1. Performance and Image Enhancing Drugs (PIEDS)

2. Prevalence, Culture, Types, Problems, Methods of Administration, all cooked up in 1hr

3. Prevalence and Trends Poor UK survey Data Small area or location studies Glasgow accurate NEO data

5. Steroid use 'on par with heroin' 2007 Steroid use may be more than twice as common as official figures suggest, a leading expert has told the BBC. According to the British Crime Survey there are 42,000 regular anabolic steroid users in the UK. Drugs expert Jim McVeigh said there could be as many as 100,000. "Basically we're looking at numbers being on a par with heroin users," he added. One treatment centre in Merseyside reports that steroid use has rocketed in the last three years. Staff now treat four new steroid users for every new heroin user - a reversal of the situation in 2004. There is a particular problem with users aged under 25.

6. 6 Number of clients injecting specific drugs 2013 -2014

8. Glasgow’s PIEDs Clinic Established in 2009 Drop in service – 1 evening per week Staffed by 2 workers and nurse ( supported by lead medical officer) Based in the GDCC and supported by Turning Point 8

9. Aim Of Clinic To provide a specialised and accessible service. To raise the awareness of the risk of BBV (Blood borne virus) To identify ‘other’ harms and complications Provide alternatives to PIEDs use To improve injecting techniques To direct individuals to their local pharmacy needle exchanges for future transactions. 9

11. Why do people use our service What clients wantWhat clients need/we offer Equipment for injecting Advice (particularly on dosage) Help with side effects and harms Blood tests Large amounts of needles Explanation of how SIEDs work Explanation of specific steroids (esters etc) Preparation and injecting demos Diet and training advice Info on likely side effects Harms and risk minimisation Blood tests

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13. Clients want…..equipment for injecting Large amounts of needles are asked for, however, help is needed to calculate properly This is also our opportunity to discuss length of cycle injecting tech etc Stuffing needles in a bag wont cut it - we need to ask the right questions……..

14. Calculating equipment - it shows knowledge and understanding What are you using? - test prop, tren ace and hgh How long – 14 week cycle Where are you injecting? – Glutes, thighs and belly 98 I.M injections 98 green 49 long blue 49 short blue 98 Subcut Injections 981mls 44 1mls for prep 338 needles needed Secondary distribution too?

15. Discussion Points you can raise when sorting the equipment Injecting tech (prep, sterility, site rotation, choosing the right needles) Substance frequency of injecting (ester) Length of cycle Ancillary meds i.e. aromatase inhibitors What to expect when the cycle finishes PCT

16. Clients want…… advice on dosage(controversial I know) Have a reference – so it’s not your opinion Anabolic 10 th Edition is ideal If you are going to advise on high/dangerous doses…………….. If you are going to advise on cycles which are too long…………… If you are going to feedback abnormal blood results Giving advice on labels e.g. ‘mg per ml’ will lead to discussion on dose Giving advice on duration of esters will lead to discussion on dose Giving advice on syringe marking will lead to discussion on dose People often find peptide doses hard to calculate.

18. Other common questions On CycleOff Cycle Is this stuff real? Why am I not getting bigger? How can I deal with this… acne, gyno, bloating etc? What is PCT? Where’s my sex drive? Why am I loosing size so quickly? Why do I feel low? Why am I emotional? When should I start again? Why have I got these side effects when I have stopped using? What are my testosterone levels at?

19. Help – something's not right Problem related visits are common Similar issues Usually the reason is clear Usually the solution is clear but its not always what they want to hear The best time to discuss ‘sides’ is before the cycle starts

20. PIED using groups

21. Action Man - influencing image since 1966

22. If Barbie developed at the same rate?

27. Types of steroids produced  Pharmaceutical grade Good quality but often low in strength and amounts  Underground May be poor quality/unsterile often high concentrations Veterinarian Not designed for human use  Counterfeit Often contain no active product and may be unsafe

28. Recent example of counterfeit 28

29. Patterns of Use Stacking: taking several different steroids at the same time Cycling: taking multiple doses over a period of weeks or months, stopping, then starting again. Pyramiding: slowly increasing amount of steroids taken over 6-12wks, then decreasing the amount slowly ‘Addictive’ behavioural patterns are easily identifiable

30. Sample stack and cycle & cost 30 Cost £200 Cost £50Cost £45

31. 31 Cost £320Cost £80 Cost £160 Cost £100 Cost £1000 Cost £70

32. What happens after the cycle finishes? After the cycle comes the crash The body enters a ‘catabolic’ state Testes become de-sensitised FSH and LH are not produced/released Oestrogen levels can rise Lethargy and low mood can set in 32

33. 33 8 Week Cycle

34. Anabolic Steroid Induced Hypogonadism- Dr Scally “An unproven and unfounded assumption has been made in the medical establishment that the treatment for an individual suffering from ASIH is to do nothing which is coined ‘watchful waiting’ and in time HPTA functioning will return to normal” Doctors appear to be treating the symptoms of low test, not the cause 34

35. Post Cycle Therapy Idea is to accelerate and restore the body’s endogenous test production There are many different views on how this can be achieved However, most involve the same drugs……….. 35

36. Post Cycle Therapy – Rationale 36

37. Harm Reduction Advice 37