The FDA says people are confusing poppers with energy shots, and dying. Experts want proof

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.

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.