Alkyl Nitrites Research Articles

Poppers, the Politics of Exemption and the Characteristics of Poppers Users in the annual English Festival Study, 2014–23

Abstract This paper explores the relationship between socio-demographic characteristics, self-reported alkyl nitrite (‘poppers’) use and sexual behaviours against a backdrop of UK policy change and ambiguity surrounding legal status. In 2024, the Advisory Council on the Misuse of Drugs recommended a unique, government-initiated, legal exemption from the Psychoactive Substances Act 2016 for poppers, because of its use by gay and bisexual men to reduce the risk of injury during anal sexual intercourse. Data from the annual convenience sample English Festival Study 2014–23 (n = 11,566) were used for Bayesian regression analyses of self-reported poppers use in three-time frames: lifetime, past year and past month use. Gay men were significantly more likely to report poppers use and particularly those reporting past-year participation in anal sex. Providing a critical analysis of recent trends in UK drug policy, the authors highlight how differential discrimination occurs within drug control where targeted exemption meets the politics of protected characteristics in UK law. This paper argues that poppers, therefore, provide a unique example in UK drug policy of how an apparent liberalization of legislative control could bolster the overarching drug prohibition regime while maintaining the appearance of rationality and fairness.

Multiphase nitrosation based on N2O3 intermediate and process intensification in a microflow reactor

Nitrosation of alcohols with nitrous acid is widely used to prepare alkyl nitrites, but the reaction mechanism and formation pathways of gaseous side products remain unclear. Here, we propose a nitrosation mechanism based on a highly reactive intermediate, dinitrogen trioxide (N2O3). The N2O3-based mechanism shows a lower energy barrier than the previously reported acid-catalyzed and nitrosyl cation mechanism. Furthermore, a microfluidic platform was established to investigate the gas–liquid-liquid reaction system and characterize the gas holdup of the multiphase reaction system. The results suggest that the reaction rate and selectivity primarily depend on the interfacial mass transfer of N2O3 between the aqueous-organic and gaseous-organic phases. A tubular microreactor was employed to intensify the nitrosation process of isopropanol. In contrast to the batch process operated by adding reactants dropwise in several hours, the product yield of 95 % can be achieved in a residence time of only 10 s in the microflow reactor.

Assessing Popper Purity—Implications for the Regulation and Recreational Use of Alkyl Nitrites

Alkyl nitrites (“poppers”) are a diverse class of volatile chemical compounds with a varied legal and medical history. Though once commonly prescribed to treat angina, popper use is now almost exclusively recreational. Currently, poppers are widely available and sold legally under labels like “solvent cleaner”, despite marketing suggesting they are meant to be consumed. As a result, there is little incentive for producers to implement robust quality controls to protect users. In this study, nine common popper brands were analyzed using hydrogen-1 and carbon-13 nuclear magnetic resonance spectroscopy to assess the presence of impurities. Physical labels on all nine samples indicated the contents were “pure” isobutyl nitrite, despite contradictory online marketing in several cases. Spectral results showed isobutyl nitrite was present in all popper samples. However, there was evidence that various unlabeled compounds were also present in all samples. The identity and concentration of these contaminants were not clear, but the seemingly ubiquitous presence of impurities and lack of consistency in the tested samples are concerning and may represent a threat to users’ health. We hope the results of this study draw attention to the potential dangers of recreational popper use and the need to reassess how these compounds are regulated.

Unauthorised alkyl nitrites (poppers) pose serious health risks

Unauthorised alkyl nitrites (poppers) pose serious health risks

Method Validation Study of Dipstick Urinalysis as a Screening Tool for Sodium Nitrite Toxicity.

The incidence of suicide by intentional nitrite ingestion has increased since 2017. Limited options exist for commercial laboratory analysis for nitrite/nitrate. This study investigates the use of urine dipsticks for screening at autopsy for potential toxicity with sodium nitrite and, less commonly, alkyl nitrite. Archived samples of blood, urine, vitreous fluid, and gastric contents from 4 sodium nitrite/nitrate cases, 3 alkyl nitrite cases, and 4 control cases were tested using dipsticks. A rapid, strong positive result for nitrite was in the vitreous fluid of all 4-sodium nitrite/nitrate cases, along with 2 positive urine and 1 positive gastric. The 2 alkyl nitrite inhalation toxicity cases had no positive results. One alkyl nitrite ingestion case had a positive urine. The 4 controls had negative urine: equivocal results in 2 vitreous, and 1 positive gastric. Urine dipsticks are a useful adjunct to laboratory testing for nitrite toxicity and provide a rapid, cost-effective tableside result that may guide the need for further testing. Vitreous fluid and urine appear to be the most reliable specimens, although testing of gastric liquid may be useful to corroborate oral ingestion. Dipsticks may not be a reliable adjunct for testing for alkyl nitrite toxicity via inhalation route, likely due to the much lower nitrite concentration compared to nitrite ingestion cases.

Quand l’activité sexuelle solitaire tourne au drame. Comment objectiver une prise de « poppers » en post-mortem ?

Alkyl nitrites have been used as recreational drugs for some time and are often referred to as "poppers." Inhaling poppers causes short periods of euphoria and muscle relaxation.The perception of the general public and young people in particular is that there is no danger in using these drugs. Poppers are increasingly consumed in the context of “Chemsex” because they facilitate sexual intercourse and prolong arousal. It is in a context of solitary sexual practice that a man is found dead: he is wearing sadomasochistic clothing, white tablets and bottles of poppers are found near him. A forensic doctor carried out a body examination, no autopsy was carried out. He concludes to a very marked agonal syndrome that is not specific to a cause of death and a reference toxicological assessment is carried out. The toxicological results were negative regarding the search for volatile substances. This case study discusses the difficulties of revealing, through toxicological analyses, the use of poppers.

Retinal neurotoxicity induced by inhalation of isopropyl nitrite

Purpose: Popper is a slang term given broadly to drugs of the chemical class called alkyl nitrites that are inhaled. Most widely sold products include the original isopropyl nitrite (IPN) a mix of isopropyl alcohol with nitrous acid and sulphuric acid. Multiple cases of retinopathy have been reported since 2001 that have been associated with the inhalation of poppers, predominantly in Europe. However, no clear information about the effect of these inhalant agents on retinal cells have been shown to date. Our work tries to address the neurotoxic effect of IPN on outer retinal cells evidenced by immunocytochemical technique on murine model.Methods: 8 Opn4‐KO mice were used, n:4 were treated with IPN using a aero chamber inhalator for 20 days (1 mL/5 s) and n:4 with oxygen (ctrl group). CARR antibody was used, encoded by the Arr3 gene in murine species. All the animals were supplied by the Animal Experimentation Center of the UAH. The euthanasia of the animals was carried out in accordance with RD 53/2013 Spanish regulations.Results: The sagittal sections of the Opn4 mouse retina taken with confocal microscopy at 40×, the expression of arrestin‐C can be observed, predominantly in the internal and external segments of the cones without disruption, the presence of CARR confirms the presence of cells of retinal cone in our CARR cuts (Cy5, red), The exposure parameters of the samples and image capture in the confocal microscope were taken based on the immunoreactivity in the Opn4 animal model, remaining stable for the rest of the photos. Labelling at the level of the outer plexiform layer is equally intense in Opn4 Ctrl and Opn4 to animals.Conclusions: The results failed to demonstrate morphological changes of clinical importance that could determine a neurotoxic role in the retina of IPN inhalation; however, we propose the existence of other factors and/or pharmacological interactions with the use of poppers in the aetiopathogenesis of this new ophthalmological disease.

Selective Oxidation of Cyclohexanone to Adipic Acid Using Molecular Oxygen in the Presence of Alkyl Nitrites and Transition Metals as Catalysts.

This paper presents a not previously reported catalytic system consisting of transition metals Co2+ and Mn2+ and alkyl nitrites R-ONO for the oxidation of cyclohexanone with oxygen to adipic acid. The influence of type and amount of catalyst, temperature, time, and type of raw material on conversion and product composition were determined. In addition, the oxidation of selected cyclic ketones such as cyclopentanone, cyclohexanone, cyclooctanone, cyclododecanone, 2-methylcyclohexanone, 3-methylcyclohexanone, and 4-methylcyclohexanone in acetic acid as solvent was performed. The results showed that R-ONO systems, under established reaction conditions, form NO·radicals, which oxidize to NO2 under a strong oxidization reaction environment. The Co2+/Mn2+/NO2 system was shown to be highly active in the oxidation of cyclic ketones with oxygen.

Characterizing changes in drug use behaviour following supply shortages of 5-MeO-DIPT, alkyl nitrites and new psychoactive substances among men living with HIV in Japan.

Since 2005, Japan has incrementally banned a range of new psychoactive substances (NPS), including 5-MeO-DIPT (5MO; foxy) and alkyl nitrites (AN; rush, poppers) that have commonly been used among men who have sex with men (MSM). After the largest ban in 2014, these drugs were reported to have disappeared from the domestic market. Given that 5MO/AN/NPS use has been prevalent among men living with HIV in Japan, a population largely comprised of MSM, we sought to characterize changes in their drug use behavior following the supply shortages. Using data from two waves of a nationwide survey of people living with HIV in Japan in 2013 and 2019-20 (n=1042), we employed multivariable modified Poisson regression to identify correlates of self-reported reactions to the 5MO/AN/NPS shortages and changes in drug use behavior in 2019-20vs. 2013. Among 391 men (96.7% MSM) surveyed in 2019-20, following the supply shortages, 234 (59.8%) stopped using 5MO/AN/NPS, 52 (13.3%) retained access to the supply, and 117 (29.9%) used substitute drugs: most commonly, methamphetamine (60.7%). Individuals who used substitutes were more likely to report unprotected sex (adjusted relative risk [ARR]=1.67; 95% confidence interval [CI]: 1.13-2.47) as well as low (ARR=2.35; 95% CI: 1.46-3.79) and lower middle (vs. upper middle to high) socioeconomic status (ARR=1.55; 95% CI: 1.00-2.41). The prevalence of past-year methamphetamine use (ARR=1.93; 95% CI: 1.11-3.35) and self-reported uncontrollable drug use (ARR=1.62; 95% CI: 1.07-2.53) were significantly higher in 2019-20 compared to 2013. Following the supply shortages, approximately one-fifth of our participants used methamphetamine as a substitute for 5MO/AN/NPS. Methamphetamine use and perceived uncontrollable drug use also appeared to have increased at the population level after the supply shortages. These findings suggest a potentially harmful substance displacement effect of the aggressive ban. Harm reduction interventions are needed in this population.

A policy analysis of how alkyl nitrites (poppers) became prescription-only in Aotearoa New Zealand.

Alkyl nitrites ('poppers') are a group of drugs that includes amyl nitrite, butyl nitrite, and isopropyl nitrite. Their use is prevalent among men who have sex with men (MSM), to enhance sexual comfort and pleasure. In Aotearoa New Zealand, all alkyl nitrites became prescription-only from March 2020. With alkyl nitrites no longer sold locally in stores, and no availability via pharmacies (even with a prescription), access has been significantly reduced. This decision was opposed by advocacy groups and people who use alkyl nitrites. This policy case study explores how this decision was made and impacts on MSM. We use policy formation theory; both policy framing and Multiple Streams Framework, to analyse factors that contributed to this regulatory decision. Analysis of issue framing by policy coalitions was undertaken through review of documents including submissions and committee minutes. Two policy coalitions emerged, which differed in their issue framing. The Medicines Classification Committee conveyed concerns about evidence limitations, and recommended reclassification. NGOs and people who use alkyl nitrites communicated that there was no evidence of harm from alkyl nitrite use in New Zealand, and thus, given that there was evidence of benefit, the status quo should be maintained and further regulatory responses were unnecessary. Pre-existing processes created a situation where alkyl nitrite scheduling came unexpectedly onto the New Zealand policy agenda, and set the issue onto a somewhat pre-determined pathway with limited policy choices available. As a drug policy case study, it appears that reclassification was initiated due to a policy process that did not enable or support plausible alternatives. While the purpose of the reclassification was to improve safety, there was no evidence of harm prior to reclassification, and the reduction in access is likely to have increased harm for MSM.

Neither legal nor illegal: Poppers as ‘acceptable’ chemsex drugs among men who have sex with men in the Philippines

Our article provides the first qualitative inquiry into the use of alkyl nitrites or poppers in the Philippines. Drawing from thematic analysis of 13 semi-structured interviews, we illuminate the role of poppers in the lives of men who have sex with men (MSM) in the country, arguing that the popularity of these substances is embedded within multiple, occasionally conflicting sexual and chemical ideologies. More than their multifunctionality as drugs that fulfill many roles and are used in various sexual settings, it is their ideological acceptability that largely explains their popularity. In the contexts of the ongoing Philippine drug war and of Philippine society's long history of stigmatizing people who use drugs, poppers are widely regarded as biomedically, sociopolitically, and legally ‘harmless’ and ‘acceptable’, especially relative to other substances used for chemsex. In constructing poppers as chemsex drugs, we depart from definitions of chemsex established mainly by the Global North and provide a glimpse into how MSM who use poppers situate themselves in a particularly hostile sociopolitical milieu. We consider the implications of our findings against the country's drug paradigm, reflecting on the nature of poppers as substances located in the gray area of legality, and what they mean for sexuality, drug use, and the localized, cultural taboos of our time.

ParTy ’n’ Play: Associations Between Sex-Related Substance Use and the Disinhibited Externalizing Spectrum Among Gay and Bisexual Men

Research suggests sex-related substance use can be conceptualized within the disinhibited externalizing spectrum of psychopathology. However, this research has generally excluded sexual-minority samples. In the current study, we examined the associations between the disinhibited externalizing spectrum and several sex-related substance use domains (i.e., heavy drinking and poppers [alkyl nitrite], cannabis, cocaine, and methamphetamine use) in a clinical sample ( N = 254) of sexual-minority men. Disinhibited externalizing was significantly associated with reporting sex-related cannabis and methamphetamine use versus not and with frequency of sex-related alcohol and cocaine use. These results suggest few and generally weak associations—except for methamphetamine use—between the disinhibited externalizing spectrum and sex-related substance use. Implications for the applicability of dimensional models of psychopathology for sexual-minority populations, future directions for research on sexual behavior and substance use grounded in the specific sociocultural context in which sexual-minority men exist, and transdiagnostic interventions for sex-related substance use are discussed.

Assessing options for poppers policy in Canada: A call to action for evidence-based policy reform.

When inhaled, poppers products (alkyl nitrites) relax smooth muscle tissue and produce a pleasant "rush." As such, they are used by some gay, bisexual, and other men who have sex with men (sexual minority men), including during anal intercourse. In 2013, Health Canada cracked down on poppers sales by introducing threats of fines and imprisonment and seizing poppers in stores and at the border. While no new legislation was introduced, Health Canada takes the position that poppers fall within the definition of a "drug" under the Food and Drugs Act because they "modify organic function" in humans. This crackdown has not prevented poppers use and has added harms related to an illicit and unregulated drug supply. In an effort to reduce harms and advance more equitable and public health-centred approaches to poppers drug policy, we discuss how a series of anticipated outcomes (accessibility, equity, consumer safety, commercial feasibility, and stigma) relate to the following alternative approaches to regulation: (1) poppers as a prescription medicine; (2) poppers as a non-prescription drug (likely accessible 'over-the-counter'); (3) poppers as a consumer product rather than just a medicine; and (4) ending the crackdown without legislative changes. To improve health equity and reduce harms among sexual minority men in a way that is politically and commercially feasible, we recommend the last approach-ending the crackdown without legislative changes-including ceasing the confiscation of poppers products in stores and at the border.

The Clinical Assessment and Treatment of Inhalant Abuse.

Although inhalant abuse is common, it is one of the most neglected and overlooked forms of substance abuse. Inhalants refer to a wide variety of substances including volatile solvents, aerosols, gases, and nitrites. The mechanism of action of inhalants has not been fully defined. Several molecular targets contribute to the pharmacology, including ion-channel proteins that control neuronal excitability. These agents interact with various receptors and can cause changes in cell-membrane fluidity and nerve-membrane ion channels. Three main pharmacologic categories of inhalants, namely, volatile solvents and anesthetic gases, nitrous oxide, and volatile alkyl nitrites, have distinct pharmacologies, mechanisms of action, and toxicities. Inhalants are linked to multisystem damage affecting the pulmonary, cardiac, dermatologic, renal, hematologic, gastrointestinal, hepatic, and neurologic systems. Chronic inhalant abuse can also cause psychiatric, cognitive, behavioral, and anatomical deficits in humans, leading to reduced productivity and quality of life. Inhalant abuse during pregnancy is associated with fetal abnormalities. Clinical assessment for inhalant abuse should be done systematically. After decontamination and stabilization of the patient, further history and physical examination is necessary to establish an appropriate diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Laboratory testing for inhalant abuse is very limited, and imaging studies may be helpful in certain situations. The treatment of inhalant use disorder is similar to that of other substance abuse disorders and includes supportive care, pharmacotherapy, and behavioral therapy. Preventive measures are essential.

Defining and measuring 'inhalant' use in population-based surveys.

The term 'inhalants' is commonly used to describe a group of drugs that are characterised by the route of administration. There are three main sub-groups of inhalants; volatile solvents, alkyl nitrites, and nitrous oxide. These drugs all have different pharmacological properties, use patterns, and potential harms; yet they are sometimes grouped together in survey instruments. This critical review aimed to present a comparative analysis of how these inhalant drugs are defined, and use measured, across a range of population-level drug use surveys. Population-level drug use surveys of youth (n=5) and general population (n=6), which measured use of at least once type of inhalant drug, were analysed as case studies. The types of inhalants surveyed were extracted, as well as definitions of these drugs, from code books or survey methods. Differing definitions were used between surveys, and included differences between countries, and between surveys intended to measure youth and general population drug use. Of the six general population surveys; five reported nitrous oxide use, five reported volatile solvent use, and four reported alkyl nitrite use. Of the five youth-specific surveys; three reported volatile solvent use, whereas only one reported on alkyl nitrite use, and one reported nitrous oxide use. There is no consistent approach used to define or measure the use of inhalant drugs, which has implications for global comparisons and understanding drug use in different populations. We conclude that the term 'inhalants' should be discontinued, due to the limited value in continuing to group very different types of drugs solely on the basis of their route of administration. Improving the epidemiology of volatile solvents, alkyl nitrites, and nitrous oxide as distinct drug types will be of benefit to harm reduction, treatment, and prevention efforts, and ensure these are targeted appropriately to population groups and context of use.

Clinical characteristics of chemsex users attended in a ngo in madrid

IntroductionThe intentional use of drugs before or during sexual intercourse (chemsex) is a phenomenon of special importance in the MSM (men who have sex with men) population due to its impact on mental, physical and sexual health.ObjectivesThe objective of this study was to describe the sociodemographic and medical characteristics, psychoactive substances use of a sample of users with sexualized drug use (chemsex) attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You”.MethodsA cross-sectional descriptive analysis of a sample of users attended by the non-govenrmental organization Apoyo Positivo in the program “Sex, Drugs and You” was performed.Results230 participants were included. Most common drugs used during sexual intercourse were: mephedrone, cocaine, poppers, GHB and methamphetamine. The frequencies of substances consumed during sex were: mephedrone (95%), methamphetamine (80%), GHB (92.2%), ketamine (52%), poppers (alkyl nitrites) (95%), cocaine (89 .7%), speed (amphetamine sulfate) (49.6%) and drugs for erectile dysfunction (86%). 61.3% reported having practiced slamsex intravenous substance use at some time in their life, being a habitual practice at the time of collecting information for 50.7%. The most frequent genitally transmitted infections were: syphilis, chlamydia and gonorrhea. Users reported having been diagnosed with the following genitally transmitted infections: hepatitis B virus (7.4%), hepatitis A virus (18.6%), syphilis (69.6%), human papillomavirus (16 %), herpes (9.4%), chlamydia (43%), gonorrhea (60.5%) and candidiasis (9.7%).ConclusionsSlamsex and STIs are usually reported in our sample. Interventions for chemsex users must include a colaborative model which includes professionals from different areas, including internists and emergency physicians, psychiatrists, psychologists, nurses, social workers and sexologists.Disclosure of InterestNone Declared

The Impact of Systemic Medications on Retinal Function.

This study will provide a thorough review of systemic (and select intravitreal) medications, along with illicit drugs that are capable of causing various patterns of retinal toxicity. The diagnosis is established by taking a thorough medication and drug history, and then by pattern recognition of the clinical retinal changes and multimodal imaging features. Examples of all of these types of toxicity will be thoroughly reviewed, including agents that cause retinal pigment epithelial disruption (hydroxychloroquine, thioridazine, pentosan polysulfate sodium, dideoxyinosine), retinal vascular occlusion (quinine, oral contraceptives), cystoid macular edema/retinal edema (nicotinic acid, sulfa-containing medications, taxels, glitazones), crystalline deposition (tamoxifen, canthaxanthin, methoxyflurane), uveitis, miscellaneous, and subjective visual symptoms (digoxin, sildenafil). The impact of newer chemotherapeutics and immunotherapeutics (tyrosine kinase inhibitor, mitogen-activated protein kinase kinase, checkpoint, anaplastic lymphoma kinase, extracellular signal-regulated kinase inhibitors, and others), will also be thoroughly reviewed. The mechanism of action will be explored in detail when known. When applicable, preventive measures will be discussed, and treatment will be reviewed. Illicit drugs (cannabinoids, cocaine, heroin, methamphetamine, alkyl nitrite), will also be reviewed in terms of the potential impact on retinal function.

Substance Use and Attendance Motives of Electronic Dance Music (EDM) Event Attendees: A Survey Study.

EDM event attendees are a high-risk population for substance use and associated adverse effects. The aim of this study was to examine substance use at EDM events, focusing on associations between attendance motives and substance use. Sociodemographic characteristics, event specifics, past-year use, and attendance motives were assessed through an online survey. Participants were 1345 Belgian EDM event attendees (69.44% male, Mage = 22.63, SDage = 4.03). Ecstasy/MDMA/Molly (52.28%), other synthetic hallucinogens (53.68%), ketamine (42.13%), amphetamines (40.45%), and alkyl nitrites (poppers) (32.76%) were most frequently used at festivals/outdoor parties/raves. In nightclubs, cocaine (32.29%) was shown to be prevalent as well, while other synthetic hallucinogens (15.79%) were less often consumed. At events with a more private character, cannabis (68.88%) and magic mushrooms (66.44%) were most frequently used. Aside from alcohol (47.76%), substance use in pubs/bars was negligible. Overall enjoyment was demonstrated to be the key attendance motive, which was succeeded by those relating to music and socialization. A wide range of motives proved to be more important to users (e.g., dance, exploration, escapism, excitement, alcohol, drugs) than non-users, while some were associated with the use of particular substances. The prevalence of substance use was shown to be dependent on the specifics of the setting. Moreover, the idea of a three-dimensional classification of the most principal motives for music event attendance was supported. Finally, correlations were estimated between attendance motives and substance use as well as specific substances. Results could enable more tailored approaches in prevention and harm reduction efforts as well as event management strategies.

Do ART and Chemsex Drugs Get Along? Potential Drug-Drug Interactions in a Cohort of People Living with HIV Who Engaged in Chemsex: A Retrospective Observational Study.

People living with HIV (PLWH) who engaged in chemsex are at risk of potential drug-drug interactions (pDDIs) with recreational drugs. This study aimed to characterize pDDIs between antiretroviral treatment (ART) and chemsex drugs and evaluate their association with unscheduled relevant hospital consultations. We conducted a single-center, retrospective, observational study in a series of gay, bisexual, and other men who have sex with men (gbMSM) living with HIV who engaged in chemsex and who attended a tertiary hospital in Barcelona, Spain, from February 2018 through August 2019. Associations between all recorded pDDIs and relevant unscheduled consultations were estimated using the incidence rate (IR) per 100 person-years of those events compared between patients with no pDDI (green flag) or moderate severity pDDI (orange flag) with patients with high severity pDDI (red flag) using the incidence rate ratio (IRR). Among 172 PLWH engaged in chemsex, 249 ART regimens were prescribed: 44% based on integrase inhibitors, 30% on boosted ART, and 26% based on non-nucleoside reverse transcriptase inhibitors. The substances and recreational drugs most frequently used were erectile dysfunction agents (83%), methamphetamine (79%), GHB (77%), and alkyl nitrites (71%). Polydrug use was reported in 52%. We observed 2048 pDDIs. Of these, 23% were orange flag pDDIs; 88% related to boosted ARTs. The IR of the 285 unscheduled relevant episodes in patients with orange flag pDDIs was 64.67 (95%CI 40.07-89.28). The IRR of green flag pDDIs was 1.05 (95%CI 0.60-1.8; p = 0.876). One in four pDDIs were of moderate severity but no significant increase in the incidence of unscheduled relevant consultations was observed. A high number of unscheduled consultations, predominantly for psychiatric events and intoxication, were observed. Beyond using non-boosted ART to minimize pDDIs, other factors related to the practice of chemsex must be addressed, in order to offer a better approach.

Food insecurity as a social determinant of sexual health and substance use independent of poverty status among men who have sex with men in the United States

PurposeTo characterize the prevalence of food insecurity among men who have sex with men (MSM) and assess its associations with sexual health measures and substance use, as compared to poverty status. MethodsIn 2017, 10,049 US MSM were recruited online and completed the American Men's Internet Survey. The survey assessed food insecurity, annual household income and past-year behaviors: condomless anal intercourse, exchange sex, any illicit substance use other than marijuana, use of methamphetamine, alkyl nitrites or gamma-hydroxybutyrate (GHB), HIV testing, and sexually transmitted infection testing and diagnosis. We tested associations between behavioral outcomes and food insecurity or poverty, controlling for demographic characteristics. ResultsThe prevalence of food insecurity among AMIS participants was 15.8%. Food insecurity nonresponse was 2.5% while income nonresponse was 19.0%. Food insecurity was significantly and positively associated with all behavioral outcomes, while poverty was significantly and positively associated only with exchange sex, any illicit substance use, methamphetamine, and GHB use. In models that included both food insecurity and poverty as exposures, food insecurity remained independently positively associated with all behavioral outcomes and the associations for poverty level were null for all outcomes except methamphetamine and GHB use. ConclusionsAssessing food insecurity in sexual health and substance use survey research may provide a more robust indicator of economic deprivation and provide insight for HIV and STI prevention interventions.