AMYL NITRITE

OFFICIAL NAMES: Amyl nitrate, amyl nitrite

STREET NAMES: Amy, high-tech, kix, liquid gold, locker room, poppers, ram, rave, rush, snappers, thrust, TNT

DRUG CLASSIFICATIONS: Not scheduled, inhalant

OVERVIEW

Amyl nitrite was discovered in England in the 1840s and used to treat angina pectoris, a heart condition marked by severe chest pains and shortness of breath. Until then, physicians had treated the condition by using leeches to "bleed" the body of impurities. Amyl nitrite was used to treat angina pectoris because it dilated blood vessels, causing the heart to get more oxygen and thereby relieving the pain. However, one of the side effects was that it caused the patient to experience a short but dizzying burst of euphoria.

The drug was packaged in small, mesh-covered glass vials, which could be crushed with the thumb and fingers and the vapors inhaled. (The vials of amyl nitrite became known as "poppers" because of the sound they made when crushed.) The drug triggered an almost immediate jump in the heart rate and a corresponding drop in blood pressure, causing smooth muscle tissue to relax. At the same time, it cuts the amount of oxygen to the brain, causing a sudden, intense weakness and dizziness that lasts two or three minutes.

Over time, amyl nitrite was used less and less to treat angina, but it grew in popularity with rumors that it allegedly intensified sexual orgasm. Although there is no research that suggests amyl nitrite is an effective aphrodisiac, by the 1950s it had gained a reputation in the British show business industry for enhancing sexual orgasm. In the 1960s, it found particular acceptance among gay men in the United States, especially in urban areas like New York, Los Angeles, and San Francisco.

In the 1970s, the drug became popular among young gay males in both the United States and Britain. It was widely used in discos and dance clubs to get a momentary "rush" while dancing. The sudden usage increase coincided with the Food and Drug Administration's (FDA) decision to eliminate the need for a prescription to obtain the drug in the early 1960s. When the FDA reinstated the prescription requirement in 1969, manufacturers got around it by using slightly altered formulas. The alterations were minor and the effects of the drugs were the same.

The modified formulas, called butyl nitrite and isobutyl nitrite, did not require FDA approval because they were not marketed as either a drug or food product. They were marketed heavily in the gay community under the general name of "poppers." By 1974, poppers were in full swing within the gay community, and large advertising campaigns were mounted in gay publications, according to Randy Viele, outreach coordinator for Project H.O.P.E. (HIV Outreach Prevention Education) in northeast New York.

During the 1960s, amyl nitrite, along with a variety of other drugs, including marijuana, heroin, opium, LSD, and amphetamines, made its way to U.S. soldiers fighting in Vietnam. When the soldiers returned to the U.S. after their tour of duty, many continued their poppers habit. The FDA reinstated its ban on amyl nitrite without a prescription in 1969, following reports from soldiers and former soldiers in the United States of serious problems caused by the drug. These problems included skin burns, fainting, dizziness, breathing difficulties, and blood anomalies.

In 1988, the U.S. Consumer Products Safety Commission banned the sale of butyl nitrite. But manufacturers kept one step ahead of federal regulatory agencies. Each time a specific formula was banned, the manufacturers would adjust by altering the chemical composition slightly. As of 2002, the newest popper was cyclohexyl nitrite, commonly sold in drug paraphernalia or "head" shops and adult bookstores as a head cleaner for VCRs. Cyclohexyl is chemically similar to amyl nitrite and butyl nitrite and produces the same effect when inhaled.

CHEMICAL/ORGANIC COMPOSITION

Amyl nitrite is generally sold in small glass bottles or, in rare cases, small vials or ampoules. It is chemically related to nitroglycerine. It is part of a group of closely related chemicals known as alkyl nitrites. In street terminology, amyl, butyl, isobutyl, isoamyl, isopropyl, and cyclohexyl nitrates and nitrites are collectively referred to as amyl nitrite or poppers. Depending on he specific molecule, it is the nitrite or nitrate portion of the molecule that causes the muscles to relax and blood vessels to dilate. This effect is achieved regardless of what organic molecule, such as amyl or butyl, to which it is attached.

INGESTION METHODS

Amyl nitrite vapor is usually inhaled through the nose and more rarely inhaled through the mouth. It can be fatal if swallowed and can cause burns if it comes in contact with the skin.

THERAPEUTIC USE

Amyl nitrite was originally manufactured and prescribed to treat angina pectoris, a heart condition marked by severe chest pains and shortness of breath. More effective treatments now exist, and it is rarely prescribed for this purpose.

Amyl nitrite is also considered an antidote for cyanide poisoning and is usually one of three medications found in cyanide poisoning kits used by the militaries of some countries, some emergency medical services, and at plants where cyanide is used. Cyanide is used by industry in many chemical syntheses, electroplating, plastics processing, gold and silver extraction, tanning, metallurgy, and as a fumigant against rodents. The most extreme use of cyanide is as a chemical weapon, since high doses can kill large groups of people almost instantly. This application, especially by terrorists, has become of increasing concern since the September 11, 2001, terrorist attacks on the United States and the subsequent anthrax attacks.

The North Atlantic Treaty Organization (NATO) and the U.S. military consider cyanide a possible weapon of so-called rogue nations such as Iraq, Iran, and North Korea, and terrorist groups. Iraq is believed to have used cyanide to kill thousands in the 1980s during its war with Iran and against Kurds in northern Iraq. With this in mind, the possibility of an antidote takes on added importance. However, the effectiveness of amyl nitrite as an antidote for cyanide poisoning has come under question by some medical authorities. The U.S. military removed amyl nitrite from its cyanide antidote kits, because of adverse side effects (low blood pressure, dizziness, and headaches) and other concerns.

USAGE TRENDS

The use of amyl nitrite as a prescription drug for angina pectoris has dropped considerably from a few decades ago and since the early 1960s has been prescribed rarely in the United States. Because a prescription is required to obtain amyl nitrite in the United States, two variants of the drug, butyl nitrate and isobutyl nitrate, became popular in the 1970s. After falling out of favor in the 1980s and 1990s, there again appears to be a slight surge in the drugs' usage. The primary users today are teenagers and young adults who attend raves and all-night dance parties. Poppers are often used in conjunction with other so-called rave or club drugs, such as 3, 4-methylenedioxymethamphetamine (MDMA or ecstasy), ketamine, 2C-B, and gamma hydroxybutyrate (GHB).

Scope and severity

There are few studies or research data that tracks the scope and severity of amyl nitrite usage, particularly among adults. It is usually lumped in the general category of inhalants. However, it is generally believed the problem is not as severe as with other, more readily available inhalants, such as solvents, aerosol propellants, and aliphatic nitrites, such as cyclohexyl nitrite.

Inhalant abuse is found in both urban and rural areas of the United States and Canada. Research indicates social and economic rather than racial and cultural factors in general impact the rate of inhalant abuse. Poverty, physical or mental abuse as a child, poor grades in school, and dropping out of school are all associated with increased inhalant abuse. At particularly high risk are Native American youths who live on reservations where poverty and school dropout rates are high.

According to Alcoholism & Addiction Magazine, researchers have put together a "user profile" of inhalant abusers. Almost all of the profile indicators relate to social and economic conditions. The profile of a typical inhalant abuser is: poor academic achievement in junior high or middle school, no father living at home, poor coping skills, insecurity and low self-esteem, low I.Q., depression, an alcoholic living in the home, family problems, and low family income.

Age, ethnic, and gender trends

Amyl nitrite abuse can be found in all ethnic groups, age levels, and genders. However, the predominance seems to be among older adolescents, white, from families with low to average incomes, male, and those who frequent dance clubs and raves. Most abusers use amyl nitrite in combination with other drugs.

The University of Michigan has conducted the Monitoring the Future (MTF) study, sponsored by the National Institute on Drug Abuse (NIDA), each year since 1991. It tracks drug use among students in the eighth, tenth, and twelfth grades. While inhalant use has

been tracked for all three grade levels, amyl nitrite use has been tracked only for twelfth grade students.

In 1991, 1.6% of the nation's high school seniors reported using amyl nitrite at least once during their lifetime. For the next five years, the survey found the rate relatively consistent, between 1.5% and 1.8%. In 1997, the rate rose to 2% and jumped to 2.7% the following year. It dropped to 1.7% in 1999 and plunged to less than 1% in 2000, the lowest level in 10 years. But in 2001, the rate jumped again, to 1.9%, a 1.1% increase over the previous year. It was the largest percentage increase between 2000 and 2001 of any of the 20 drugs or drug groups tracked by the study (which includes alcohol and tobacco), with the exception of steroids, which showed a 1.2% increase among twelfth-graders.

Researchers involved in the study were unsure what caused the increase. The only other drugs that showed usage gains among twelfth-graders between 2000 and 2001 were marijuana and hashish (0.2%), hallucinogens other than LSD (0.1%), PCP (0.2%), MDMA or ecstasy (0.7%), amphetamines (0.6%), tranquilizers(0.4%), and Rohypnol (0.3%). Since most of the increases were in the so-called club drugs, it is likely that amyl nitrite is being used in conjunction with these drugs.

Amyl nitrite was not tracked among eighth- and tenth-graders in the MTF study, but was included in the general category of inhalants. Data from national and state surveys have found that inhalant abuse is most commonly found in junior and senior high school students, reaching a peak in seventh through ninth grades. In the MTF survey, about 20% of eighth grade students said they have sniffed inhalants. This compared to about 16% of tenth-graders and 15% of high school seniors.

One obvious question then is how can fewer tenth and twelfth grade students than eighth grade students report they have ever used inhalants? There are two possible answers, according to NIDA. First, older students may not remember their earlier use of inhalants. Second, and more troubling to researchers, is that many eighth grade inhalant abusers may have dropped out of school before they reached the twelfth grade.

Gender differences in inhalant abuse have been identified at different age levels, according to NIDA studies. One study showed inhalant abuse is higher for boys than girls in the fourth through sixth grades, occurs at similar rates in the seventh through ninth grades when overall use is highest, and is higher for boys in the tenth through twelfth grades. The National Household Survey on Drug Abuse (NHSDA) among Americans found that in 1998, the use of inhalants among 12- to 17-year-olds was evenly divided among boys and girls. The same study found that among 18– to 25-year-olds, the rate of inhalant abuse was twice as high among males compared to females. This suggest the long-term use of inhalants is much more common among males.

Inhalant abuse among eighth, tenth, and twelfth grade students gradually declined between 1996 and 1999, according to MTF surveys. However, the rates are still higher than they were in the late 1980s, according NHSDA data. Usage seems to vary from state to state. Few states track the use of amyl nitrite among students. One that does is Maryland, which reports one of the lowest rates of inhalant abuse among students.

In the rural state of West Virginia, 28.4% of high school students reported they had used an inhalant to get high in 1997, according to the Office of National Drug Control Policy (ONDCP). Among female students, the rate was 26.4% and among males, 30.6%. In neighboring Kentucky, the rate was 18.2% for 1999. In Ohio, which has both large urban and rural areas, 17.1% of high school students said they had used an inhalant, according to a 1999 ONDCP report. In Texas, a 1996 survey found that 20% of seventh and eighth grade students had used an inhalant to get high at least once.

In Britain, the trend is taking amyl nitrite into the general youth and adolescent population. A 2000 survey of 16-year-olds in northwest England found that more than 20% said they have used inhalants at least once. The number of Canadian youths between 12 and 17 years of age who have tried inhalants is between 3% and 5%, according to the Canadian Medical Association (CMA). However, the percentage is much higher among certain impoverished populations, such as the Inuit and Aboriginal communities, where the CMA stated the problem is widespread and epidemic.

MENTAL EFFECTS

Inhalants in general can, and often do, cause serious impairment of mental functions. They also can cause irreversible brain damage, particularly to the cerebral cortex and the cerebellum. This can result in personality changes, memory impairment, hallucinations, loss of coordination, and slurred speech, according to the ONDCP.

Amyl nitrite and other poppers can cause confusion, dizziness, drowsiness, and a slowed perception of time, even with only limited use. For these reasons driving, operating machinery, or any other work that requires being alert or responsive, is not recommended while under the influence of amyl nitrite. Amyl nitrite can also cause people to feel less inhibited, relaxed, and give them a sense of well-being and intensified emotions. This can impair judgment, especially when it comes to sexual behavior.

PHYSIOLOGICAL EFFECTS

Amyl nitrite is rapidly absorbed into the blood stream and quickly reaches the brain, with effects usually beginning five to 10 seconds after inhaling. The initial effects are often referred to as a "rush" or "head rush" and last from two to five minutes. It causes the walls of blood vessels to relax, resulting in lowered blood pressure. This increases pulse rate because the heart is beating faster than usual to restore normal blood pressure. It also causes facial flushing and dizziness. The dilation of blood vessels in the brain appears to trigger an increase in pressure in the brain, which may give rise to the euphoria reportedly experienced by users. Amyl nitrite also causes muscles to involuntarily relax. Adverse reactions include skin and throat irritation, nausea, and headache.

Harmful side effects

Poppers have the ability to cause asphyxia, which can cause a person to stop breathing and become unconscious, resulting in a lack of oxygen or excess carbon dioxide in the body. They can also cause a short-term deficiency of oxygen reaching the tissues of the body, a condition called hypoxia. When inhaled, amyl nitrite ions can burn sensitive mucous membranes in the throat, nose, and lungs, causing irritation, pain, coughing, bronchitis, and difficulty breathing.

Excessive use of amyl nitrite can be dangerous to anyone. However, people with anemia, diabetes, glaucoma, an overactive thyroid, or high blood pressure, or who have had a recent head injury or heart attack, are at greater risk for encountering severe health problems, according to the NIDA. Pregnant women should not use amyl nitrite or any inhalant since the chemical can cross the placenta into the fetus, causing damage. Adverse reactions and side effects may be more frequent and severe in persons over the age of 60.

Many nitrates and nitrites increase pressure in the nerves and blood vessels of the eyes, which can cause a feeling of pressure behind the eyes and a severe headache. This can lead to glaucoma, a potentially blinding eye disorder.

Amyl nitrite, as with other inhalants, have the potential to cause sudden sniffing death (SSD) syndrome. The condition is brought on by unexpected disturbances in the heart's rhythm, causing heart failure and death. SSD syndrome can result when a user deeply inhales a chemical for its intoxicating effect. This causes a decrease in available oxygen to the body. If the user becomes startled or engages in sudden physical activity, the flow of adrenaline increases from the brain to the heart, inducing cardiac arrest. Death occurs within minutes.

Overdose symptoms include nausea, vomiting, dangerously low blood pressure, difficulty breathing, fainting, cold skin, blue lips or fingernails, rapid heartbeat, and headache or a strong feeling of pressure in the head.

Long-term health effects

The nitrite ions generated by amyl nitrite inhalation increase the body's production of certain carcinogens, which increases the risk for cancer. They can also damage red blood cells by interfering with oxygen supply to vital tissues that can cause an often-fatal anemia. This type of poisoning happens most frequently to users who swallow rather than inhale the chemical. It requires immediate medical attention.

The National Institute on Drug Abuse reports that recent research conducted on laboratory animals shows a possible link between the abuse of amyl nitrite and the development and progression of infectious diseases and tumors. The research indicates that inhaling nitrites and nitrates depletes many cells in the immune system and impairs the way the immune system fights infectious diseases, such as HIV, gonorrhea, syphilis, hepatitis A, and chicken pox. This also means that in people with HIV, using amyl nitrite can increase the speed at which the virus replicates. The higher a person's viral load, the greater the risk for developing AIDS.

One problem with long-term inhalant abuse is that it can break down myelin in the body, according to a NIDA report. Myelin is a fatty tissue that surrounds many of the body's nerve cells called neurons. The nerve cells in the brain and spinal cord are like a "command central" for the body. They transmit messages that control just about everything the body does. If the myelin breaks down, the nerve cells may not be able to transmit messages.

This could happen in the frontal cortex, the area of the brain that solves complex problems and plans for the future. If inhalants make their way into the brain's cerebellum, which controls movement and coordination, they can make a person move more slowly or clumsily. Studies also show that nerve cells in the brain's hippocampus can be damaged by inhalants. Since the hippocampus controls memory, a person who repeatedly uses inhalants may lose the ability to learn new things, or may have a hard time keeping track of simple conversations.

Many persons who have abused inhalants, especially for prolonged periods of several days, find they have a strong need to continue using them. Compulsive use and a mild withdrawal syndrome can occur with long-term inhalant abuse.

Other long-term effects of amyl nitrite use are unclear. Mood swings and personality changes have been reported but have not been studied. Tolerance to poppers develops on repeated exposure. Chemical dependence does not occur, and the drugs have a low potential for psychological dependence.

REACTIONS WITH OTHER DRUGS OR SUBSTANCES

Amyl nitrite is commonly used in conjunction with other illicit drugs, including marijuana, cocaine, methamphetamines, and hallucinogens, to enhance the high. Doing so increases the risk of adverse reactions. A British survey published in 2000 found that a majority of young people at dance clubs and raves regularly used more than one drug at a time, with amyl nitrite often part of the mix. For example, 49% of those surveyed said they regularly used amyl nitrite in conjunction with ecstasy. The use of amyl nitrite with these and other so-called club drugs can lead to psychiatric problems and physiological conditions such as overheating, dehydration, and heart strain.

Amyl nitrite is particularly dangerous when combined with the prescription drug Viagra, used to treat impotence. Since both act to dilate blood vessels, taking the two together can cause blood pressure to drop to dangerous levels. This can lead to heart attack and stroke. Amyl nitrite also should not be taken by men using minoxidil (Rogaine) to treat hair loss, since it has the potential to reduce blood pressure.

Amyl nitrite can also be dangerous for people who take prescription medications to treat hypertension or high blood pressure. These include:

• Diuretics, such as hydrochlorothiazide and hydrochlorothiazide combinations (Aldoril, Capozide, Dyazide, HydroDiuril, Maxzide, and Lopressor HCT).
• Beta-blockers, including carvedilol (Coreg), atenolol (Tenormin), betaxolol (Kerlone), metoprolol (Lopressor, Toprol XL), penbutolol (Levatol), and propranolol (Inderal).
• Angiotensin-converting enzyme (ACE) inhibitors, such as benazepril (Lotensin), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), quinapril (Accupril), and ramipril (Altace).
• Calcium channel blockers, including diltiazem (Cardizem SR, Dilacor XR, Tiazac), nicardipine (Cardene), amlodipine (Norvasc), felodipine (Plendil), and enalapril maleate-felodipine ER (Lexxel).
• Angiotensin II receptor antagonists, such as losartan (Cozaar, Hyzaar), valsartan (Diovan), irbesartan (Avapro), and candesartan cilexetil (Atacand).
• Vasodilators, including guanfacine (Tenex), methyldopa (Aldomet), prazosin (Minipress), terazosin (Hytrin), hydralazine (Apresoline), and minoxidil (Loniten).

Amyl nitrite can also act adversely or unpredictably in people taking heart medications such as nitroglycerine, or anti-depression medications. There is also new research that suggests amyl nitrite can interfere with and reduce the effectiveness of HIV medications. Of particular concern are protease inhibitors, such as indinavir (Crixivan), saquinavir mesylate (Invirase), nelfinavir mesylate (Viracept), and ritonavir (Norvir).

TREATMENT AND REHABILITATION

There are no withdrawal symptoms for amyl nitrite commonly associated with other inhalants. Since amyl nitrite is not addictive, there is no suggested treatment or rehabilitation regimen that is specific to the drug. However, since amyl nitrite is often used in combination with other drugs, abusers are likely to benefit from drug dependency treatment programs, including counseling.

As with all abused drugs, education and knowledge regarding the dangers of sniffing amyl nitrite is a key to preventing use and in getting help when abuse occurs. Studies show that peer pressure is the number one reason young people try drugs. Therefore, it is important that young people not only resist the pressure, but try to persuade friends who are using amyl nitrite or abusing any drug to get help.

PERSONAL AND SOCIAL CONSEQUENCES

Amyl nitrite, unlike other inhalants, are abused primarily because they are believed to enhance sexual pleasure and performance through loss of inhibition. However, abandoning inhibition leads to unsafe sex and a much greater risk for sexually transmitted diseases, including HIV, hepatitis A, gonorrhea, and syphilis.

Studies and surveys in the United States and Great Britain show that people who use poppers generally tend to do worse in school and are more likely to drop out. Drop-outs are more likely to end up in low-paying jobs or become part of the welfare system. A number of studies show that people who abuse drugs are much more prone to illness, particularly viruses and other infections.

Students who are convicted of using or possessing amyl nitrite can be denied federal scholarships and loan guarantees, which may affect their ability to get a college education. In 2001, about 14,000 high school graduates were denied federal aid, at least temporarily, because of prior drug convictions.

LEGAL CONSEQUENCES

The FDA made the possession, use, or sale of amyl nitrite without a prescription illegal in the United States in 1969. In 1988, the U.S. Consumer Products Safety Commission banned the sale of butyl nitrite. However, the most commonly found poppers today contain cyclohexyl nitrite, which has a similar effect as amyl butyl nitrite. With cyclohexyl nitrite legal and readily available in the United States, the illegal use and sale of amyl and butyl nitrite is limited. Researchers point out that regardless of the legal status, the dangers of using any nitrite or nitrate are similar.

The laws and punishment regarding possession of poppers in the United States vary from state to state. In some states, it is illegal to inhale any type of fumes for the purpose of intoxication. For example, in New York, possession or use of any alkyl nitrite, including amyl, butyl, and isobutyl, is a Class A misdemeanor, which carries a jail term of up to one year. The judge also has other punishment options, including imposing a fine and driver's license suspension or revocation. In Connecticut, conviction for possession of amyl nitrite without a prescription carries a penalty for a first offense of up to seven years in prison and a fine of up to $50,000. The maximum penalty for a second conviction is 15 years in prison and a fine of $100,000.

Possession of amyl nitrite without a prescription in Pennsylvania is a misdemeanor under the state's Controlled Substances, Drugs, Devices, and Cosmetics Act. A first-time conviction carries a penalty of up to three years in state prison and a fine of up to $5,000. A second offense conviction carries a penalty of up to three years in prison and a fine of up to $25,000. In Georgia, amyl nitrite is considered a "dangerous drug." A conviction for possession without a prescription carries a penalty of up to a year in jail and a fine of up to $5,000. A conviction of amyl nitrite possession in South Dakota is a Class One misdemeanor. It carries a maximum penalty of one year in county jail and a fine of $1,000 for the first offense.

Several states have made it a crime to drive while under the influence of poppers, regardless of the formula. New Jersey adopted a law in 1995 that specifically bans driving while under the influence of amyl, butyl, ethyl, or propyl nitrates or nitrites. It further bans driving while under the influence of any inhalant or other substance that releases a toxic vapor or fumes capable of causing intoxication, inebriation, excitement, stupefaction, or the dulling of the brain or nervous system.

Conviction under the New Jersey law carries a fine of between $250 and $400 and up to 30 days in jail for a first offense. The offender can also lose their driver's license for six months to a year. For a second conviction, the penalty is a $500 to $1,000 fine and up to 90 days in jail. Offenders must also perform 30 days of community service work and lose their driver's license for two years. A third or subsequent conviction carries a $1,000 fine and up to six months in jail. Offenders also forfeit their driver's license for 10 years. In West Virginia, the minimum penalty for conviction of driving under the influence of amyl nitrite is one day in county jail and a $100 fine. The maximum sentence is six months in jail and a $500 fine.

California's Proposition 36

In 2000, California voters approved a ballot measure that allows state courts to sentence first- and second- time drug use offenders to rehabilitative treatment rather than jail or prison. The measure, Proposition 36 (Prop.36), also known as the Substance Abuse and Crime Prevention Act, took effect July 1, 2001. As of March 1, 2002, more than 15,000 individuals had been referred to treatment under Prop. 36. The law mandates probation and drug abuse treatment for offenders instead of jail time. Persons sentenced under Prop. 36 are required to spend up to a year in a state-approved treatment regimen. Treatment can include outpatient care, inpatient treatment at a halfway house, psychotherapy, and drug education and prevention classes. The law applies to persons convicted of possession of amyl nitrite without a prescription.

The philosophy behind the law is two-fold. First, it frees up jail and prison space for persons convicted of violent offenses. Second, it mandates treatment and education that a drug user may not get in jail. The goal of Prop. 36 is to reduce repeat drug use and lower crime rates. Drug policy officials say it is too early to determine if the California program is successful in achieving either of these goals. A similar measure, Proposition 200, was approved by voters in Arizona in 1996.

International penalties

The sale of amyl nitrite is illegal in Great Britain without a prescription. But the possession or use without a prescription is not illegal. In New Zealand, amyl and butyl nitrites are controlled under the Medicines Act of1981. This Act limits the availability of substances that can be used as medicines and imposes penalties for misuse of these drugs. Penalties can be up to three months in jail, a fine of $500, or both. Police also can hold people under the influence of the drug for detoxification under the Alcoholism and Drug Addiction Act 1966. This is rarely done, since the visible effects of amyl nitrite use usually wear off after a few minutes.

Legal history

Federal law required a prescription for the sale, use, or possession of amyl nitrite until 1960, when the FDA lifted the requirement. The FDA reinstated the prescription requirement in 1969. Other poppers were banned in 1988, and the law was amended in 1990 to include a broader range of nitrites.

In Great Britain, the Medicines Act deems it illegal to sell amyl nitrite without a prescription. However, possession or use without a prescription is not a crime. Most other nitrates sold as poppers have escaped prosecution under the Medicines Act since distributors claimed they were room deodorizers and not marketed as medicine. However, the European Union (EU), of which Great Britain is a member, has issued a directive that any substance for sale that has a mood-altering or psychoactive effect can be classified as a medicine even if it is not labeled or marketed as such. The Medicines Control Agency, which administers the Medicines Act, has concurred with the EU directive, although as of early 2002, there was no move to control or ban poppers.

Federal guidelines, regulations, and penalties

The federal Food, Drug, and Cosmetic Act bans the sale, possession, or use of amyl nitrite without a prescription. The law is usually enforced for trafficking in the drug. Federal charges of sale or possession brought in a federal court usually constitute a misdemeanor. Conviction carries a penalty of one year in prison and/or a $1,000 fine per count for a first offense. A second offense is usually a felony. Conviction carries a penalty of up to three years in federal prison and up to a $250,000. Most enforcement is left to state and local law enforcement agencies. Penalties and enforcement vary from state to state.

See also Inhalants

RESOURCES

Books

Monroe, Judy. Inhalant Drug Dangers. Berkeley Heights, NJ: Enslow Publishers, Inc., 2002.

Young, Ian. The Stonewall Experiment: A Gay Psychohistory. New York: Cassell, 1999.

Periodicals

Bradberry, S.M. "Volatile Nitrite Abuse: Mechanisms of Toxicity, Features, and Management." Journal of Toxicology: Clinical Toxicology (March 2000): 178.

Heredia, Christopher. "'Poppers' Link to HIV Prompts Call For Warnings in S.F." San Francisco Chronicle (Oct. 25, 2001): A22.

Lyttle, John. "Try and Ban Them If You Like. But You Won't Change the Undeniable Fact: Poppers Rule." The Independent (London, England). (Jan. 17, 1997): 4.

McGarvey, E.L., et al. "Adolescent Inhalant Abuse: Environments of Use." American Journal of Drug and Alcohol Abuse. (Nov. 1999): 731-741.

Meyerhoff, Michael K. "Facts About Inhalant Abuse." Pediatrics for Parents (July 2001): 9.

Scheller, Melanie. "Inhalants—Don't Let Them Take Your Breath Away." Current Health 2 (A Weekly Reader Publication). (Sept. 2000): 16.

Stapleton, Stephanie. "'Household High' Found to be Growing Threat to Teen Health." American Medical News (April 10,2000): 32.

Organizations

National Institute on Drug Abuse (NIDA), National Institutes of Health, 6001 Executive Boulevard, Room 5213., Bethesda, MD, USA, 20892-9561, (301) 443-1124, (888) 644-6432, [email protected], <http://www.drugabuse.gov>.

Ken R. Wells