As a student investigating this problem, I’m not convinced. 

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First, the risks they identify don’t check out – at least in the published literature.  Fear of mixing medications seems to stem from one precautionary statement by Pfizer (1), frequently echoed by researchers without real data to back it up.  As for overdose concern, one study counted 250 million recreational doses sold per year in the United States, without any overdose deaths on record (2). While overdose from poppers is possible, it is exceedingly rare and deaths tend to result from drinking products meant to be inhaled.

Questionable evidence aside, if Health Canada wanted to reduce harm to GBQ men, banning poppers would not be the way to do it. Prohibition didn’t work for alcohol, it didn’t work for cannabis, and it won’t work for poppers. Data from CBRC’s Sex Now survey, a periodic nationwide study of GBQ men in Canada, show only marginal decreases in poppers use since the ban.  Having used poppers in the past year dropped from 33.9% in 2012 to 28.4% in 2015, while prevalence of daily use did not change.

This can be explained by an increase in unauthorized sales, both in-person and online. The problem is that some products on the market appear to be significantly more harmful than those available before the crackdown. The term “alkyl nitrites” refers to a family of chemicals, in which amyl nitrite and isobutyl nitrite are the most popular. Without a regulated supply, it is no longer possible to know what chemical is in the bottle, and newer forms appear to be causing central vision blindness (3)(4) and intensifying headaches according to anecdotal evidence.

Given that the 2013 policy change appears to be worsening health outcomes, how did a crackdown get on Health Canada’s agenda in the first place? Keep in mind, poppers carry almost no risk for dependence in the way that cigarettes and alcohol do. All clues suggest the ban was not made on the basis of sound health research. It is perhaps more likely that poppers were banned on the basis of conservative anti-drug, anti-gay values. For the previous government, it was probably more about preventing unorthodox behaviour than preventing implicit poppers-related harm.

This was right on brand for drug policy at the time. The National Anti-Drug Strategy (NADS), renewed in 2012, was criticized for blindly emphasizing enforcement at the expense of health outcomes. According to the Canadian Drug Policy Coalition, a national think-tank advocating for evidence-based drug policy, the NADS had “no overall strategies which identify goals against which effects could be measured”. In the case of the poppers ban, there was no evaluation from a public health standpoint at all.

Could societal values really have contributed to a false sense of risk being upheld? As drugs that enhance sexual pleasure and intimacy, it may be useful to compare poppers to erectile enhancement drugs. While neither are particularly harmful according to scientific evidence, the fact that poppers are inhaled and used disproportionately for anal sex means that they are subject to stereotypes of drug abuse and gay promiscuity in ways that erectile enhancement drugs are not. These stereotypes not only bias perceptions of poppers-related risk, but the resulting stigma has meant for little support of poppers in the public sphere. After all, it’s easier to talk publicly about the dangers of illicit drugs than the mechanics of anal sex.

Poppers vials resting amongst potted plant

Even if the thought of poppers fumes wafting in bathhouses seems risqué for some, shouldn’t poppers users (the only ones actually affected by the policy) have at least been consulted in the process of decision making?  Health Canada should be banning products after proper evidence review and processes of stakeholder engagement, not based on an association with deviance.  Underneath layers of moral panic, poppers remain a part of GBQ culture: an accessory on the dancefloor and a practical means of reducing pain during sex. 

A curious part of this story is that no new legislation was passed. The crackdown was justified on the basis of the Food and Drugs act, updated in 1985. In reality, poppers had been illegal to sell in Canada for almost 30 years, but the rationale for the government’s sudden interest was never published. 

That’s not to say poppers don’t deserve government attention. Despite being some of the safest drugs out there, there is more to learn about the potential role of amyl and isobutyl nitrite in the transmission of viral STIs like HIV and HPV. Evidence suggests the physiologic effects of poppers temporarily increases the body’s susceptibility to viruses, and more research in this area could inform health campaigns aimed to actually improve the health of GBQ men. Instead, guys were left shaking their heads as poppers were stripped from Canadian storefronts and unregulated markets started to flourish.

All of this is to say that our government needs to do a better job separating risk from risqué. We can’t let moral crusades get conflated with health policy, because if we’re talking about the wellbeing of citizens, banning poppers was never an effective strategy. How can we move forward? As a first step, let’s try scrapping the ban and enforcing a big “sniff, don’t drink” label on poppers bottles instead.

References

  1. James JS. Viagra warning re “poppers” and notice re protease inhibitors. AIDS Treat News. 1998;(No 294):1.
  2. Lowry TP. Psychosexual aspects of the volatile nitrites. J Psychoactive Drugs. 1982;14(1–2):77–9.
  3. Gruener AM, Jeffries MAR, El Housseini Z, Whitefield L. Poppers maculopathy. Vol. 384, The Lancet. 2014. p. 1606.
  4. Rewbury R, Hughes E, Purbrick R, Prior S, Baron M. Poppers: Legal highs with questionable contents? A case series of poppers maculopathy. Br J Ophthalmol. 2017;101(11):1530–4.

Written by Cameron Schwartz

* The views expressed in this article are solely those of the author(s) and do not necessarily reflect the policies or opinions of CBRC or its funders.

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About CBRC

Community-Based Research Centre (CBRC) promotes the health of gay men through research and intervention development. We are inclusive of bisexual and queer men (cis and trans) and Two Spirit people.
Vapour and Mirrors: Poppers in the context of Canadian drug policy
Vapour and Mirrors: Poppers in the context of Canadian drug policy
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