Experts from the Australian Federation of AIDS Organisations (AFAO) and the National LGBTI Health Alliance have slammed the Therapeutic Goods Administration’s proposal to ban poppers by placing them in the same category as heroin in Australia.
Poppers are an inhalant used recreationally by some in the gay community, giving users a brief head rush while clubbing or to relax muscles during anal sex.
But while it’s currently illegal to sell, supply or inhale the products unless prescribed by a doctor, poppers occupy a legal grey area and can be bought variously labelled as room deodoriser, “vinyl cleaner”, “DVD cleaner”, or similar.
Common side-effects of poppers include headaches, dizziness and temporary erectile dysfunction, but the products are not thought to create long-term health issues unless the user has pre-existing health conditions.
The proposed ban would move the product’s ingredients, a group of substances called alkyl nitrites, to Schedule 9 of the Poisons Standard and potentially expose those caught selling, using or possessing poppers to criminal charges.
“There are increasing reports of misuse and abuse of ‘poppers’ containing short chain volatile alkyl nitrites for purposes of recreational use alongside narcotics in the clubbing/dance scene in Australia and globally,” the TGA explained.
“Ophthalmologists in Australia are reporting an increase in the number of cases of maculopathies (retinal damage) caused by recreational use of poppers/’lubricants’ containing alkyl nitrites. These reports have also been observed internationally.”
‘Limited evidence of harm’
In a joint submission responding to the TGA’s interim decision on the ban, AFAO and the National LGBTI Health Alliance say the decision “significantly overstates the toxicity of the substance and the potential for abuse” and is based “upon limited evidence of harm”.
Instead, the proposed ban “will cause far more significant harm through the criminalisation of marginalised populations than that caused by the use of alkyl nitrites,” the submission reads.
It states that various forms of alkyl nitrites have been widely used by gay men for over four decades, but there was “very little evidence of harm” over that period.
“Multiple assertions of high rates of harm from the use of these alkyl nitrites are listed in the reason for the change, however, almost no substantive evidence of this harm is provided beyond rare instances of vision problems, methaemoglobinaemia and a small number of calls to the poison hotline,” the submission reads.
“While the reports of a small number of people with short term deterioration in vision are concerning, the evidence of significant harm is inconsistent.
“While one quoted source indicates that some vision loss could be permanent, another indicates that this appears to be rectified quickly on consultation with medical professionals and the cessation of use of the substance.”
The groups said the evidence presented by the TGA “takes the form of anecdotes and case studies rather than systematic evidence of harm.”
“Many of the anecdotes provided relate to unusual circumstances, such as rare pre-existing conditions and highly excessive use, both of which are best managed through health service engagement and not the criminal justice system,” the submission reads.
The AFAO and Health Alliance submission points to one study quoted in the TGA’s decision that drew a link between a “change in substance being used” in the poppers and the apparent appearance of symptoms.
“That is to say, the regulation of a less harmful alkyl nitrite caused a new version to be used that had more (albeit still limited) risks associated with it,” the submission reads.
“Given the ubiquity of use within parts of the gay community, it is likely that demand for alkyl nitrites would continue and be met through unregulated supply or, in the alternative, chemical variations that have unknown harms.”
In the submission, AFAO and the National LGBTI Health Alliance recommend “that the most appropriate way of managing uncertainty around alkyl nitrite use in the community is through health promotion activities and through healthcare professionals discussing use with individuals in medical consultations.
“This would be significantly more effective, from a cost and public health perspective, than regulatory changes leading to a criminal justice response.”
‘Regulate poppers like Viagra’
The TGA’s proposal to reclassify poppers has caused outrage among users in the LGBTIQ community, who have instead called for tighter regulation of the products in a similar way to sex aid Viagra.
A Change.org petition started by activist Steve Spencer calls on the TGA to abandon the blanket ban and instead “regulate the substance for safe use” by receptive sexual partners.
“Poppers are not a drug of dependance or addiction and result in little harm,” activist Steve Spencer wrote in the petition.
“The TGA has proven capable of regulating Viagra (a comparably dangerous substance) for the benefit of active partners.”
A similar ban on poppers was considered in the United Kingdom in 2016 but was rejected by the government after its advisory body found popper use was “not seen to be capable of having harmful effects sufficient to constitute a societal problem.”