Crossin Rose, Whelan Jai, Hughes Emily, Ang Ben Birks
Department of Population Health, University of Otago, Christchurch, New Zealand.
Department of Psychology, University of Otago, Dunedin, New Zealand.
Int J Drug Policy. 2025 Oct;144(Pt 2):104105. doi: 10.1016/j.drugpo.2023.104105. Epub 2023 Jun 22.
Alkyl nitrites ('poppers') are a group of drugs that includes amyl nitrite, butyl nitrite, and isopropyl nitrite. Their use is prevalent among men who have sex with men (MSM), to enhance sexual comfort and pleasure. In Aotearoa New Zealand, all alkyl nitrites became prescription-only from March 2020. With alkyl nitrites no longer sold locally in stores, and no availability via pharmacies (even with a prescription), access has been significantly reduced. This decision was opposed by advocacy groups and people who use alkyl nitrites. This policy case study explores how this decision was made and impacts on MSM.
We use policy formation theory; both policy framing and Multiple Streams Framework, to analyse factors that contributed to this regulatory decision. Analysis of issue framing by policy coalitions was undertaken through review of documents including submissions and committee minutes.
Two policy coalitions emerged, which differed in their issue framing. The Medicines Classification Committee conveyed concerns about evidence limitations, and recommended reclassification. NGOs and people who use alkyl nitrites communicated that there was no evidence of harm from alkyl nitrite use in New Zealand, and thus, given that there was evidence of benefit, the status quo should be maintained and further regulatory responses were unnecessary. Pre-existing processes created a situation where alkyl nitrite scheduling came unexpectedly onto the New Zealand policy agenda, and set the issue onto a somewhat pre-determined pathway with limited policy choices available.
As a drug policy case study, it appears that reclassification was initiated due to a policy process that did not enable or support plausible alternatives. While the purpose of the reclassification was to improve safety, there was no evidence of harm prior to reclassification, and the reduction in access is likely to have increased harm for MSM.
亚硝酸烷基酯（“Poppers”）是一类药物，包括亚硝酸戊酯、亚硝酸丁酯和亚硝酸异丙酯。它们在男男性行为者（MSM）中广泛使用，以增强性快感。在新西兰，自2020年3月起，所有亚硝酸烷基酯都成为了处方药。由于亚硝酸烷基酯不再在当地商店销售，也无法通过药店获取（即使有处方），其获取途径已大幅减少。这一决定遭到了倡导团体和使用亚硝酸烷基酯的人群的反对。本政策案例研究探讨了这一决定是如何做出的以及对男男性行为者的影响。
我们运用政策形成理论，包括政策框架和多源流框架，来分析促成这一监管决定的因素。通过审查包括意见书和委员会会议记录在内的文件，对政策联盟的议题框架进行了分析。
出现了两个政策联盟，它们在议题框架上存在差异。药品分类委员会表达了对证据局限性的担忧，并建议重新分类。非政府组织和使用亚硝酸烷基酯的人群表示，在新西兰没有证据表明使用亚硝酸烷基酯会造成危害，因此，鉴于有证据表明其有益处，应维持现状，无需进一步的监管措施。既有的程序导致亚硝酸烷基酯的管制安排意外地进入了新西兰的政策议程，并将该问题置于某种预先确定的路径上，可供选择的政策有限。
作为一个药物政策案例研究，重新分类似乎是由于一个未能促成或支持合理替代方案的政策过程而启动的。虽然重新分类的目的是提高安全性，但在重新分类之前并没有危害的证据，而获取途径的减少可能对男男性行为者造成了更大的危害。
