1. Performance and Image Enhancing Drugs
John Campbell

2. Presentation Overview
Reasons for use
How Steroids work
Common Steroids
How they are taken
Risks
Harms
Reducing harm
PCT
The Law

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 There is a particular problem with users aged under 25.

6. Drugs injected at registration – all sites 2012 -2013

7. New Registrations GDCC 2012 – 2013 (drugs injected)
   
   
New Registrations GDCC 2012 – 2013 (drugs injected)

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

9. Aim Of Clinic To provide a specialised and accessible service.
To raise the awareness of the risk of BBV (Blood borne virus) and related infections.
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.

11. Letting clients know about the service
successful
unsuccessful
Referrals from other exchanges
Gym buddies
Dealers
Forums
Gym owners
Supplement Stores
Poster displays

12. What we offer
Needles and paraphernalia provision, including water for injection.
Consultations/assessments
Discussions on; ‘harmful’ doses, understanding ‘labels’ and syringe markings
Safer injecting advice and demonstrations
Alternatives such as diet and exercise
Wound identification
Product identification
Blood tests

13. Date Collected
HIV
NEG
HEP B
HEP C
Test Declined No
Abnormal U&E
Yes
Abnormal LFT
Abnormal Cholestrol
Abnormal Hormones
Repeat Test

14. PIED using groups Image enhancing Athletic/sports
Non-athletic training
Occupational
Dysmorphia/self esteem

15. Comparison with Street Drugs
Similarities
differences
Stigma
Method of administration
Poly drug use
How bought
Dependency
Self perception
How bought
Legality
Self welfare
Social status?
Ratio of men to women
No instant gratification

16. Anabolic/Androgenic Steroids (AAS)
They are synthetically produced variants of the naturally occurring male sex hormone testosterone. “Anabolic” refers to muscle- building, and “androgenic” refers to increased male sexual characteristics. “Steroids” refers to the class of drugs.
These drugs can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, as well as diseases that result in loss of lean muscle mass, such as cancer and AIDS.

17. How Steroids work

18. Natural Test production
HYPOTHALAMUS
GnRH
PITUITARY
LH FSH
TESTES
Testosterone

19. Common Substances
Anabolic/Androgenic steroids : to increase bulk, strength and power
Oestrogen-blockers: to block symptoms of feminisation
Diuretics: to remove excess water
Fat-burners: to remove excess fat and “cut up”
Growth Enhancers: to promote new cell growth
Post-cycle treatments: to stimulate natural testosterone production
Injectable tanning agents: to stimulate pigmentation

20. Commonly used steroids Injectables (commercial and street names)
Sustanon 250/Omnadren (sust)
Testosterone Cypionate (cyp)
Testosterone Enanthate (test)
Testosterone Propionate (prop)
Trenbolone (tren)
Nandrolone (Deca Durabolin deca)
Stanozolol solution (Winstrol winny)
Methenolone (primobolan primo)
Boldenone (equipoise)
Various blends emerging

21. Oral Steroids Testosterone Undecanoate (andriol)
Oxymetholone (Anadrol/oxies)
Oxandrolone (oxandrin - Anavar)
Methandrostenolone (Dianabol d-bol)
Stanozolol tablets (Winstrol winny)
ORAL STEROIDS CAN BE MORE HARMFUL THAN INJECTABLES

23. 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

24. Recent example of counterfeit

25. Human Chorionic Gonadotrophin
Other substances
Miscellaneous
Human Growth Hormone
GHRP 2 & 6
CJC 1295
LR3
IGF -1
Insulin
Melanotan 1&2
Fat Burners
Ephedrine
Clenbuterol T3 T4
ECA stack
Anti-estrogen & PCT
Human Chorionic Gonadotrophin
Nolvadex (tamoxifen)
Clomid Citrate
Arimidex
Letrozole
Viagra

26. hGH hGH (and the IGF-1 that is a result of
its use) is the only substance that
can actually initiate hyperplasia (new cells).
GH is produced by the pituitary, IGF-1
is produced primarily by the liver in
response to GH
It requires careful storage, handling and
preparation
Many newer peptides also work in a similar way

27. Melanotan 2 Melanotan is a hormone that stimulates melanin production
Other reported benefits:
weight loss
increased libido
healthy spot free skin

28. 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 wks, then decreasing the amount slowly
‘Addictive’ behavioural patterns are easily identifiable

29. Sample stack and cycle
Cost £200
Cost £200
Cost £50
Cost £45

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

31. 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
Estrogen level rise
Lethargy and low mood can set in

32. 8 Week Cycle

33. 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. 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. Post Cycle Therapy – Rationale
shocks the testicles into action - increasing testicular mass
HCG
Nolvadex
blocks negative feedback from too much estrogen
Clomid
stimulates the hypothalamus
HYPOTHALAMUS
GnRH
PITUITARY
LH FSH
TESTES
Testosterone

36. HARMS

37. Risks - Adolescents
One of the most detrimental thing that could happen is the stunting of growth plates
Other complications involve extreme bone pain, liver toxicity, vascular damage, kidney damage, and joint problems

39. Risks - Women Changes in the reproductive system
Birth defects (virilisation of female foetus)
Development of a more masculine physique, shrinkage of the breast tissue, deepening of the voice, male pattern baldness and coarse skin.

41. Risks - Men Shrinking of the testicles - temporary
Reduced sperm count - infertility
Sexual dysfunction
Prostate enlargement
Baldness
Gynaecomastia - development of breasts

42. Risks All
Increases in LDL (bad cholesterol) and decreases in HDL (good cholesterol)
Modification in the left ventricle of the heart, with serious implications
Increased risk of developing heart related complications/stroke
Acne
High Blood Pressure
Mood swings
Jaundice/liver damage
Pain in the joints (esp with Winny or hGH)
Urinary problems

43. Steroid Dependence Fact or Fiction?
DSM IV - Drug dependency occurs if:
The drug is taken higher doses or for longer than intended
Unsuccessful efforts to stop or cut down
Excessive time spent obtaining or using the substance
Important activities are given up
Continued use despite negative health effects
Need for higher amounts to be taken for the desired effect
Withdrawal symptoms occur

44. PIED Dependance
If people are “addicted” to using these substances what interventions may help?
Do we work with PIEDs users in the same way as we would other drug users?
If we need to change our approach how do we do this?

45. Addiction, Dependence and treatment?
Talking therapies
Continued use due to fear of muscle loss – CBT
Dealing with steroid cravings – Relapse Prevention
Unwillingness to stop - MI
Medical interventions
Depression post cycle – antidepressants
Loss of sexual function - Viagra
Hypogonadism – HCG & Clomid

46. Harm Reduction Advice Use reasonable dosages and stacks
Always cycle
Use only the safest drugs
Use testosterone as a first choice?
Avoid toxic oral steroids
Avoid counterfeit and underground
Always consider risk and reward
Use proper injecting tech
Get regular blood tests
Use reasonable dosages and stacks