The Therapeutic Goods Administration has not properly weighed the risks and benefits of a blanket ban on alkyl nitrites, the main ingredient in sex aid “poppers”, a group of queer health advocates has said.
Poppers are used by gay and bisexual men and others to dilate the user’s blood vessels and relax muscles, helping receptive sexual partners comfortably enjoy anal sex. The products are not thought to create long-term health issues unless the user has pre-existing health conditions.
But the TGA is proposing five types of alkyl nitrites be reclassified under schedule 9, alongside marijuana and heroin and effectively criminalising their possession and use.
In its interim decision the TGA claimed that there is a “high potential for misuse and abuse of alkyl nitrites for euphoric properties, and as sex aids due to their muscle relaxant properties” in “particular sections of the community”.
On Thursday, sexual health physician Dr Vincent Cornelisse and community health advocate Mr Daniel Reeders met with the TGA to discuss the clinical issues and community impact of the proposed ban on poppers.
A submission to the TGA co-authored by Dr Cornelisse and Reeders and three others presented research showing despite widespread use of poppers, known “adverse events” associated with their use were relatively uncommon, making criminalisation “disproportionate to the risk”.
The authors said the TGA had listed “the benefits of use as risks of use” in their interim decision and poppers’ “analgesic and muscle relaxant effects” was a “legitimate, beneficial and therapeutic use” during anal sex.
“Use as sex aids due to their muscle relaxant properties should not be considered misuse and abuse of these substances,” they argued.
Reduce ban to isopropyl nitrite only
The TGA said in its interim decision that “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.”
But Dr Cornelisse and Reeders argues those cases only emerged after a decision by the European Union to ban isobutyl nitrite – at the time the most common active ingredient in poppers – leading to substitution of isopropyl nitrite, a substance UK researchers have attributed as the most likely cause of the vision loss.
They said the risk of vision loss to users could be addressed with a more limited ban on isopropyl nitrite alone.
Community education remains the most effective strategy to reduce the risks of use, while criminalisation may make it harder for patients to disclose use to their doctors, they said.
Dr Cornelisse said the doctor-patient relationship is “built on trust and full disclosure” but the proposed ban “could make patients think twice about telling their doctor about their poppers use.”
“Men who currently use poppers for more adventurous sexual encounters might consider illicit drugs for the same purposes – with greater risks of overdose and dependence,” he said.
A blanket ban on alkyl nitrites might lead to popper users turning to more dangerous substances, they told the TGA.
Other risks of accidental exposure – poppers can be fatal if the liquid is consumed – could be addressed via child-safe packaging, and accurate warnings and instructions for use on product labelling.
‘We weren’t going to take this lying down’
“Our goal in the submission was to quantify the risks based on evidence, and to highlight the benefits and purposes of poppers use,” Reeders explained.
“We are hopeful this meeting signals the TGA are considering alternatives to prohibition that acknowledge queer and partygoer communities are capable of responsibly managing health risks.”
Reeders acknowledged the efforts community activists like Steven Spencer and Nic Holas, who started the Change.org petition, for mobilising and coordinate community opposition to the TGA’s proposed ban.
“There was a really strong community response that was cheeky and energetic – they really demonstrated that we weren’t going to take this lying down,” he said.
“We acknowledge the TGA did not start out with any intention to criminalise queer people – and they might have been a bit surprised by the strength of the community response.
“But over 90,000 gay and bisexual men have used poppers in the last six months, and that’s a lot of people who would, almost overnight, become liable to fines or even prison.”