Submission from NAT (National AIDS Trust)

1. NAT (National AIDS Trust) is the UK’s leading policy and campaigning charity on HIV.  We welcome the opportunity to provide evidence to the Home Affairs Select Committee on the Psychoactive Substances Bill. 

2. We wish briefly to raise concerns about the possible implications for gay men’s health of the Psychoactive Substances Bill, in relation to the consequential prohibition on the sale of all alkyl nitrites (often known as ‘poppers’ or ‘aromas’). 

3. Alkyl nitrites are used by many gay men to enhance pleasure during sex.  They also for many facilitate anal intercourse.  There have recently been two large convenience samples of UK gay men surveyed around drug and alcohol use – EMIS in 2010 and the Gay Men’s Sex Survey in 2014 – undertaken by Sigma Research in the London School of Hygiene and Tropical Medicine.  They found that 32% and 28% respectively of respondents had used alkyl nitrites at least once in the previous four weeks, making it the third most popular psychoactive substance after alcohol and tobacco.[1]

4. Alkyl nitrites are not exclusively used by gay men but gay men certainly use them far more than others.  Comparative statistics from the Crime Survey for England and Wales 2013/14[2] found amyl nitrite[3] use in that year for heterosexual women was  0.3% and for lesbian/bisexual women 2.4%; and for heterosexual men 0.8% and gay/bisexual men 14.3%. So gay/bisexual men were about 18 times more likely to use poppers in that year than heterosexual men, and lesbian/bisexual women were about eight times more likely to use them than heterosexual women.

5. In terms of possible harms from the use of alkyl nitrites, looking at data from the Crime Survey[4], deaths where alkyl nitrites are cited as a contributory cause number only 11 over 20 years from 1993 to 2013, and those deaths were in all probability not using the alkyl nitrite now in common use – isopropyl nitrite.  There is some evidence of increased HIV transmission risk from use of alykyl nitrites.[5]

6. However, alkyl nitrites describe a group of chemical compounds.  Particular compounds have in the past raised other health concerns and as a result effective regulatory action has been taken.  Amyl nitrite, once commonly used, is now banned for non-prescription use under the Medicines Act 1968.  Butyl nitrite is banned by the EU as a carcinogen.  As a result, these substances are not sold in shops – the common compound which is sold is isopropyl nitrite.  Isopropyl nitrite is not wholly benign.  Excessive or extensive use can lead to maculopathy (damage to the eye).

7. NAT is concerned at the possible total prohibition on the sale of alkyl nitrites, given how widely and commonly they are used by gay men.  Our fear is that were the Bill in its current form to become law, this would not end use of alkyl nitrites but simply drive retail and use ‘underground’.  This would take the use of alkyl nitrites outside any regulatory regime which might successfully protect gay men from particular compounds with serious health harms.  We would expect health harms, and even possibly deaths, to increase as a result.

8. In addition to such health harms, if gay men move from buying alkyl nitrites in shops to buying them from drug dealers, there could be a risk of migration to the use of other drugs.

9. There are some concerns about increased HIV risk from use of alykyl nitrites but we believe public health interventions will be more effective to address such risks than prohibiting their sale.

10. NAT recommends that alkyl nitrites, not otherwise restricted or prohibited through regulation, be exempted in Schedule 1 from the provisions of the Bill.

NAT

August 2015