Five teens were hospitalized after drinking poppers. But why did they do it?

Five teenagers have been hospitalized after drinking bottles of poppers at the Parklife Music Festival in Manchester. Poppers, for the unfamiliar, are a popular (and technically legal) party drug meant to be inhaled for brief bursts of euphoria, muscle relaxation, and heightened sexual desire. Colloquially, “poppers” refer to a class of nitrites first popularized in the early 20th century to medically treat angina. Amyl nitrite, like its many derivatives, causes sudden expansion of blood vessels which, in turn, triggers a number of physical effects.

In addition to a near immediate rush of blood to the brain, those who inhale poppers experience plummeting blood pressure and the rapid relaxation of smooth muscle tissue throughout the body. For some, this can translate into intensely enjoyable sex. For others, though, poppers are a fast way to intense headaches and general light-headedness.

It’s unclear exactly why the partygoers downed their poppers, but it’s possible that they were unfamiliar with them, or confused at how similar most popper vials are to bottles of energy supplements like 5-Hour Energy. Regardless of why, their hospitalizations underscore a much larger and complicated social debate involving gay culture and public health concerns.

Though poppers are used recreationally by both men and women, they’re most commonly associated with gay male culture. Widespread use of poppers as a gay “party drug” began to peak in the mid ’70s and continued well into the late ’80s. A 1988 survey found that approximately 69 percent of gay men living in the Washington, D.C./Baltimore metro area had sex while using poppers. It’s important to point out that at the time D.C. was a well-established mecca for gay men.

Today, poppers—commonly advertised as “head cleaners”—are easily obtained over the counter in most U.S. queer sex shops. But their availability here belies decades’ worth of legal battles in other countries as governments have cracked down on their use. Last week, the U.K. banned the sale of amyl nitrate under its new Psychoactive Substances Bill, a decision that Public Health England spokeswoman Rosanna O’Connor says was vital in the fight against unknown drugs.

“The risks for users of new psychoactive substances can be particularly high especially when so little is known about their content, which can be dangerous and in some cases lead to death,” she told the BBC. “A ban would aim to reduce the easy availability of these substances, but we also crucially need to continue to focus on preventing and treating the harms that they can cause.”

Rising sales of “poppers” containing chemicals other than the normal nitrites have been linked to an increase in medical accidents.

The key word that O’Connor used here is “new.” Poppers, as they’re traditionally known, have been used for decades, but rising sales of poppers containing chemicals other than the normal nitrites have been linked to an increase in medical accidents. Canada enacted a similar law in 2013, outlawing poppers after it was determined that the drug was too dangerous given that there were no regulations in place controlling its availability and quality.

“Companies that produce poppers keep tinkering with the chemical formulas to circumvent the laws banning them,” Chad Heap, a researcher of American sex culture at The George Washington University, explained to Fusion. “The poppers that are available today are a very different product than the amyl nitrite that was originally available.”

Heap continued:

I don’t think poppers ever again reached the same level of popularity that they had I the 60s and 70s, but slightly and continuously altered chemical formulas have continued to be used as sexual enhancements by gay men since then—even as they’ve been replaced with other drugs of choice, including crystal meth in recent years.

Part of the reason that popper manufacturers have continuously tweaked their formulas has to do with the substance’s complicated relationship to the law. In the U.S., amyl nitrite—the chemical found in old-school poppers—shifted between requiring a prescription and not during the ’60s, when the chemical’s social use gained popularity. Over the years, manufacturers used other nitrites like butyl, isobutyl, and isopropyl in place of amyl in an effort to stay a step ahead of the Food and Drug Administration as it periodically cracked down on poppers.

Institutional backlash against popper use further intensified in the ’80s in response to the early days of the AIDS crisis. Heavy popper use was linked to a suppression of the human immune system, and thus thought to have contributed to HIV’s spread throughout the gay population. According to some dissenting voices like the late gay activist Paul Varnell, many of these studies were scientifically unsound.

Ultimately, the current problem with poppers is about more than teens drinking them (don’t) or that the liquid in the bottles might not actually be the muscle-relaxing nitrite promised on the packaging. The matter at hand is one of cultural knowledge and misinformation.

Too often, young LGBT people find themselves without immediate access to parts of queer culture that might predate them. Depending on who you ask, gayborhoods occupied by older generations are both shrinking and/or becoming prohibitively expensive to live in. As odd as it sounds, there’s an argument to be made that a gay teen today may not have known anything better about poppers. It’s not like these aspects of gay culture are taught in schools or really even passed down from one generation to another (see: gay kids born to straight parents.)

Outlawing poppers may help prevent things like this from happening more frequently in the future. But perhaps a more lasting solution lies in strengthening the queer cultural ties across generations.