Article Data

  • Views 1668
  • Dowloads 195


Open Access


  • Kok-Yong Chin1

1Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia

DOI: 10.31083/jomh.v16i3.226 Vol.16,Issue 3,July 2020 pp.109-127

Published: 16 July 2020

*Corresponding Author(s): Kok-Yong Chin E-mail:


Inhaled nitrites are gaining popularity among Asian men who have sex with men (MSM). This review aimed to summarize the current evidence on the prevalence and correlates of inhaled nitrite use among Asian MSM. Besides, the knowledge, perception, and sexual behaviors of nitrite users among MSM were also discussed. Most of the studies on nitrite use among Asian MSM were conducted in major cities of China, with sporadic studies in Japan and Malaysia. The literature showed that inhaled nitrites were one of the most commonly used recreational drugs among Asian MSM. Younger and educated MSM with dis-posable income were more likely to use inhaled nitrites. MSM used nitrites to enhance sexual pleasure, but most were not sure about their side-effects. Some studies indicated that MSM had low barriers to obtain the substance through various sources. Inhaled nitrites use had been associated with risky sexual behav-iors, such as unprotected anal intercourse and multiple sex partners. The use of inhaled nitrites was linked with a higher risk for the infection of HIV and sexually transmitted diseases (STDs). In conclusion, the use of inhaled nitrites among Asian MSM is a serious health concern and demands innovative approaches to address this problem.


HIV; nitrites; poppers; rush; substance abuse

Cite and Share

Kok-Yong Chin. RECREATIONAL INHALED NITRITE USE AMONG ASIAN MEN WHO HAVE SEX WITH MEN – A REVIEW . Journal of Men's Health. 2020. 16(3);109-127.


1. Romanelli F, Smith KM, Thornton AC, Pomeroy C. Poppers: Epidemiology and clinical manage-ment of inhaled nitrite abuse. Pharmacotherapy. 2004;24(1):69–78. 1.69.34801

2. Neuberger A, Fishman S, Golik A. Hemolytic ane-mia in a G6PD-deficient man after inhalation of amyl nitrite (“poppers”). IMAJ. 2002;4(11):1085–6.

3.Rewbury R, Hughes E, Purbrick R, Prior S, et al. Poppers: Legal highs with questionable con-tents? A case series of poppers maculopathy. Brit J Ophthalmol. 2017;101(11):1530–4. https://doi. org/10.1136/bjophthalmol-2016-310023

4.James JS. Viagra warning re “poppers” and notice re protease inhibitors. AIDS Treatment News. 1998(No. 294):1.

5. Bos JD, Jansen FC, Timmer JG. Allergic contact dermatitis to amyl nitrite (‘poppers’). Contact Derm. 1985;12(2):109. 1985.tb01064.x

6. Schauber J, Herzinger T. ‘Poppers’ dermatitis. Clin Exp Dermatol. 2012;37(5):587–8. https://doi. org/10.1111/j.1365-2230.2011.04230.x

7. Dutta A, Uno H, Holman A, Lorenz DR, et al. Long-term nitrite inhalant exposure and cancer risk in MSM. AIDS (London, England). 2017;31(8):1169–80.

8. Hunter L, Gordge L, Dargan PI, Wood DM. Methaemoglobinaemia associated with the use of cocaine and volatile nitrites as recreational drugs: A review. Brit J Clin Pharmacol. 2011;72(1):18–26. Cha 9. HJ, Kim YJ, Jeon SY, Kim YH, et al. Neurotoxicity induced by alkyl nitrites: Impairment in learn-ing/memory and motor coordination. Neurosci Lett. 2016;619:79–85.

10. Jeon SY, Kim YJ, Kim YH, Shin J, et al. Abuse potential and dopaminergic effect of alkyl nitrites. Neurosci Lett. 2016;629:68–72.

j. neulet.2016.06.057

11. Goode E, Troiden RR. Amyl nitrite use among homo-sexual men. Am J Psychiatry. 1979;136(8):1067–9.

12. Barrett P, O’Donnell K, Fitzgerald M, Schmidt AJ, et al. Drug use among men who have sex with men in Ireland: Prevalence and associated factors from a national online survey. Int J Drug Policy. 2019;64:5–


13. Folch C, Fernández-Dávila P, Ferrer L, Soriano R, et al. High prevalence of drug consumption and sexual risk behaviors in men who have sex with men. Med Clin. 2015;145(3):102–7. https://doi. org/10.1016/j.medcli.2014.04.030

14. Hambrick HR, Park SH, Palamar JJ, Estreet A, et al. Use of poppers and HIV risk behaviours among men who have sex with men in Paris, France: An observational study. Sex Healths. 2018;15(4):370–3.

15. Lampinen TM, Mattheis K, Chan K, Hogg RS. Nitrite inhalant use among young gay and bisex-ual men in Vancouver during a period of increas-ing HIV incidence. BMC Public Health. 2007;7:35.

16. Hambrick HR, Park SH, Schneider JA, Mayer KH, et al. Poppers and PrEP: Use of pre-exposure pro-phylaxis among men who have sex with men who use inhaled nitrites. AIDS Behav. 2018;22(11):3658–


17. Brown RE, Turner C, Hern J, Santos GM. Partner-level substance use associated with increased sexual risk behaviors among men who have sex with men in San Francisco, CA. Drug Alcohol Depend. 2017;176:176–80. drugalcdep.2017.02.016

18. Ferrer L, Furegato M, Foschia JP, Folch C, et al. Undiagnosed HIV infection in a population of MSM from six European cities: Results from the Sialon project. Eur J Public Health. 2015;25(3):494–500.

19. Hatfield LA, Horvath KJ, Jacoby SM, Simon Rosser BR. Comparison of substance use and risky sexual behavior among a diverse sample of urban, HIV-positive men who have sex with men. J Addict Dis. 2009;28(3):208–18. https://doi. org/10.1080/10550880903014726

20. Santos GM, Coffin PO, Das M, Matheson T, et al. Dose-response associations between number and frequency of substance use and high-risk sexual behaviors among HIV-negative substance-us-ing men who have sex with men (SUMSM) in San Francisco. J Acquir Immune Defic Syndr (1999). 2013;63(4):540–4.

21. Heiligenberg M, Wermeling PR, van Rooijen MS, Urbanus AT, et al. Recreational drug use during sex and sexually transmitted infections among clients of a city sexually transmitted infections clinic in Amsterdam, the Netherlands. Sex Transm Dis. 2012;39(7):518–27.

22. Choi KH, Operario D, Gregorich SE, McFarland W, et al. Substance use, substance choice, and unpro-tected anal intercourse among young Asian American and Pacific Islander men who have sex with men. AIDS Educ Prev. 2005;17(5):418–29.

23. Chu ZX, Xu JJ, Zhang YH, Zhang J, et al. Poppers use and sexual partner concurrency increase the HIV incidence of MSM: A 24-month prospective cohort survey in Shenyang, China. Sci Rep. 2018;8(1):24.

24. Guo W, Li Y, Zhou N, Wu G, et al. Risk factors related to HIV new infections among men who have sex with men in a cohort study. Chin J Endemiol. 2018;39(1):16–20. ssn.0254-6450.2018.01.003

25. Wang X, Li Y, Wu Z, Tang Z, et al. Nitrite inhal-ant use and HIV infection among Chinese men who have sex with men in 2 large cities in China. J Addict Med. 2017;11(6):468–74. https://doi. org/10.1097/ADM.0000000000000347

26. Hidaka Y, Ichikawa S, Koyano J, Urao M, et al. Substance use and sexual behaviours of Japanese men who have sex with men: A nationwide internet survey conducted in Japan. BMC Public Health. 2006;6:239. https://doi. org/10.1186/1471-2458-6-239

27. He H, Wang M, Zhang HB, Song DD, et al. [The unprotected sexual behaviors and its influencing factors among HIV-infected men who have sex with men in Shanghai, China]. Zhonghua yu fang yi xue za zhi [Chinese Journal of Preventive Medicine]. 2012;46(11):976–81.

28. Li D, Yang X, Zhang Z, Qi X, et al. Nitrite inhalants use and HIV infection among men who have sex with men in China. BioMed Res Int. 2014;2014:365261.

29. Xu JJ, Qian HZ, Chu ZX, Zhang J, et al. Recreational drug use among Chinese men who have sex with men: A risky combination with unprotected sex for acquiring HIV infection. BioMed Res Int. 2014;2014:725361. https://doi. org/10.1155/2014/725361

30. Xu JJ, Zhang C, Hu QH, Chu ZX, et al. Recreational drug use and risks of HIV and sexually transmit-ted infections among Chinese men who have sex with men: Mediation through multiple sexual part-nerships. BMC Infect Dis. 2014;14:642. https://doi. org/10.1186/s12879-014-0642-9

31. Chen X, Li X, Zheng J, Zhao J, et al. Club drugs and HIV/STD infection: An exploratory analysis among men who have sex with men in Changsha, China. PLoS One. 2015;10(5):e0126320. https://doi. org/10.1371/journal.pone.0126320

32. Lim SH, Cheung DH, Guadamuz TE, Wei C, et al. Latent class analysis of substance use among men who have sex with men in Malaysia: Findings from the Asian Internet MSM Sex Survey. Drug Alcohol Depend. 2015;151:31–7. https://doi. org/10.1016/j.drugalcdep.2015.02.040

33. Wang Z, Li D, Lau JT, Yang X, et al. Prevalence and associated factors of inhaled nitrites use among men who have sex with men in Beijing, China. Drug Alcohol Depend. 2015;149:93–9. https://doi. org/10.1016/j.drugalcdep.2015.01.021

34. Chen MQ, Cheng WB, Xu HF, Cai YS, et al.[Predictors of rush popper use among 825 men who have sex with men in education in Guangdong Province]. Zhonghua yu fang yi xue za zhi [Chinese Journal of Preventive Medicine]. 2016;50(11):949–53.

35. Lei Y, Wang H, Xiao X, Chen J, et al. [Status and influencing factors of rush poppers use and HIV infection among men who have sex with men in Changsha]. Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]. 2016;50(2):148-152.

36. Yang GL, Zhang AD, Yu Y, Liu H, et al. Drug use and its associated factors among money boys in Hunan Province, China. Public Health. 2016;140:213–20.

37. Zhang H, Teng T, Lu H, Zhao Y, et al. Poppers use and risky sexual behaviors among men who have sex with men in Beijing, China. Drug Alcohol Depend. 2016;160:42–8. https://doi. org/10.1016/j.drugalcdep.2015.11.037

38. Zhang Y, Chen F, Ding F, Lin X, et al. [Unprotected sexual behaviors and related factors of HIV-positive MSM with multiple sexual partners]. Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi. 2016;37(4):517–21.

39. Duan C, Wei L, Cai Y, Chen L, et al. Recreational drug use and risk of HIV infection among men who have sex with men: A cross-sectional study in Shenzhen, China. Drug Alcohol Depend. 2017;181:30–6. 2017.09.004

40. Zhang Z, Zhang L, Zhou F, Li Z, et al. Knowledge, attitude, and status of nitrite inhalant use among men who have sex with men in Tianjin, China. BMC Public Health. 2017;17(1):690. https://doi. org/10.1186/s12889-017-4696-7

41. Zhao P, Tang S, Wang C, Zhang Y, et al. Recreational drug use among Chinese MSM and transgender individuals: Results from a National Online Cross-Sectional Study. PLoS one. 2017;12(1):e0170024.

42. Zhu ZP, Zhang M, Xu YY, Xu WJ, et al. [Cross-sectional surveys on the use of recreational drug nitrous-acid-ester rush-poppers in men who have sex with men, Nanjing]. Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi. 2017;38(2):189–93.

43. Chen H, Yang Y, Huang Y, Dai Y, et al. Prevalence of poppers use and its sexual risks among men who have sex with men in southwestern China: A cross-sec-tional study. BMC Public Health. 2018;18(1):1103.

44. He L, Pan X, Wang N, Yang J, et al. New types of drug use and risks of drug use among men who have sex with men: A cross-sectional study in Hangzhou, China. BMC Infect Dis. 2018;18(1):182. https://doi. org/10.1186/s12879-018-3091-z

45. Luo W, Hong H, Wang X, McGoogan JM, et al. Synthetic drug use and HIV infection among men who have sex with men in China: A six-teen-city, cross-sectional survey. PLoS One. 2018;13(7):e0200816.

46. Tuo XQ, Wang H, Yeledan M, Zhang ZL, et al.[Rush poppers use and risks of human papillo-mavirus infection among men who have sex with men in Urumqi: Mediation effect through high-risk sexual behaviors]. Zhonghua yu fang yi xue za zhi [Chinese Journal of Preventive Medicine]. 2019;53(2):202–5.

47. Yun K, Xu J, Leuba S, Zhu Y, et al. Development and validation of a personalised social media platform-based HIV incidence risk assessment tool for men who have sex with men in China. J Med Internet Res. 2019;21(6):e13475. https://doi. org/10.2196/13475

48. Zhou N, Zheng M, Li H, Yu M, et al. Evaluation on follow-up intervention program in men who have sex with men in Tianjin. Chin J Endemiol. 2018;39(9):1228–33.

49. Thurtle N, Dargan PI, Hunter LJ, Lovett C, et al. A comparison of recreational drug use amongst sex-ual health clinic users in London with existing prev-alence data. Int J STD AIDS. 2016;27(14):1309–16.

50. Okafor CN, Gorbach PM, Ragsdale A, Quinn B, et al. Correlates of preexposure prophylaxis (PrEP) use among men who have sex with men (MSM) in Los Angeles, California. J Urban Health. 2017;94(5):710–15.

51. Moody RL, Starks TJ, Grov C, Parsons JT. Internalised homophobia and drug use in a national cohort of gay and bisexual men: Examining depression, sexual anxiety, and gay commu-nity attachment as mediating factors. Arch Sex Behav. 2018;47(4):1133–44.

52. Puckett JA, Newcomb ME, Garofalo R, Mustanski

B. Examining the conditions under which inter-nalized homophobia is associated with sub-stance use and condomless sex in young MSM: The Moderating role of impulsivity. Ann Behav Med. 2017;51(4):567–77.

53. Dunne T, Bishop L, Avery S, Darcy S. A review of effective youth engagement strategies for men-tal health and substance use interventions. J Adolesc Health. 2017;60(5):487–512. https://doi. org/10.1016/j.jadohealth.2016.11.019s

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Directory of Open Access Journals (DOAJ) DOAJ is a unique and extensive index of diverse open access journals from around the world, driven by a growing community, committed to ensuring quality content is freely available online for everyone.

SCImago The SCImago Journal & Country Rank is a publicly available portal that includes the journals and country scientific indicators developed from the information contained in the Scopus® database (Elsevier B.V.)

Publication Forum - JUFO (Federation of Finnish Learned Societies) Publication Forum is a classification of publication channels created by the Finnish scientific community to support the quality assessment of academic research.

Scopus: CiteScore 0.7 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Norwegian Register for Scientific Journals, Series and Publishers Search for publication channels (journals, series and publishers) in the Norwegian Register for Scientific Journals, Series and Publishers to see if they are considered as scientific. (

Submission Turnaround Time