Amyl Nitrite Abuse
Amyl nitrite is a prescription medication used for the treatment of angina, a form of chest pain that occurs when the heart muscle receives insufficient amounts of oxygen. Outside of its medical context, it belongs to a group of substances called “poppers,” which are abused recreationally for their drug-like effects. In turn, poppers belong to broader range of recreationally abused substances known as inhalants. Misuse of amyl nitrite can lead to the onset of a number of significant health problems, including immune system suppression, red blood cell damage, and overdoses.
Amyl nitrite is also sometimes known as isoamyl nitrite or amyl nitrate. In the treatment of angina, it achieves its effects by dilating (widening) the blood vessels and thereby increasing the flow of oxygen-rich blood to the heart muscle. This increased blood flow eases the heart’s workload and decreases painful overexertion. Doctors also sometimes use the medication to counter the effects of cyanide poisoning. Potential side effects associated with prescribed use of amyl nitrite include an accelerated heartbeat, flushing of the skin on the neck or face, mild headaches, mental agitation, and dizziness that occurs primarily during changes in body position.
Status as a Recreational Drug
Along with amyl nitrite, substances used recreationally as “poppers” include butyl nitrite (isobutyl nitrite), isopropyl nitrite, and cyclohexyl nitrite. All of these substances belong to a class of chemicals known as alkyl nitrites. Their popularity as recreational drugs rests on their ability to induce a pleasurable state called euphoria, increase sexual libido, and relax the involuntary muscles found in the vagina and anus. While abuse of amyl nitrite and other poppers once occurred primarily among gay males in urban centers, abuse of these substances now also occurs among a variety of adults, especially people who frequent dance clubs or similar nighttime social environments. In some cases, people combine amyl nitrite or other poppers with MDMA (Ecstasy) or cocaine in order to increase the intensity of their euphoric state, or use poppers to ease withdrawal symptoms in the aftermath of Ecstasy or cocaine use.
Immune System Suppression
Use/abuse of amyl nitrite can reduce normal levels of important immune system components called CD3+ T lymphocytes. Apparently, this reduction is only temporary. At one point, doctors and researchers believed that amyl nitrite and other poppers could produce more lasting, systemic changes in immune function. In turn, this belief led some scientists to propose popper use as a potential contributing factor in AIDS development, especially within the gay community. However, no firm scientific evidence supports this proposition and, according to a study published in 2004 in the journal Pharmacotherapy, popper use among people who develop AIDS appears to be merely a statistical coincidence.
Red Blood Cell Damage
Abuse of amyl nitrite or any other popper can result in the onset of a red blood cell disorder called methemoglobinemia. This occurs when the presence of poppers triggers a structural change in hemoglobin, the protein inside red blood cells that carries oxygen through the bloodstream and releases it into tissues throughout the body. The structural change produced by poppers turns hemoglobin into a protein called methemoglobin, which has no ability to properly release its oxygen content. Possible consequences of the oxygen deprivation associated with uncorrected methemoglobinemia include convulsions, a potentially fatal condition called shock, and death. Some people already have pre-existing problems with high methemoglobin levels; these individuals have particularly high risks for fatal outcomes when they use amyl nitrate or any related substance.
People who inhale as little as 5 to 10 drops of amyl nitrite may experience an overdose. As with all other forms of drug overdose, this phenomenon occurs when the effects of the drug overwhelm key aspects of normal body function. Specific symptoms of an amyl nitrite overdose include fainting, shortness of breath, abnormally shallow breathing, an unusually rapid and/or weak heartbeat, abnormal fatigue or muscle weakness, nausea, vomiting, an unusual sensation of pressure accumulation in the head, abnormally low blood pressure, and a bluish skin discoloration in the fingers, hands, or lips.
Because of amyl nitrite’s relatively short period of activity within the body, overdoses of the drug do not typically pose high risks for death. However, risks for fatal outcomes may increase in people simultaneously affected by the symptoms of methemoglobinemia. In addition, the National Institute on Drug Abuse lists both amyl nitrite and butyl nitrite as potential causes of sudden sniffing death syndrome (SSDS), a form of unpredictable, rapid death that occurs when inhalant abuse makes the heart muscle unusually susceptible to the effects of naturally occurring chemicals in the body called epinephrine and norepinephrine.