Psychosexual Aspects of the Volatile Nitrites

Thomas P. Lowry, M.D.

Journal of Psychoactive Drugs; Jan-Jun, 1982; Vol. 14(2): 77-79
T.P. Lowry, M.D., Chief, Department of Psychiatry,
Kaiser Foundation Rehabilitation Center,
975 Sereno Drive, Vallejo, CA 94590

The inhalable nitrites may be the nearest thing to a true aphrodisiac. Approximately 250 million recreational doses are consumed yearly in the United States. Six aspects of these remarkable substances will be considered: chemistry, availability, mode of action, social uses, toxicology and legal trends.

The volatile nitrites are yellowish flammable liquids with an odor variously described as fruity or like old gym socks. They are unstable and decompose when exposed to light, heat and oxygen. There are two available forms: amyl nitrite, a prescription item used in cardiology for over a century in conditions such as angina pectoris; and butyl nitrite, which is marketed as a "room odorizer," under a variety of trade names such as Quicksilver and Hardware. There are more than a dozen other trade names commonly found, including Rush, Bolt, Locker Room, Bullet, Aroma of Men, Dr. Bananas, Cum, and Heart-On. The manufacturers avoid any drug claims for these products, relying on word of mouth and product recognition, an easy matter in the homosexual community where nitrite usage is commonplace, but perplexing to most heterosexuals who are unfamiliar with these substances. Among counseling professionals, there has been increasing familiarity with the social uses of the nitrites, based on recent publications and conference discussions.

From 1960 to 1969, amyl nitrite was an over-the-counter item, but was returned to the prescription list following a Food and Drug Administration (FDA) hearing, apparently related to the politics of pharmacy economics, since no evidence of harm was presented at the hearing. Amyl nitrite users in the Southwest travel to Mexico where no prescription is needed for purchase. Butyl nitrite is available at head shops, adult bookstores, by mail and at a few liquor stores. Amyl nitrite is usually sold in 0.3 ml crushable glass ampules ("poppers," "snappers"), while butyl is available in 12 ml screw-top bottles. Both should be stored in cool, dark locations.

The basic pharmacological action of the nitrites is relaxation of vascular smooth muscles. Its beneficial cardiac action is not by direct effect on the heart, but rather by relaxing systemic arterioles, resulting in a fall in blood pressure, reflex tachycardia and a decrease in left ventricular work. The drop in blood pressure is maximal in 30 seconds, averaging 30 mm of mercury systolic, and return to normal is complete in less than two minutes. The user experiences a sense of warmth, giddiness and a pounding heart. The individual's face and chest blush. The psychological response varies with setting, expectation and individual chemistry, ranging from cosmic bliss to mild nausea and headache.

Mental effects of chemicals are produced by action on brain physiology. As with most other psychoactive substances (e.g., alcohol, morphine, LSD), the mode of action is not fully known. A recent review (Lowry 1980) of studies done on amyl nitrite since 1914, shows the major brain effect is dilation of the retinal and pial arteries and veins, an increase in brain volume and an increased cerebral blood flow. There is a brief elevation of cerebrospinal fluid pressure. EEG studies of five normal volunteers (Lowry l979b) showed no pathological changes. The usual reaction was an alerting response, with a shift from alpha to beta waves. Marcus (1979) studied cortical and brain stem auditory evoked responses. There were large changes in amplitude which returned to normal within 15 minutes. The significance of these changes is unknown. Mathews (1981) is studying cerebral blood flow changes in response to butyl nitrite, using radioactive xenon, which should clarify the issues. In short, the volatile nitrites produce a brief drop in systemic blood pressure and an increase in brain blood flow. The mental effects are due to some effect other than anoxia.

The social uses of the nitrites involve dancing and sexuality. In discos (especially gay discos) patrons sniff nitrites on the dance floor, enjoying the combined high of rhythm, lights, drugs and social-sexual excitement.

In explicitly sexual settings, nitrite usage can be divided into two areas: foreplay (that dreadful, cheerless term for one of earth's chief delights) and penetration-orgasm. In foreplay, the nitrites have a disinhibiting effect, enabling the user to experience total skin-surface sensuality. Nitrites are reported by many women to be useful for a chief female sexual dysfunction -- distraction -- in which peripheral thoughts of unfinished business, child care, body self-consciousness and day-to-day domestic annoyances block the abandonment to sensation, vital for a full sexual experience. Of course, no chemical can substitute for trust, intimacy and respect, but in otherwise positive situations, nitrites may facilitate the process of "letting go." A sensation of timelessness mixed with immersion in the immediate moment is described by many users.

Penetration may be facilitated by enhanced perception of both being filled and being grasped; anal penetration becomes easier, probably from a combination of muscular relaxation and decreased pain perception. When inhaled shortly before orgasm, the user may experience a sense of exhilaration and acceleration, a freeing of inhibition of movement and vocalization, and perception of orgasm as prolonged, intense and exalted. The mind's eye may be filled with rapidly changing patterns of color and shape, often containing symbolic representations of the sexual moment.

A frequent visual perception is that of a bright yellow spot with purple radiations. This phenomenon is so consistent that it must reflect some aspect of the neurophysiology of the nitrites.

Toxicology begins with the truism, "Anything which feels that good must be bad for you." Happily, the ratio of pleasure to harm is more favorable for the nitrites than for most other psychoactive chemicals. Approximately 250 million recreational doses a year are consumed in this country and there have been no known deaths from inhalation.

The most common toxic effect is headache, reported by 43% of users on at least one occasion. However, most of the users most of the time do not have headaches. In a survey of 255 experienced users (Lowry 1979c), 10% had experienced nasal irritation at least once and five percent had experienced nausea or temporary loss of erection. These negative effects were usually associated with "overuse" or with certain brands, perhaps reflecting a product quality or storage problem. Thirty percent of new workers in a nitrite bottling plant experienced headache; this is similar to the vascular headache reported years ago among workers in nitroglycerine plants.

Using a recording spirometer, Swenson (1978) studied 20 males who averaged four poppers a day for seven years. The results were compared with a nonuser control group. There were no significant differences between the lung function of the two groups, even though the nitrite-using group smoked much more tobacco and marijuana than the control group.

The Drug Abuse Warning Network (DAWN) found that of 1,350,000 drug-related emergency visits, only 67 were related to volatile nitrites. There were no deaths. In a survey of 605 emergency room specialists (Lowry 1979a), 592 had never seen a patient with inhaled nitrite problems. Thirteen respondents reported patients with transient headaches or methemoglobinemia. This author has interviewed 10 users who have used a dozen amyl nitrite ampules or a 12 ml bottle of butyl nitrite in one evening and had no perceptible ill effects. It would seem that even heavy inhalation usage has a very, wide margin of safety.

However, ingestion is a different matter, Shesser (1980) reported death by methemoglobinemia in a 30-year-old man who drank 12 ml of butyl nitrite. Smith (1980), Steiner (1980) and Wason (1980) all reported cases of serious methemoglobinemia following ingestion of butyl nitrite. In these cases, early administration of 10% methylene blue intravenously gave immediate improvement and full recovery. This author has read a newspaper account (reference unavailable) of a man who died several hours after injecting a large amount of amyl nitrite into his jugular vein.

To summarize the evidence on toxicity, both forms of volatile nitrite appear to be relatively safe when inhaled and clearly toxic when swallowed or injected. Since the labeling of butyl nitrite clearly recommends against swallowing and since no authority has recommended the usage of any volatile nitrite by either ingestion or injection, it would seem that only the most reckless disregard of available information would be likely to lead to any serious harm.

The legal status of amyl nitrite is clear: an FDA approved prescription drug. The status of butyl nitrite varies with locale and time. Several states have moved to ban its sale, usually on the basis of danger to public health. At various times in the past five years, the states of California, Wisconsin, Connecticut, Texas and Pennsylvania have made moves to ban the sale of butyl nitrite within their borders, but following hearings or litigation have dropped these attempts when no evidence of medical harm was forthcoming. The FDA has taken no clear position on butyl nitrite. The Consumer Product Safety Commission is reviewing the labeling of several brands, with an eye toward a more explicit warning label.

The psychology and sociology of governmental bans and restrictions on amyl and butyl nitrite is worth considering. The usual allegations are that the substance in question has either no "legitimate usage," could be a "drug of abuse" or "is used solely for recreation." The underlying philosophical assumption is that any chemical whose sole purpose is pleasure is a priori wrong. There is a rich, clear Puritanical vein visible here regarding any activity which is not practical and productive. America has a rich Comstockian heritage of banning activities because they might bring pleasure to some other person. In the field of government regulations, significant exceptions are made for the psychoactive drugs used by the dominant population, including those socioeconomic groups which tend to be active in legislative matters and consumers of such products as alcohol, tobacco and coffee. A "drug of abuse" is almost always one which is not in wide use by the social class which aspires to elected office. The social origins of governmental decisions regarding psychoactive substances are worth continuing examination and reflection.


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