Hank Wilson, a San Francisco switchboard operator, became worried five years ago because a boyfriend inhaled a foul-smelling chemical excessively for a sexual "rush." The more he read up, the more upset he became about "poppers."
Concern about alkyl nitrites--marketed as room odorants but known as poppers on the street and on the dance floor--has heightened considerably in recent months after new research into their possible connection to the AIDS epidemic.
"First, they said poppers caused AIDS. Then in 1983 the federal Public Health Service printed a booklet that said nitrites didn't cause immune system suppression. In 1985 they revise the booklet to say 'don't use inhalants.' No wonder there is so much confusion," said Wilson, who has spearheaded the effort in California to place restrictions on their sale. "Hank's the guy who hounded us into doing it," said Bruce Decker, head of the California AIDS Advisory Committee, which last year asked the state health department to require warnings at the point of purchase. So far, officials have not acted on the recommendation.
Wilson's anger--and differences among government officials over how to deal with the chemical--are symptomatic of the debate over alkyl nitrites. In some ways, efforts to regulate the chemicals because of concerns they may contribute to acquired immune deficiency syndrome reprise the arguments over closing gay bathhouses.
While federal officials say that manufacturers have been able to avoid regulation by clever marketing and some gay-oriented businesses have voluntarily dropped the products, state and local governments have stepped into the debate, which has been marked by shifting medical opinions. Eleven states--including New York, which has the most AIDS cases in the country--have restricted sale and use of the chemicals.
Health Concern Cited
And the debate is heating up in California, where county supervisors in San Francisco and Los Angeles and the City Council in West Hollywood are considering similar actions. The Los Angeles board today is expected to order a study on a recommendation of the Public Health Commission to ban sales of poppers, according to aides of Supervisor Edmund D. Edelman.
Dr. Shirley Fannin, deputy director of the Los Angeles County Health Department, recommends a total ban. "Even use as a room (odorant) means than any person who walks into that room will be exposed to it. This is intolerable from a public health standpoint," she said.
"It is a dangerous substance and should be banned," said attorney Walter Kaplan. "It is being marketed as a room (odorant), but the stuff stinks like a locker room, and it is being inhaled. The federal government has failed to regulate it."
Kaplan represents a former San Francisco government clerk, Ted Tilley, who has filed a product liability suit in San Francisco Superior Court against the maker and seller of the odorant for allegedly contributing to a stroke he suffered in 1982.
The federal Food and Drug Administration says that manufacturers have been able to skirt drug laws by marketing the chemicals as incense or room odorants.
"The makers have done their homework," said Edward Nida, an FDA spokesman. "There's not a damn thing we can do about it."
Butyl and isobutyl nitrites are chemically related to amyl nitrite, which was first used in the late 1800s to provide relief from angina pain. Amyl nitrite came encased in mesh pearls, which when opened caused a popping sound--thus the nickname. The drug dilates blood vessels, making it easier for blood to get to the heart.
Amyl nitrite was eclipsed by newer medicines and in 1960 the FDA eliminated a requirement that it be sold by prescription. Nine years later that status was reinstated because there was significant abuse among young adults. In the 1970s, after some manufacturers changed the chemical composition so a prescription was no longer needed, butyl and isobutyl nitrites began appearing in adult book stores, discos, bars, and bathhouses--primarily but not exclusively gay oriented.
In 1978, sales of poppers were estimated in one study at $50 million. Manufacturers will not reveal financial information, but some researchers believe that figure may have doubled. A survey of drug use among high school students conducted in 1979 by the University of Michigan found that one in every nine seniors had tried the inhalants.
The chemicals, which cost from $3 to $8 a bottle, have names such as Rush, Bolt, Locker Room and Crypt Tonight.
When inhaled, they make users feel lightheaded and, some say, act as an aphrodisiac. Drug experts say side effects can range from headaches and fainting to abnormally low blood pressure.
Spreading Abuse Noted
Spot checks of 26 hospitals nationally show growing abuse, according to the National Institute of Drug Abuse. In 1976, there was only one emergency case involving poppers at these hospitals. There were 25 cases in 1984.
Against this backdrop, government officials express frustration and disagreement over their role in regulating the product.
"Unless the manufacturers stop calling it room (odorant) and call it a drug with therapeutic properties, there is no regulatory handle we can grab hold of," says Nida of the FDA.
Bob Poth, a spokesman for the Consumer Product Safety Commission which reviews nitrite labeling, said, "As long as they are properly labeled as to intended use, toxicity and flammability, there's nothing we can do."
And Tony Guarino, a spokeswoman for the Federal Trade Commission, which oversees advertising claims of products, says nitrites "could pose a legal enforcement quagmire." If an ad does not encourage a use other than as an odorant, the legal question becomes whether the ads are deceptive because of "implied" claims, she said.
In 1977, the California Department of Health Services filed suit to halt sales of "Rush," arguing that it causes dramatic drops in blood pressure and could cause death. The suit was settled when Pacific Western Distributing Corp. of San Francisco agreed not to advertise it as a drug and to label it not for sale to minors.
Sales to Minors
Manufacturers of inhalants say that they support laws banning minors from buying their products, but say that a total ban is uncalled for.
"We fall into the same category as finger nail polish and glue, which have also been misused by some consumers," said Joseph F. Miller, chief executive officer of Indianapolis-based Great Lakes Products. "We recognize that the nitrite can be misused as inhalants. We have a responsibility for consumers, that's why we have warning labels that they should not be inhaled."
FDA officials point out that alkyl nitrites are used in large quantities in chemical manufacturing and for some industrial purposes.
The medical evidence has been almost as confusing as the government response.
In early 1981, when the AIDS epidemic began, doctors noticed almost all the victims used poppers. With not much else to go on, they first believed that the chemicals might be the cause. But that theory dissolved when the HTLV-III virus was isolated in 1984. However, because 90% of those exposed to the AIDS virus do not develop AIDS, the search for co-factors--social or medical conditions that make some more susceptible to contracting the disease--continues.
More than 25% of the approximately 18,000 AIDS victims have suffered from Kaposi's sarcoma, in which the blood vessels proliferate, causing skin tumors. More than 90% of the Kaposi victims are gay, and of those, 96% used inhalants, according to the federal Centers for Disease Control.
Researchers have looked into co-factors such as income, sex partners, medical problems and nitrite use. Dr. Harry Haverkos, epidemiologist at the National Institutes of Health, found that heavy use of nitrites was the co-factor most strongly associated with with Kaposi's and Pneumocystis carinii pneumonia.
Researchers at the National Jewish Center for Immunology and Respiratory Medicine, in studying mice, found that inhalation of nitrites may further impair the body's ability to fight off infectious disease in those with immune system abnormalities characteristic of AIDS.
"We believe our findings establish that inhaling isobutyl nitrite should be considered dangerous to those at high risk for AIDS," said investigator P.R.J. Gangadharam.
Beyond the inconclusive medical evidence, local officials are facing divided opinion from gay leaders over what to do.
Bay Area Prohibition
San Francisco in 1983 prohibited sale to minors and required point-of-sale health warnings. The city, on the recommendation of its health department, is now considering a ban on use in public but appears determined to sidestep the issue of private use.
In the meantime, the chemical is readily available and much of the gay press continues to run advertisements.
"For 18 years we have been fighting for the rights of gays who want to keep government out of their sex lives," said Michael Shively, associate publisher of the Los Angeles-based magazine the Advocate, which accepts ads for poppers. "There should be education and warnings about nitrites, like with cigarettes. Then people can decide for themselves."
Decker of the state AIDS Advisory Committee said his group called only for point-of-sale warnings because "When you ban it, all you do is increase the price of it."
"People are looking for a quick fix for AIDS. First it was close the bathhouses, now ban nitrites." Decker added, "It's our job to communicate risks. But it is shortsighted to think that stopping such things are going to stop AIDS. People should be more willing to put more effort into real solutions--more safe sex education and more money for research."