1. CENTRE FOR PUBLIC HEALTH FACULTY OF EDUCATION, HEALTH & COMMUNITY LIVERPOOL JOHN MOORES UNIVERSITY 3 rd National Intelligence Network meeting on the health harms associated with drug use 29 th January Image & Performance Enhancing Drugs Emerging Trends

4. Prevalence Characteristics of users Reasons for use Efficacy Methods regimes & risks Harms Effective drug prevention Effective harm reduction Very little Some A bit Limited Mostly flawed Patchy Nothing at all Intuitive What do we actually know about anabolic steroid use in the UK?

5. Approx 25% first use in teens Users more likely to use orals before injecting (??) More likely to have been to prison (17%) Small numbers injected drugs other than IPEDs Cycles longer & approx 25% ‘blast & cruise’ Nobody knows what they are taking! In the last 12 months 47% snorted cocaine 12% used amphetamine Anabolic steroid use facts

7. Proportionn Anabolic Steroids57%226 Anti-oestrogens23%92 Clenbuterol15%60 Ephedrine20%78 Thyroid Hormones9%37 PDE5i (Viagra / Cialis)6.6%26 Oral use in previous year Hope, McVeigh et al

8. Proportionn Anabolic Steroids86%340 Growth Hormone32%128 HCG16%62 Insulin injected5.6%22 Melanotan8.6%34 Other PIED (inc. EPO, IGF-1 and Nubain)5.1%20 Injected in previous year Hope, McVeigh et al

9. Prevalence of growth hormone use amongst anabolic steroid users

10. Pegylated Mecano Growth Factor A long acting MGF similar to IGF-1 Growth Differentiation Factor 8 a myostatin inhibitor. FST Possibly Follistatin –myostatin inhibitor. Sermorelin Stimulates growth hormone release The new stuff…

11. The three most ‘popular’ internet shops identified A total of 73 vials of melanotan II 10mg were purchased Melanotan II in vials ranged between 4.32 to 8.84 mg Contained impurities ranged from 4.1 to 5.9% Melanotan Kimergård, McVeigh et al.

12. The strange case of GHRP-6… Kimergård, McVeigh et al. “We aim for a high standard….” EU PEPTIDES We Are Sorry For The Inconvenience Currently Our Site Is Under Construction

13. ‘No dieting… No self-denial… No strenuous exercises… You can have the slender figure of Youth’. ‘Literally burns the fat away’. ‘Sounds too good to be true? Yet it is true’ Unpredictable responses & narrow therapeutic window In just 2 years, 160 reported cases of cataracts and at least 10 deaths Metabolic poison Advert for Dilux-Redusols containing dinitrophenol, 1936. The old stuff… Dinitrophenol - It’s back

14. “People who hadn’t seen me since school would come up to me and go, ‘Oh my God, you look massive, you look fantastic’ “ (Steroid and growth hormone user aged 36) “I like to increase my strength, and now it’s more for conditioning” (Steroid user and doorman aged 35) “I think I started weight training more seriously as I was losing my hair because I think I started to suffer a loss of confidence” (Steroid user aged 35) Motivation to use steroids

15. “You can’t get anything pharmaceutical grade, everything is ‘underground’” (Steroid user, competing bodybuilder and gym owner aged 45) “You wouldn’t know, but you do find out the difference after you’ve finished your course and your are not getting the results you should be getting. I think that’s a risk you take, it comes in life, it comes everywhere” (Steroid user aged 27) The market Kimergård & McVeigh “I’ve heard horror stories about dealers that I talk to...there’ll be a tray of vials and they’ll ask, ‘what are you after?’ [specific types of steroids] And they say, ‘well there’s the bottles, there’s the labels, take whatever labels you need and just stick them on the bottles’” (Steroid user, competing bodybuilder and gym owner aged 45)

16. “...certain steroids on the [illicit] market are called different names to what they are called in the ‘book’ (Llewellyn, 2009)], and some aren’t in the book. So, I go on the Internet for that information, but each site says different things about it” (Steroid user aged 22) Obtaining information on anabolic steroids “My mate was on them, so I started to learn from him. He got on the internet and researched, so that he made sure that he knew what he was doing” (Steroid user aged 21) “I’ve never had any information off drug services, all my information has been from the guy I bought the steroids from” (Steroid user, NSP) “If I get problems with cholesterol, I’ll take statins, which is a drug that can lower cholesterol. That helps control that” (Steroid user aged 35) Kimergård & McVeigh

17. Aggression “I got bigger, I got stronger, but I also got nasty and more aggressive, and the two put together was dangerous. I kept fighting all the time and used to get myself locked up, and in the end it wasn’t working. I could be really nasty. I was a horrible person to talk to” (Steroid user aged 23) Kimergård & McVeigh “Working as a doorman I get provoked every night” Steroid user and doorman aged 35)

18. “No bodybuilders that I know share. I mean you hear of what are called druggies, people who use other stuff. I don’t mix in those circles to be honest” (Steroid user, NSP) Blood borne viruses Kimergård & McVeigh

19. “...the drug service is just a handy place to get your needles, literally that is all” (Steroid user, NSP,) Kimergård & McVeigh Service expectation

20. Enhancement Drugs & Public Health 9 th April 2014 Liverpool

21. CONTACT DETAILS Jim McVeigh Acting Director Centre for Public Health 0151 231 4512 j.mcveigh@ljmu.ac.uk www.cph.org.uk Twitter @mcveigh_jim