It's not unusual for the packaging of one product to resemble that of another, potentially leading to mix-ups. But the U.S. Food and Drug Administration (FDA) has warned people who drink energy shots to make sure they're not accidentally chugging a bottle of poppers — or they might end up sick or dead.
"Don't be fooled. These poppers, often purchased online or in novelty stores, are unapproved products and should not be inhaled or ingested, regardless of how they are packaged, labelled or displayed," the FDA notes in its online warning shared in recent social media posts.
But those who work in LGBTQ sexual health say the FDA's warning that people are confusing poppers with energy shots, with sometimes dire consequences, may actually be doing more of a disservice.
Such messaging "borders on inflammatory" and may contribute to the "the stigmatization of the product [and] the stigmatization of the person who's using poppers," said Rod Knight, an associate professor at the at Université de Montréal's School of Public Health, who has also conducted research on poppers.
Poppers are a chemical substance that belongs to a class of drugs known as alkyl nitrates. When they're inhaled as vapour, from a small liquid-filled bottle wrapped in a colourful plastic label, the user can almost instantly get the short-lasting, light-headed sensation of a head rush, Knight explained.
He explained they also relax the sphincter muscle of the anus, making receptive anal sex more comfortable for some people. Poppers have been popular among gay, bisexual and other men who have sex with men for decades.
Knight acknowledges that there are sometimes side effects, which may include nausea, headaches, reduced blood pressure — alkyl nitrates are vasodilators, meaning they open blood vessels — and even vision issues. But he suggested such side effects "can be remedied through change of usage patterns."
According to the FDA's website, they are usually purchased in sex shops or online — often labelled as other products such as leather cleaner or deodorizers — even though the agency recommends against using them. Alkyl nitrates as poppers are unauthorized in Canada and Health Canada has cracked down on the sale of them since 2013, though they're not necessarily illegal to purchase, possess or consume.
Does the FDA claim pass the sniff test?
Energy shots are flavoured beverages containing some amount of caffeine, and vitamins or other natural substances that purportedly boost your energy, like ginseng or ginkgo biloba. They're sold in small bottles with colourful plastic labels. They're commonly found at convenience stores, supermarkets or bought online.
If by some chance you had both products side-by-side and didn't realize your mistake by the time you peeled off the plastic and cracked open the bottle, the distinct smell of poppers should be a red flag, explained Adam Awad, the communications manager for the Gay Men's Sexual Health Alliance in Toronto.
"If you're about to drink a 5-Hour Energy drink [a popular energy shot brand] and it smells like nail polish remover, you know, maybe you should ask yourself some questions before touching it to your lips," he said.
Awad said he isn't aware of any cases of people dying from a poppers-related mishap like the FDA described — a claim the agency previously made in 2021 — but he said he "would be very keen to see any evidence that they've got or reports on the actual number of cases."
CBC News reached out to the FDA for data on injuries or death related to the accidental oral ingestion of poppers and an explanation for the social media warning, but did not receive a response.
In 2012, however, the agency stated that it was investigating 13 deaths and 33 hospitalizations related to the consumption of 5-Hour Energy drinks.
But if serious or fatal mix-ups with poppers and energy shots are happening, it would certainly be a dangerous situation, said Knight. He said he's curious to know in what context such a serious mistake might have happened and whether there were other contributing factors to these incidents.
There is also a flip side to poppers, Knight said, that health agencies like the FDA and Health Canada do not mention in their cautionary messaging.
"This drug is being used by gay and queer men for very therapeutic reasons," Knight said. "[Poppers] can prevent muscle spasm and injury during receptive anal intercourse."
Should Canada ease its restrictions on poppers?
Health Canada states alkyl nitrites can only be used when prescribed by a doctor, but there are currently no approved products sold as poppers. In a statement to CBC News, the agency said "there have been no submissions filed by any company [or] manufacturers for authorization of a popper product."
Knight said it would be difficult and unlikely for many producers to go through the clinical trials and regulatory processes needed to get approval for prescription use and, even if that did happen, it would only create other barriers to accessing the drug.
"This drug is not really well known among a lot of clinicians, except for those who specialize in sexual health," he said.
He said the current restriction has done little to prevent people from acquiring poppers one way or another, whether it's ordering them online, buying them over the border in the U.S. or procuring them by some other means.
He noted a survey from the Community-Based Research Centre that showed only a slight drop in the percentage of people using poppers, after the ban on sales, and had little effect on regular use.
"If this was a drug that was being used among, for example, straight guys at a rate of 30 per cent of straight guys across Canada, there would be a very different approach to how the drug would be treated," he said.
He believes the restriction has done more harm than good, pushing poppers into a form of "illicit market," making it unclear what ingredients they may contain because manufacturers aren't "incentivized" to label their products with accurate health information.
There is also the possibility poppers may be packaged in a way that resembles other products in order to "disguise them" because of the restriction, added Awad, potentially setting up that very mixup scenario.
