Performance Enhancing Drugs

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Performance Enhancing Drugs An increasingly
Issue for Drugs Agencies
BIG
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Problems with Terms
Anabolic Steroids But not all the compunds that
are used are anabolics Anabolic and Androgenic
Steroids As above a wide range of compounds
which are used are not AAS Performance and Image
Enhancing Drugs A term preferred by many in the
drugs field, but again omits a large number of
compounds which dont enhance perfomance or
image Performance and Image Enhancing Drugs and
Ancillary Compounds Includes substances which are
not of themselves enhancing performance or image
but are used as part of a regime Sports and
Image Drugs My personal preferred phrase
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A Wide Range of Compounds
Ancillary Compounds Aromatise Inhibitors Oestrogen
blockers
Anabolic Androgenic Steroids
Fat burnersephedrine, T3 etc
Post cycle treatment compoundse.g Clomid, HCG
Diuretics
Additional compoundsInsulin, Growth
HormoneIGF-1
Tanning Agentse.g. Melanotan ii
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A diverse population

• Primary target population is white men aged 20
  but
• Still low level of female PED users, but
• Escalating numbers of BME users, especially
  young Asian men
• Significant population of Gay users, especially
  within the Gay muscle scene
• A growing number of young people using Anabolics
  as an aspect of polydrug use
• An emergent population of ex-heroin and ex-crack
  users migrating across to PED use entry
  route via gym-referral or prison
• A small population of transgender users using
  non-prescribed PEDs to change gender
  identity
• Population of people exclusively using
  image-enhancers such as tanning agents

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Discussion Areas

• Are you seeing more people using PEDs?
• What is the profile of this population?
• How do you currently engage with PED users?
• What plans are in development for the coming
  year?

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Trends
Source Presentation by Jim McVeigh NCIDU 2006
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Trends
Source Presentation by Jim McVeigh NCIDU 2006
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A Hidden Population?

• Research evidence scanty
• dont present via offending routes as frequently
• Less likely to present for treatment for
  dependency
• May be systematic under-reporting via BCS
• Restricted access to needle exchange
• Extensive secondary Nx peer distribution
• And as a diverse population some of the less
  obvious populations, e.g young PED users or women
  using tanning agents are even less well measured.

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Patchy Treatment Routes
Pharmacy Nxnot all distribute the right
equipment in the right quantities
Fixed siteNeedle Exchange
Gym outreach Limited activity, access
problemsnot all users are gym goers
Non-injectors
Wider drug services
Sourcing via peers,internet
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Reasons for Use
Athletic Maximising performance at top end of
sporting spectrum Body-building For people
who are competing or displaying in
body-building contests Functional For people
who professionally find size and bulk useful
door staff, security etc Short-cut to
development Use of steroids to try and get quick
results Peer-pressure To keep up with
peers who are lifting more and achieving
better results Dysmorphic To cope with mental
self-perception as being weak, small or
under-developed Dependent Bulk, ritual and
social behaviours make it difficult to stop
using
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A growing population

• Increased number of people collecting from Nx
  being recorded
• as using PEDS
• Quantity of equipment logged to PEDs users has
  increased
• Dedicated clinics seeing growing number of
  people
• Age of users MAY be decreasing more younger
  users
• presenting to agencies
• The number of compounds being used may be
  increasing
• The duration of use per cycle may be increasing
• The amounts used may be increasing
• Time spent on cycle increasing and off cycle
  decreasing

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A Dissimilar Population

• Tend not to view themselves as drug users.
• Use is not illegal
• More likely to be employed, housed, in
  relationship
• Likely to be in better health
• Attentive to diet and appearance
• Not presenting with a view to cessation

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A Similar Population

• Some users have underlying reasons for use
  e.g. dysmorphism
• Exposure to risk of BBVs via injecting
• In need of injecting equipment, and safer
  injecting information
• At risk of dependency
• Use may cause physical, mental or social
  problems
• Use of other substances may be present

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An under-serviced population?

• Strategy
• not a target group
• current NTA guidance
• Services
• opening hours
• lack of distinct service
• under-trained staff
• extent of Nx delivered via Pharmacy Exchange
• Resources
• reliance on pre-pack equipment
• restrictions on quantities given out

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Law uk

• Most Steroids are Controlled Drugs under the
  Misuse of Drugs Act 1971.
• Class C drugs.
• Supply of Class C drugs, including anabolic
  steroids is now a maximum of 14 years.
• Schedule 4ii under the Misuse of Drugs
  Regulations 2001.
• possession in a medicinal form is not a criminal
  offence.
• Premises (such as gyms) that knowingly allow
  supply of steroids will be commiting an offence
  under Section 8(b) of the Misuse of Drugs Act
  1971.
• Other products used may be covered under the
  Medicines Act and may be Prescription Only
  medicines, making supply outside of medical
  settings an offence.

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Challenges

• To gain a better insight in to the scale of PIED
  use via regional and national studies
• To free up funds to pay for additional, dedicated
  services not likely in current climate
• To increase credibility of drugs agencies with
  PED users
• Training, publicity and specialisist provision
• To develop the policy and ethics framework for
  drugs agencies working with PEDs
• To train staff on PEDs and recruit dedicated
  workers with a specialist interest in this
  subject
• To realign services to allow effective work with
  PED users
• Assessment tools, care pathways

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Key Development Issues Areas of Service
Engagement

• At present engagement is primarily via Needle
  Exchange
• There is moderate engagement with specialist
  sports clinics within a small number of drugs
  services offering wider health screening, blood
  testing and input around key drugs
• There may be limited engagement via drugs
  education input e.g in young peoples drug
  services or drugs awareness
• There is minimal input with psychotherapeutic
  interventions dependency on performance
  enhancing drugs, dysmorphia, treatment

1 Discussion area should drug services engage
with all these aspects of SIDs use fully?
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Key Development Issues Ethics

• Drugs agencies dont currently have an ethical
  framework with which to work with steroid use
• Possibly because we are intimidated by steroid
  use, we seem to want to engage with it in a
  radically different way to how we engage with
  other substance use
• Drugs agencies need to develop a framework which
  informs what the limits of information could be
  when advising on steroid use.

2 Discussion area a young steroid user comes in
at the start of their first cycle. It is clear
that they have no idea about aromatisation,
gynecomastia, or how to prevent it. What are the
ethical dilemmas workers face. What solutions can
you offer?
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Key Development Issues Staff Training

• staff are generally undertrained regarding SIDs
• the nature and range of literature doesnt
  improve the situation
• Undertrained and under-resourced staff are
  underconfident regarding these drugs
• This underconfidence and lack of knowledge can
  mean
• People using these drugs dont engage well with
  drug services because they feel that the services
  dont understand the subject
• Workers engage less well as they are
  under-confident
• Workers stick to areas which they know about
  (e.g. injecting) rather than areas where they are
  less confident
• Workers may view the clients as different or
  unwilling to engage

3 Is training on steroids happening is it a
priority? Has it impacted on how you work?
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Key Development Issues Assessment Tools

• assessment tools for needle exchange and
  treatment are slanted heavily towards opiate use
  rather steroids
• Assessment questions relating to intravenous
  injecting, filter sharing, etc are exclusive to
  street-drugs and alienate steroid users
• Such assessments dont encourage or prompt
  workers to ask the right questions of steroids
  users.

4 To what extent have you been able to develop
SIDs specific assessment tools. If you havent
done so, what could you envisage them including
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Key Development Issues Service Development and
Care Pathways

• remembering our diverse population of SIDs users
  we need to develop services relevant and
  accessible to
• Serious body-builders
• Young polydrug using SIDs users
• Young premature SIDs users
• People using tanning agents and other beauty
  products
• Other populations

4 What would illustrative care pathways look
like for some of these different populations?
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Further Information
http//injectingadvice.com/ includes a steroid
assessment tool and regular articles about
SIDs especially with regards injecting
behaviour http//www.muscletalk.co.uk/ -
Useful discussion board widely used by AAS
users Well moderated http//www.s.teroids.ne
t - Set up by Jim McVeigh discussion
group for professionals quiet at the
moment http//www.mickhart.com/ - promoter of
AAS in the UK pro-steroids lots of swearing
and casual prejudice Anabolic Steroids 2009
Llewellyn, W - the reference book on the
subject Available on-line, or from
Gym Ratz
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Contact Details
kfx_at_ixion.demon.co.uk www.ixion.demon.co.uk