Sex­ual uses of pop­pers should weigh against ban, LGBT health ad­vo­cates warn

The Guardian Australia - - Politics - Paul Karp

The Ther­a­peu­tic Goods Ad­min­is­tra­tion failed to con­sider the ther­a­peu­tic uses of alkyl ni­trites – in­clud­ing their use in re­cep­tive anal sex – when they pro­posed to ban the in­halants, LGBT health ad­vo­cates have warned.

The TGA will meet sex­ual health physi­cian Vin­cent Cor­nelisse and com­mu­nity health advocate Daniel Reed­ers on Thurs­day after the pair made a sub­mis­sion warn­ing a ban would crim­i­nalise the prac­tice of an es­ti­mated 90,000 adult gay and bi­sex­ual men who use the in­halant dur­ing in­ter­course.

After its in­terim de­ci­sion in Septem­ber, the TGA is con­duct­ing con­sul­ta­tion on its pro­posal to ban alkyl ni­trites, which has trig­gered a back­lash over its dis­crim­i­na­tory im­pact on gay and bi­sex­ual men.

Cor­nelisse, Reed­ers and three other co-au­thors have made a sub­mis­sion ar­gu­ing that in its in­terim de­ci­sion, the TGA failed to prop­erly weigh the risks and ben­e­fits of alkyl ni­trites, com­monly re­ferred to as “pop­pers”. Amyl ni­trate is the most com­mon form of the drug.

Pop­pers di­late the user’s blood ves­sels, help­ing re­cep­tive sex­ual part­ners com­fort­ably en­joy anal sex. The pro­posal would list alkyl ni­trites in sched­ule 9, along with the most se­ri­ous drugs and ef­fec­tively crim­i­nalise pos­ses­sion and use.

The TGA has claimed that there is a “high po­ten­tial for mis­use and abuse of alkyl ni­trites for eu­phoric prop­er­ties, and as sex aids due to their mus­cle re­lax­ant prop­er­ties” in “par­tic­u­lar sec­tions of the com­mu­nity”.

Reed­ers, Cor­nelisse and their co-au­thors ac­cused the TGA del­e­gate of “list­ing the ben­e­fits of use as risks of use”, which they ar­gued “per­haps [re­flects] a pre­judg­ment of the sched­ul­ing de­ci­sion”.

The au­thors also sub­mit­ted the in­terim de­ci­sion was con­tra­dic­tory be­cause it claimed pop­pers had “lit­tle or no ther­a­peu­tic ben­e­fit” de­spite con­ced­ing they are used for their “eu­phoric … anal­gesic and mus­cle re­lax­ant ef­fects”.

“Use as sex aids due to their mus­cle re­lax­ant prop­er­ties should not be con­sid­ered mis­use and abuse of these sub­stances,” they ar­gued. In­stead, this was a “le­git­i­mate, ben­e­fi­cial and ther­a­peu­tic use” of pop­pers, which help pre­vent spasms and tear­ing dur­ing anal sex.

The LGBT health ad­vo­cates also called on the TGA to con­sider the men­tal health im­pact of a de­ci­sion to “crim­i­nalise the prac­tice of an es­ti­mated 90,000 adult gay and bi­sex­ual men, as well as an un­de­ter­mined num­ber of queer women, non-bi­nary peo­ple, and het­ero­sex­ual men and women who cur­rently use ni­trite in­halants”.

The sub­mis­sion pre­sented ev­i­dence that pop­pers are widely used and ad­verse events associated with use are rel­a­tively un­com­mon – mak­ing crim­i­nal­i­sa­tion dis­pro­por­tion­ate to the risk.

The sub­mis­sion noted that an in­crease in “ad­verse events” – in­clud­ing oph­thal­mo­log­i­cal dam­age – in re­cent years came after the Euro­pean Union banned isobutyl ni­trite in 2007, sug­gest­ing that sub­sti­tu­tion of iso­propyl ni­trite may to be blame for vi­sion loss in some users.

In a state­ment Cor­nelisse and Read­ers said they will ar­gue that the TGA could pre­vent risks of vi­sion loss with “a more lim­ited ban on iso­propyl ni­trite alone”.

The pair will warn that ban­ning alkyl ni­trites might lead to pop­pers users turn­ing to more dan­ger­ous sub­stances, such as “huff­ing” ethyl chlo­ride or il­licit drugs such as crys­tal metham­phetamine.

The sub­mis­sion also notes that for­mer AFP com­mis­sioner Mick Palmer warned in Septem­ber that the pro­posed ban on alkyl ni­trites was un­likely to be ef­fec­tive.

Reed­ers ex­pressed hope that the con­sul­ta­tion “sig­nals the TGA are con­sid­er­ing al­ter­na­tives to pro­hi­bi­tion that ac­knowl­edge queer and par­ty­goer com­mu­ni­ties are ca­pa­ble of re­spon­si­bly man­ag­ing health risks”.

Cor­nelisse said the ban “could make pa­tients think twice about telling their doc­tor about their pop­pers use”, un­der­min­ing the “trust and full dis­clo­sure” needed for an ef­fec­tive re­la­tion­ship.

“Men who cur­rently use pop­pers for more ad­ven­tur­ous sex­ual en­coun­ters might con­sider il­licit drugs for the same pur­poses – with greater risks of over­dose and de­pen­dence,” he said.

Pho­to­graph: Alamy

A for­mer AFP com­mis­sioner has warned the pro­posed ban on alkyl ni­trites was un­likely to be ef­fec­tive.

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