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For other uses, see Popper (disambiguation). Variety of popper brands Poppers is a slang term for various alkyl nitrites inhaled for recreational purposes, particularly amyl nitrite, butyl nitrite, isopropyl nitrite and isobutyl nitrite.[1][2] Amyl nitrite is used medically as an antidote to cyanide poisoning,[3] but the term "poppers" refers specifically to recreational use. Amyl nitrite and several other alkyl nitrites, which are present in products such as air freshener and video head cleaner, are often inhaled with the goal of enhancing sexual pleasure.[4] These products have also been part of the club culture from the 1970s disco scene to the 1980s and 1990s rave scene.[5] Poppers have a long history of use due to the rush of warm sensations and dizziness experienced when the vapours are inhaled. Although, according to at least one analysis, poppers have a lower risk of harm to society and the individual than do certain other recreational drugs,[6] more recent cases have shown that serious adverse effects can occur, especially following acute exposure. In an article in the New England Journal of Medicine, an opthamologist described numerous cases in which recreational users of poppers experienced serious vision damage, particularly to the retina.[7] And with heavy long-term use there is a potential for neurological damage.[8] Swallowing or aspirating the liquid, rather than inhaling the vapours, is especially dangerous and can prove fatal.[9][10] Direct, concentrated inhalation of amyl nitrite and the other light alkyl nitrites leads to a non-specific relaxation of smooth muscle, resulting in coronary vasodilation and decreased systemic vascular resistance and left ventricular preload and afterload. In addition, the use of poppers has been associated with an increased risk of HIV infection and AIDS, though research concluded the relationship was not causal and due to the correlation with high-risk sexual behavior. There is some evidence to indicate that even occasional use of poppers may affect vision.[11] Contents 1 History 2 Effects 3 Health issues 3.1 Association with AIDS epidemic 4 Chemistry 5 Legality 6 See also 7 References // History Sir Thomas Lauder Brunton Known for Treatment of angina pectoris Sir Thomas Lauder Brunton (March 14, 1844–September 16, 1916), a Scottish physician, famously pioneered the use of amyl nitrite to treat angina pectoris. Brunton's clinical use of amyl nitrite to treat angina was inspired by earlier work with the same reagent by Arthur Gamgee and Benjamin Ward Richardson. Brunton reasoned that the pain and discomfort of angina could be reduced by administering amyl nitrite to dilate the coronary arteries of patients, thus improving blood flow to the heart muscle. In addition, the light alkyl nitrites cause the formation of methemoglobin wherein, as an effective antidote to cyanide poisoning, the methemoglobin combines with the cyanide to form nontoxic cyanmethemoglobin.[12] First responders typically carry a cyanide poison kit containing amyl nitrite, such as the popular Taylor Pharmaceutical Cyanide Antidote Kit.[13] TIME and the Wall Street Journal reported that the popper fad began among homosexual men as a way to enhance sexual pleasure, but "quickly spread to avant-garde heterosexuals" as a result of aggressive marketing. A series of interviews conducted in the late 1970s revealed a wide spectrum of users, including construction workers, a "trendy East Side NYC couple" at a "chic NYC nightclub", a Los Angeles businesswoman "in the middle of a particularly hectic public-relations job" (who confided to the reporter that "I could really use a popper now"), and frenetic disco dancers amid "flashing strobe lights and the pulsating beat of music in discos across the country."[14] User surveys are hard to come by, but a 1988 study found that 69% of men that had sex with men in the Baltimore/Washington DC area reported they had used poppers, with 21% having done so in the prior year. The survey also found that 11% of recreational drug users in the area reported using poppers, increasing to 22% among "heavy abusers," with an average age of first use of 25.6 years old. Both survey groups used poppers to "get high," but the men that had sex with men were more likely to use them during sex. It was reported that this group reduced usage following the AIDS epidemic, while the drug-users had not.[15] A 1987 study commissioned by the US Senate and conducted by the Department of Health and Human Services found that less than 3% of the overall population had ever used poppers.[16] Use by minors is historically minimal due, in part, to the ban on sales to minors by major manufacturers for public relations reasons and because some jurisdictions regulate sales to minors by statute.[17] A paper published in 2005 examined use of poppers self-reported by adolescents aged 12–17 in the (American) 2000 and 2001 National Household Surveys on Drug Abuse. In all, 1.5% of the respondents in this age group reported having used poppers. This figure rose to 1.8% in those over 14. Living in nonmetropolitan areas, having used mental health services in the past year (for purposes unconnected with substance use treatment), the presence of delinquent behaviours, past year alcohol and drug abuse and dependence, and multi-drug use were all associated with reporting the use of poppers.[18] In contrast to these low rates, a survey in the North West of England found a rate of 20% self-reported use of poppers among 16-year-olds.[5] Originally marketed as a prescription drug in 1937, amyl nitrite remained so until 1960, when the Food and Drug Administration removed the prescription requirement due to its safety record. This requirement was reinstated in 1969, after observation of an increase in recreational use. Other alkyl nitrites were outlawed in the USA by Congress through the Anti-Drug Abuse Act of 1988. The law includes an exception for commercial purposes. The term commercial purpose is defined to mean any use other than for the production of consumer products containing volatile alkyl nitrites meant for inhaling or otherwise introducing volatile alkyl nitrites into the human body for euphoric or physical effects.[19] The law came into effect in 1990. Visits to retail outlets selling these products reveal that some manufacturers have since reformulated their products to abide by the regulations, through the use of the legal cyclohexyl nitrite as the primary ingredient in their products, which are sold as video head cleaner, polish remover, or room odorants. Amyl nitrite, manufactured by Burroughs Wellcome (now GlaxoSmithKline) and Eli Lilly and Company, was originally sold in small glass ampoules that were crushed to release their vapors, and received the name "poppers" as a result of the popping sound made by crushing the ampule.[20] Today, reformulated poppers containing isobutyl nitrite are sold under brand names such as RUSH,[2][4], Locker Room,[2][4] Snappers,[2][21] and Liquid Gold.[1][2] Many different brands exist and are sold in different localities. Effects Inhaling nitrites relaxes smooth muscles throughout the body, including the sphincter muscles of the anus and the vagina.[3] It is unclear if there is a direct effect on the brain.[22] Smooth muscle surrounds the body's blood vessels and when relaxed causes these vessels to dilate resulting in an immediate increase in heart rate and blood flow throughout the body, producing a sensation of heat and excitement that usually lasts for a couple of minutes.[23] Alkyl nitrites are often used as a club drug or to enhance a sexual experience.[4] The head rush, euphoria, and other sensations that result from the increased heart rate are often felt to increase sexual arousal and desire.[4] It is widely reported that poppers can enhance and prolong orgasms.[1] While anecdotal evidence reveals that both men and women can find the experience of using poppers pleasurable, this experience is not universal;[24] some men report that poppers can cause short-term erectile problems.[1] Health issues Acute intake of poppers may cause asphyxia, arrhythmias, cardiovascular depression, carbon monoxide poisoning, hepatorenal toxicity, methemoglobinemia, neurologic dysfunction, mucosal, pulmonary, skin irritation and facial dermatitis. With chronic use neurological damage may occur.[8][25] Swallowing alkyl nitrites can cause serious acute medical complications and may result in death.[9] Accidental aspiration of amyl or butyl nitrites may lead to the development of lipoid pneumonia.[10] Poppers can interact with other vasodilators, such as sildenafil (Viagra), to cause a serious decrease in blood pressure, leading to fainting, stroke, or even heart attack.[26][27][28] Poppers can also increase intraocular pressure, resulting in glaucoma.[29][30] In reference to vision loss, a published case concluded "No similar cases have been described in the more than 100-year history of pharmacological use of amyl nitrite for angina pectoris, and pharmacologically it is hard to point out a rationale behind the sequential visual loss."[31][32] In October, 2010, Dr. Michel Paques at the Quinze-Vingts National Hospital in Paris, France reported that at least some people may suffer permanent or temporary eye damage from the use of poppers—even when the poppers are used only once—in a letter to the New England Journal of Medicine.[11] The significance of these isolated observations remains uncertain. Rarely, the use of poppers can cause methemoglobinemia and hemolysis, especially in individuals predisposed towards such a condition or in overdose. An overdose via ingestion (rather than inhalation) may result in cyanosis, unconsciousness, coma and even death. Methylene blue is a treatment for methemoglobinemia associated with popper use.[3][33][34][35] Other risks include burns if spilled on skin, loss of consciousness, headaches,[1][36] and red or itching rashes around the mouth and nose. The Merck Manual of Diagnosis and Therapy reports that there is little evidence of significant hazard associated with inhalation of alkyl nitrites.[4] A study and ranking of drugs for harmfulness devised by British-government advisers and based upon scientific evidence of harm to both individuals and society showed that poppers pose little potential harm to individuals or to society when compared to other recreational drugs.[6] A 1983 U. S. Consumer Product Safety Commission investigation Briefing Package stated that "Available injury data did not indicate a significant risk of personal injury or illness from room odorizer abuse."[37] Association with AIDS epidemic It has been suggested that poppers have been related to AIDS, HIV infection, and the AIDS-related cancer Kaposi's sarcoma.[38] Initially poppers were considered as a hypothesis for the then-burgeoning AIDS epidemic, and the idea has persisted in large part due to the activities of AIDS denialists as a pseudoscientific rationalization for the presence of AIDS in homosexual males.[39] Animal studies have suggested an association between alkyl nitrites and Kaposi's sarcoma, a type of skin cancer associated with HIV-positive individuals,[40][41] though a study of the use of poppers by HIV positive men did not support biological link between the two.[42] Instead it has been suggested the correlation was based on a bias among some popper users towards high-risk sexual behaviours.[43][44] In a 1986–1988 series of study reviews and technical workshops with leading authorities, mandated by the US Congress, it was concluded that nitrites are not a causal factor in AIDS infection or Kaposi's sarcoma.[16] A study that followed 715 gay men for eight and a half years published in the Lancet in 1993 rejected any causal relationship between AIDS and poppers.[45] Although the study did conclude an association between the use of poppers in the gay culture and contracting the HIV virus, it also concluded an association between anal sex and contracting the HIV virus. Citing this link, health authorities in some areas of the United States have mandated point of sale warnings on poppers.[46] Because of possible alterations to the immune system, it has been suggested that HIV positive individuals may face extra health risks from the use of poppers.[47] Chemistry Main article: Alkyl nitrites Poppers are a class of chemicals called alkyl nitrites. These are chemical compounds of structure R-ONO. In more formal terms, they are alkyl esters of nitrous acid. The first few members of the series are volatile liquids; methyl nitrite and ethyl nitrite are gaseous at room temperature and pressure. Organic nitrites are prepared from alcohols and sodium nitrite in sulfuric acid solution. They decompose slowly on standing, the decomposition products being oxides of nitrogen, water, the alcohol, and polymerization products of the aldehyde. Physical and Chemical Properties (Sutton, 1963): Butyl Nitrite Isobutyl nitrite Amyl (Isoamyl Nitrite) Formula CH3(CH2)2CH2ONO (CH3)2CHCH2ONO (CH3)2CHCH2CH2ONO Molecular Weight 103.12 103.12 117.15 Physical State Oily Liquid Colorless Liquid Transparent Liquid Boiling Point (°C) 78.2 67 97–99 Specific Gravity 0.9144 (0/4°C) 0.8702 (20/20°C) 0.872 Legality Around 1990, many Western governments banned the sale, importation or usage of alkyl nitrites (poppers) for use as an inhalant. In France, the sale of products containing butyl nitrites, pentyl nitrites, or isomers thereof, has been prohibited since 1990 on grounds of danger to consumers.[48] In 2007, the government extended this prohibition to all alkyl nitrites that were not authorized for sales as drugs[49]. After litigation by sex shop owners, this extension was quashed by the Council of State on grounds that the government had failed to justify such a blanket prohibition: according to the court, the risks cited, concerning rare accidents often following abnormal usage, rather justified compulsory warnings on the packaging.[50] Poppers remain available over the Internet, under descriptions such as "video head-cleaning fluid", "room aromas" or "polish remover", as they remain legal in countries such as Poland, the United Kingdom and China.[51] In the United Kingdom, poppers are widely available and frequently (legally[52]) sold in gay clubs/bars, sex shops, drug paraphernalia head shops, over the Internet and on markets.[53] It is illegal under Medicines Act 1968 to sell them advertised for human consumption, in order to bypass this they are usually sold as deodorisers.[1] See also Alcohol and sex Sex and drugs References ^ a b c d e f "Poppers". Frank. http://www.talktofrank.com/drugs.aspx?id=198. Retrieved 2007-03-14.  ^ a b c d e "Poppers: The effects, the risks, the law". TheSite.org. YouthNet UK. http://www.thesite.org/drinkanddrugs/drugsafety/drugsatoz/poppers. Retrieved 2007-03-14.  ^ a b c "Amyl Nitrite". Medsafe. New Zealand Medicines and Medical Devices Safety Authority. 2000-05-18. Archived from the original on 2006-11-11. http://web.archive.org/web/20061111105814/http://www.medsafe.govt.nz/Profs/datasheet/a/Amylnitrateinh.htm. Retrieved 2007-03-15.  ^ a b c d e f Porter, Robert S., et al., ed (November 2005). "Volatile Nitrites". The Merck Manual Online. Merck & Co.. http://www.merck.com/mmpe/sec15/ch198/ch198m.html#sec15-ch198-ch198m-400. Retrieved 2007-03-16.  ^ a b "Nitrites". Drugscope. Archived from the original on 2007-04-05. http://web.archive.org/web/20070405132026/http://www.drugscope.org.uk/druginfo/drugsearch/ds_results.asp?file=%5cwip%5c11%5c1%5c1%5cnitrites.html. Retrieved 2007-04-24.  ^ a b Nutt, D.; King, LA.; Saulsbury, W.; Blakemore, C. (Mar 2007). "Development of a rational scale to assess the harm of drugs of potential misuse.". Lancet 369 (9566): 1047–53. doi:10.1016/S0140-6736(07)60464-4. PMID 17382831.  ^ http://www.nytimes.com/2010/10/19/health/research/19vision.html?ref=science The New York Times: "Vision: A Quick High for Sex May Damage Vision" ^ a b Linden, CH. (Aug 1990). "Volatile substances of abuse.". Emerg Med Clin North Am 8 (3): 559–78. PMID 2201521.  ^ a b Dixon, DS.; Reisch, RF.; Santinga, PH. (Jul 1981). "Fatal methemoglobinemia resulting from ingestion of isobutyl nitrite, a "room odorizer" widely used for recreational purposes.". J Forensic Sci 26 (3): 587–93. PMID 7252472.  ^ a b Hagan, IG.; Burney, K. (Jul–Aug 2007). "Radiology of recreational drug abuse.". Radiographics 27 (4): 919–40. doi:10.1148/rg.274065103. PMID 17620459. http://radiographics.rsna.org/content/27/4/919.long.  ^ a b Mozes, Alan (October 16, 2010). "Club drug "poppers" may be linked to eye damage". USA Today. http://www.usatoday.com/yourlife/health/medical/2010-10-16-drugs-poppers_N.htm. Retrieved 2010-10-17.  ^ "AMYL NITRITE". New Zealand Medicines and Medical Devices Safety Authority. http://www.medsafe.govt.nz/profs/datasheet/a/Amylnitrateinh.htm. Retrieved 2008-03-27. [dead link] ^ "AMYL NITRITE". Emergency Medical Products, Inc. http://www.buyemp.com/product/1124401.html. Retrieved 2008-03-27.  ^ "Rushing to a New High". Time. 1978-07-17. http://www.time.com/time/magazine/article/0,9171,916269,00.html. Retrieved 2007-04-29.  ^ W.R. Lange, C.A. Haertzen and J.E. Hickey et al., Nitrite inhalants patterns of abuse in Baltimore and Washington, DC, Am J Drug Alcohol Abuse 14 (1988), pp. 29–39. ^ a b Kennedy, Edward, U.S. Senate, Chair Committee on Labor and Human Resources. "REPORT of the Committee on Labor and Human Resources."Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments of 1988. Section 4015. 1988. ^ Nickerson, Mark, John Parker, Thomas Lowry, and Edward Swenson.Isobutyl Nitrite and Related Compounds; chapter on "Sociology and Behavioral Effects" . 1st ed. San Francisco: Pharmex, Ltd, 1979. [1] ^ Ringwalt CL, Schlenger WE. Wu L (2005) "Use of nitrite inhalants ("poppers") among American youth",Journal of Adolescent Health 37 (1) Jul 2005, pp.52–60. ^ Anti-Drug Abuse Act of 1988 (Public Law 1QO-690,section 2404) (15 U.S.C. 2d57a(e)(2)). ^ "Poppers". homohealth.org. Lifelong AIDS Alliance. http://www.homohealth.org/mens_program/sexualhealth/poppers.htm. Retrieved 2007-03-18.  ^ "Inhalants". National Institute on Drug Abuse. http://www.drugabuse.gov/DrugPages/Inhalants.html. Retrieved 2007-03-15.  ^ Balster, RL. (Jun–Jul 1998). "Neural basis of inhalant abuse.". Drug Alcohol Depend 51 (1–2): 207–14. doi:10.1016/S0376-8716(98)00078-7. PMID 9716942.  ^ "?". http://www.drugs.com/ppa/amyl-nitrite.html.  ^ E.M. Brecher, while stating that he personally found amyl nitrite sexually unrewarding, quoted a lady friend as follows: "For me, an orgasm is like a hippopotamus. But with amyl nitrite, it is like a whole herd of hippopotami." E. M. Brecher and the Editors of Consumer Reports, Licit and Illicit Drugs (Little) 1972 ^ Foroozan, M.; Studer, M.; Splingard, B.; Cuny, JF.; Barbaud, A.; Schmutz, JL. (Mar 2009). "[Facial dermatitis due to inhalation of Poppers]". Ann Dermatol Venereol 136 (3): 298–9. doi:10.1016/j.annder.2008.02.027. PMID 19328321.  ^ Romanelli, F.; Smith, KM. (Jun 2004). "Recreational use of sildenafil by HIV-positive and -negative homosexual/bisexual males.". Ann Pharmacother 38 (6): 1024–30. doi:10.1345/aph.1D571. PMID 15113986.  ^ "Viagra May Cause Heart Attack Deaths In Younger Men With No Heart Problems, Study Finds". PSA Rising. http://psa-rising.com/medicalpike/viagracardiodeaths031500.htm. Retrieved 2007-03-15.  ^ "Experts See Dangerous Trend In Use Of Viagra With 'Party Pills'". Aetna InteliHealth. 2004-06-24. http://www.intelihealth.com/IH/ihtIH/WSIHW000/333/20789/351666.html. Retrieved 2007-03-18.  ^ Horwath, Ewald (2004-05-19). "Chemical addictions and their effect on someone with HIV". The Body. http://www.thebody.com/Forums/AIDS/Mental/Current/Q156977.html?h19o. Retrieved 2007-03-19.  ^ "Amyl Nitrate [sic]". Drug Factfile. Watton on the Web. http://www.watton.org/drugsinfo/aboutnitrates.shtml. Retrieved 2007-04-30.  ^ Fledelius HC (1999). "Irreversible blindness after amyl nitrite inhalation.". Acta Ophthalmol Scand. 77 (6): 719–721. doi:10.1034/j.1600-0420.1999.770625.x. PMID 10634573.  ^ Pece A, Patelli F, Milani P, Pierro L. (2004). "Transient visual loss after amyl Isobutyl nitrite abuse.". Semin Ophthalmol. 19 (3–4): 105–106. doi:10.1080/08820530490882292. PMID 15590547.  ^ Pruijm, MT.; de Meijer, PH. (Dec 2002). "[Methemoglobinemia due to ingestion of isobutyl nitrite ('poppers')]". Ned Tijdschr Geneeskd 146 (49): 2370–3. PMID 12510403.  ^ Stalnikowicz, R.; Amitai, Y.; Bentur, Y. (2004). "Aphrodisiac drug-induced hemolysis.". J Toxicol Clin Toxicol 42 (3): 313–6. PMID 15362601.  ^ Emergency Medicine: Principles and Practice. Harper & Collins, 2nd edition. 2008. pp. 42–51. ^ Wood, Ronald W. (1989) (PDF). The Acute Toxicity of Nitrite Inhalants. National Institute on Drug Abuse. pp. 28–29. http://hdl.handle.net/1802/1150. Retrieved 2007-03-15.  ^ CPSC, Staff Report (1983-07-10). "Briefing Package on Petition HP82-1" (PDF). U.S. Consumer Product Safety Commission. http://www.virusmythpoppersmyth.org/cpsc_report_1983/. Retrieved 2008-03-25.  ^ Drumright, LN.; Patterson, TL.; Strathdee, SA. (2006). "Club drugs as causal risk factors for HIV acquisition among men who have sex with men: a review.". Subst Use Misuse 41 (10–12): 1551–601. doi:10.1080/10826080600847894. PMID 17002993.  ^ "Debunking denialist myths". AIDStruth.org. http://www.aidstruth.org/denialism/myths#m2. Retrieved 2010-08-02.  ^ Fung, HL.; Tran, DC. (Sep 2006). "Effects of inhalant nitrites on VEGF expression: a feasible link to Kaposi's sarcoma?". J Neuroimmune Pharmacol 1 (3): 317–22. doi:10.1007/s11481-006-9024-4. PMID 18040808.  ^ Dunkel, VC.; Rogers-Back, AM.; Lawlor, TE.; Harbell, JW.; Cameron, TP. (1989). "Mutagenicity of some alkyl nitrites used as recreational drugs.". Environ Mol Mutagen 14 (2): 115–22. doi:10.1002/em.2850140207. PMID 2569972.  ^ Chao, C.; Jacobson, LP.; Jenkins, FJ.; Tashkin, D.; Martínez-Maza, O.; Roth, MD.; Ng, L.; Margolick, JB. et al. (Feb 2009). "Recreational drug use and risk of Kaposi's sarcoma in HIV- and HHV-8-coinfected homosexual men.". AIDS Res Hum Retroviruses 25 (2): 149–56. doi:10.1089/aid.2008.0196. PMID 19108691.  ^ Romanelli, F; Smith, KM; Thornton, AC; Pomeroy, C (Jan 2004). "Poppers: epidemiology and clinical management of inhaled nitrite abuse.". Pharmacotherapy 24 (1): 69–78. doi:10.1592/phco.24.1.69.34801. PMID 14740789.  ^ Beral, V.; Bull, D.; Darby, S.; Weller, I.; Carne, C.; Beecham, M.; Jaffe, H. (Mar 1992). "Risk of Kaposi's sarcoma and sexual practices associated with faecal contact in homosexual or bisexual men with AIDS.". Lancet 339 (8794): 632–5. doi:10.1016/0140-6736(92)90793-3. PMID 1347337.  ^ Schechter, MT.; Craib, KJ.; Gelmon, KA.; Montaner, JS.; Le, TN.; O'Shaughnessy, MV. (Mar 1993). "HIV-1 and the aetiology of AIDS.". Lancet 341 (8846): 658–9. doi:10.1016/0140-6736(93)90421-C. PMID 8095571.  ^ Heredia, Christopher (2001-10-25). ""Poppers' link to HIV prompts call for warnings in S.F.". San Francisco Chronicle. http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2001/10/25/MN55269.DTL. Retrieved 2007-06-08.  ^ Gendelman HE (2005). The neurology of AIDS. Oxford [Oxfordshire]: Oxford University Press. pp. 766. ISBN 0-19-852610-5.  ^ Decree 90–274 of 26 March 1990 ^ Decree 2007-1636 of 20 November 2007 ^ Council of State, Ruling 312449, 15 May 2009 ^ Clem, Will (19 Oct 2009). "Deadly sex drug sold openly on top online shop". SCMP (Hong Kong). http://www.scmp.com/portal/site/SCMP/menuitem.2af62ecb329d3d7733492d9253a0a0a0/?vgnextoid=95b24058c8864210VgnVCM100000360a0a0aRCRD&ss=China&s=idx_News. Retrieved 19 Oct 2009.  ^ http://www.aidsmap.com/cms1045243.aspx ^ http://www.bbc.co.uk/switch/surgery/advice/drink_drugs/poppers/ v • d • e Alkyl nitrites Amyl nitrite · Butyl nitrite · Ethyl nitrite · Methyl nitrite · Isopropyl nitrite · Isobutyl nitrite · Cyclohexyl nitrite · "Poppers"