inhalation of alkyl nitrites, and British governmental guidance on the relative harmfulness of alkyl nitrites places them among the less harmful of recreational drugs. Swallowing poppers (rather than inhaling the vapour) may cause cyanosis, methemoglobinemia, unconsciousness, coma, and complications leading to death. Accidental aspiration of amyl or butyl nitrites may cause lipoid pneumonia. Isopropyl nitrite poppers may be a cause of maculopathy (eye damage), as reported in France and the United Kingdom. Some studies have concluded that there may be increased risk for at least temporary retinal damage with habitual popper use in certain users; in a letter to the New England Journal of Medicine, an ophthalmologist described four cases in which recreational users of isopropyl nitrite poppers suffered temporary changes in vision. Foveal (center-of-gaze) damage has also been described, in six habitual users of isopropyl nitrite poppers. Furthermore, in June 2014, optometrists and ophthalmologists reported having noticed an increase in vision loss in chronic popper users in the United Kingdom associated with isopropyl nitrite (substitute for isobutyl nitrite which was banned in 2007). In November 2014, it was observed maculopathy is a rare complication of isopropyl nitrite abuse. A full recovery of visual acuity in longterm abuse could be demonstrated after drug abstinence. Studies have shown that poppers users who have HIV and/or use Sildenafil in combination with poppers are at an increased risk of developing poppers‐associated maculopathy. Treatment Isobutyl nitrite toxicity Isobutyl nitrite is known to cause methemoglobinemia. Severe methemoglobinemia may be treated with methylene blue. Refuted link with HIV/AIDS Early in the AIDS crisis, widespread use of poppers among AIDS patients led to the later disproved hypothesis that poppers contributed to the development of Kaposi's sarcoma, a rare form of cancer that occurs in AIDS patients. Modest, short-term reductions in immune function were observed in animal studies. Cyanide treatment Amyl nitrites were part of some kits used to treat cyanide poisoning, containing amyl nitrite, sodium nitrite, and sodium thiosulfate. The nitrites were administered to produce methemoglobin and induce vasodilation. Amyl nitrites were discontinued in 2012 in standard cyanide kits. Cyanide kits now use hydroxocobalamin. Legal status Australia Poppers are legal in Australia, and from 2020, poppers can be purchased as a schedule 3 substance from pharmacies, or a schedule 4 substance with a prescription. History of poppers legislation in Australia In June 2018, the Therapeutic Goods Administration (TGA) motioned to reschedule alkyl nitrites to be in the