Can I use poppers if I’m in drug treatment? Advice from a substance use counselor

Editor’s note: Are poppers safe? Are poppers addictive? Are poppers considered a drug? Are poppers legal? You’ve got questions and Jeremy Prillwitz, MA, CATC, a counselor for the Stonewall Project at San Francisco AIDS Foundation has answers. Jeremy is part of the dedicated team of harm reduction specialists who work with clients to identify changes they are interested in making to how they use drugs and alcohol. Find out more at sfaf.org/stonewall.

As a substance use counselor with the Stonewall Project at San Francisco AIDS Foundation, clients oftentimes ask me how (or if) poppers fit into substance use treatment. Are poppers a dangerous “gateway” drug that might cause a slip back into meth use? Or are they a relatively benign drug that’s unfairly targeted by abstinence-only groups?

Although the individualized nature of substance use change means there’s no one right answer for everyone, I think that poppers can serve as a valuable harm reduction tool for some gay men. Here’s why.

First, what are poppers?

If you stop in any sex store or tobacco shop, you’ll find an amazing array of “room deodorizers” in small, brightly colored bottles with names like “Rush” and “Jungle Juice.” These bottles are poppers: liquid alkyl nitrites—a drug that relaxes muscles and increases blood flow.

People (and lots of gay men) use them to enhance sex and for the major head rush they give. They’re a drug that’s closely associated with gay party culture, and available legally without a prescription in California as long as they contain alkyl nitrites other than amyl nitrite, and as long as they’re sold for purposes other than for having fun.

The backlash against poppers

There’s no lack of backlash against poppers in the gay community. In the early days of the AIDS epidemic, poppers were even blamed for causing AIDS.

“Don’t use poppers. This is the first and last thing to be said about them,” wrote Wilson and John Lauritsen in the book Death Rush: Poppers & AIDS, published in 1986.

This book (which reads like the poppers-version of Reefer Madness) promoted what was known at the time as the “drug hypothesis” of AIDS which argued that all AIDS deaths were connected to and likely caused by drug abuse (a not uncommon assumption at the time):

A large and growing body of medical research indicates that poppers are dangerous, and almost certainly implicated in causing AIDS. And yet the government agencies blithely accept the lie that poppers are only a harmless “room odorizer.”

Years later, we know that poppers are not the cause of HIV/AIDS and the outlandish attacks against poppers as the cause of AIDS have faded into history. Now, anti-poppers messages come from a new place: the recovery community.

The early 21^st century gay crisis du jour was the use of crystal meth and its effects in the community. Meth is recognized as a “driver” of new HIV infections, since it can reduce inhibitions and lead to behavior that is higher risk for HIV and other STIs. Since meth is heavily associated with gay sex, and so are poppers, many abstinence-based support groups like Crystal Meth Anonymous have taken a very public stand against poppers.

Essentially, the many who support abstinence-only substance use treatment claim poppers are a gateway drug back to meth for people who are trying to stop using. No study has ever shown a causal relationship between using poppers and relapsing on meth, but it remains the mainstream position among 12-steppers that using poppers IS a relapse, whether it leads to meth use or not. Here is an example from Crystal Meth Anonymous, Minnesota:

“Whatever your history with alcohol and other mind-altering substances, believe us when we tell you that our relapses have almost always begun with a whiff of poppers, a puff of a joint, or a stop in a neighborhood bar. For some of us, it took time, but for most it happened fairly quickly: That innocent escape sent us to our dealers in search of the real thing.”

On the other hand, harm reduction philosophy doesn’t demonize any particular drug—and rather helps people investigate why the use of one or more substances isn’t working.

Substituting one drug for another

Harm reduction-based drug treatment believes that substituting one drug for another can be a realistic and helpful strategy to help people stay away from drugs that are problematic.

An example that I’ve seen people use in their lives is to substitute marijuana for alcohol, opioids and meth.

With meth and poppers in the gay community, the harm reduction potential is enormous. Many gay men who quit meth find that not using meth can make their sex lives extremely difficult. Not having a satisfying sex life can be a major reason why some men relapse and start using meth again.

Finding other ways to facilitate sex—in place of meth—is essential.

Using poppers, as a way to facilitate sex without meth, is a real and effective solution for some people. Many former meth users are quite experienced with poppers, and may have built an association between poppers and sex well before they ever tried meth. The notion that the popper/sex connection can be re-established without meth in the picture is not at all outlandish. Many gay men who have quit meth are doing just that.

What do people in the community say?

In my tenure as a counselor for Stonewall Project, I’ve never had a participant say that poppers has led to unwanted meth use. In an informal survey about poppers among people with a history of meth use, people said things like¹:

“I don’t think there is any correlation between meth and poppers. My past experience has been to forgo the poppers when using meth, even though my intention was to inhale poppers.”

In other words, meth was serving the same purpose as poppers, which was to facilitate sex.

Several people said that meth and poppers do not mix well, which is another indication that poppers are not associated with meth for many guys. “Poppers and meth don’t mix well,” and, “Poppers do not affect my ability to abstain from meth,” said two people.

Some people do have concerns about poppers and if it might lead to meth use. “If I use poppers, I will probably want to smoke meth,” one person said. Another stated, “Any mind-altering substance is harmful.”

Harm reduction tips on using poppers

Like any substance, misuse of poppers can lead to problems. To reduce the harm that can come from using poppers:

• Do not swallow the liquid base of poppers. To avoid ingesting poppers, it can be helpful to soak a cotton ball with the poppers and place it in a separate container, as this reduces the possibility of splashing.
• Do not use poppers with Viagra or other erectile dysfunction drugs. The interaction between these drugs be very risky since it can lead to a significant reduction in blood pressure and possible fainting.
• Do not smoke while using poppers. Poppers are flammable.
• Before using poppers, make sure you’re in a place where no meth is available (if you’re worried that using poppers can lead to unwanted meth use).
• If you’re comfortable doing so, talk to potential sex partners about the fact that you are into poppers, but not open to meth use.

Final thoughts

As many enormous changes have occurred in the gay community over the past several decades, one constant has been that familiar smell of poppers in dance clubs, bathhouses and private parties. The reality is that many gay men continue to use poppers for sex, and probably will continue to do so.

Make a fair assessment about your substance use, and think through if you can use poppers in a way that works for you. The Stonewall Project can help with this assessment, and help with goals that range from safer use to full abstinence. Talk to a substance use counselor if you have any concerns about the way that substances are (or are not) fitting into your life.

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Jeremy Prillwitz, MA, CATC is has been a counselor at the Stonewall Project since 2012. He is a frequent presenter on harm reduction at conferences and trainings. He is currently writing a book challenging the abstinence-only treatment monopoly in the U.S., and highlighting the positive and pro-social aspects of drugs.

Want to talk about the way you use drugs and alcohol?

The Stonewall Project is here to help. Stonewall offers free harm reduction counseling to gay, bi and trans men who want to assess their substance use and are thinking about making changes.

For more information and to seek services, visit stonewallsf.org.

¹Participants granted permission to share the following examples in this article.

Article written with input from Anibal Mejia, counselor for the Stonewall Project.