1. Performance Enhancing Drugs An increasingly Issue for Drugs Agencies
BIG

2. 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 don’t 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

3. A Wide Range of Compounds
Anabolic Androgenic Steroids
Ancillary Compounds
Aromatise Inhibitors
Oestrogen blockers
Post cycle treatment compounds e.g Clomid, HCG
Fat burners ephedrine, T3 etc
Diuretics
Additional compounds Insulin, Growth Hormone IGF-1
Tanning Agents e.g. Melanotan ii

4. 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

5. 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?

6. Trends
Source: Presentation by Jim McVeigh: NCIDU 2006

7. Trends
Source: Presentation by Jim McVeigh: NCIDU 2006

8. Research evidence scanty:
A Hidden Population?
Research evidence scanty:
don’t 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.

9. Patchy Treatment Routes
Pharmacy Nx not all distribute the right equipment in the right quantities
Fixed site Needle Exchange
Gym outreach:
Limited activity, access problems not all users are gym goers
Non-injectors
Wider drug services
Sourcing via peers, internet

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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.

16. 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

17. 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 people’s 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?

18. Key Development Issues:
Ethics
Drugs agencies don’t 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?

19. Key Development Issues:
Staff Training
staff are generally undertrained regarding SIDs
the nature and range of literature doesn’t 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 don’t engage well with drug services because they feel that the services don’t 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?

20. 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 don’t 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 haven’t done so, what could you envisage them including

21. 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?

22. Further Information
includes a steroid assessment tool and regular articles about SIDs especially with regards injecting behaviour
- Useful discussion board
widely used by AAS users
Well moderated
- Set up by Jim McVeigh –
discussion group for professionals
quiet at the moment
- 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

23. Contact Details