UK Ban on Poppers Could Have Disastrous Health Consequences for MSM

As the myopic Psychoactive Substances Bill nears being waved through Parliament and into law, the future of alkyl nitrites -- or, poppers -- hangs in the balance, with the proposed ban set to have devastating consequences for some men who have sex with men (MSM).

On January 20, the Bill reaches the report stage before the House of Commons, and looks set to have its third reading that day, the government seemingly intent on ignoring the many proposed amendments to the legislation.

To say the Bill overreaches and is fundamentally flawed would be an understatement; indeed, its shortcomings are numerous, so much so that it is impossible to address them all here (see this briefing for more details). The ban on poppers in particular, though, is especially concerning as there's a very real risk that outlawing these will elevate the transmission of life-threatening viruses including HIV and increase the use of "hard drug"' among MSM in the UK.

A liquid chemical inhaled to give the user a short-term "rush," poppers dilate the blood vessels around the body, allowing more blood to enter the heart. This reduces blood pressure and relaxes voluntary and involuntary muscles, which in turn produces euphoria and disinhibition.

Poppers are widely-used in the UK by men who have sex with men. According to the Gay Men's Health Collective (GMHC), a “major wholesaler sold 180,000+ bottles to the UK in 2014; and in 2013, 300 people filled in a short anonymous survey for [charity] GMFA about using drugs while having sex 70.1% [of which] reported using poppers during sex”.

Experts argue that poppers reduce the risk of sexually transmitted infections and are essential to the sexual health of some MSM. The GMHC told TalkingDrugs that the combination of lubricant and poppers, "significantly reduces potential tearing or damage to the anal canal," adding, "if poppers are banned then the likelihood of serious harm increases and transmission of HIV, Hepatitis C and other STIs".

Any rise in sexually transmitted infections would be extremely concerning because of the already high prevalence of HIV and Hepatitis C among MSM. Currently one in seventeen MSM in the UK are HIV positive rising as high as one in eight MSM in London. This demographic, approximately 2-3 percent of the population, accounted for 54 percent of new HIV diagnoses in 2013. Additionally 8.6 percent of HIV positive MSM in the UK are also suffering from Hepatitis C infection.

Although psychoactive substances like alcohol, caffeine and tobacco will be exempted under the legislation, the Conservative government has thus far refused to follow the advice of the Home Affairs Select Committee that poppers should be included in the list of exempted "traditional" drugs. A small cross-party coalition have similarly proposed an amendment prior to the report stage to exempt poppers, though the chances of that being considered look slim.

For a population already dealing with considerable stigma, the additional burden of criminalisation for a positive sexual health aid like poppers is extremely counterproductive to increasing engagement with health services and awareness of managing sexual risks.

Worryingly, increased sexual health dangers are not the only negative predicted consequences of outlawing poppers. The small-scale nature of the poppers scene means the drug is unlikely to be quickly supplied by the black market after it is banned, if at all.

Instead, people who use poppers could be drawn towards more "readily available" stimulant drugs like GHB/GBL, ecstasy, ketamine, amphetamines, and methamphetamine (crystal meth), to create the same high. “A gay man who has never considered taking anything else except poppers [would] be tempted/ introduced to a dose of GHB/GBL or ketamine to facilitate sex” GMHC said.

In contrast to drugs like GHB/GBL which notoriously have a very fine margin between euphoric high and overdose, poppers are a considered a relatively safe drug. As long as they are not ingested, poppers rarely result in long term health complications and any implication in drug-related deaths tends to be in conjuction with other drugs or related to long-term health problems.

Removing a widely-used and relatively safe substance like poppers could whip up a perfect storm; the Bill's potential impact on the MSM community is a chastening reminder of the politicisation of drug use over proven harm reduction measures.