1. Providing Services for Performance Enhancing Drug Users Ralph Heron Team Manager Harm Minimisation Service 13 &14/10/05 Drugs In Sport Clinic and User Support DISCUS

2. Providing Services for Performance Enhancing Drug Users Aims Side Effects of PEDS Side Effects of PEDS PEDs and Associated Substances PEDs and Associated Substances Overview of DISCUS Overview of DISCUS The Role of Harm Minimisation The Role of Harm Minimisation

3. Is it Just Steroids The issue is not just about using Steroids The issue is not just about using Steroids But about using a wide range of Performance Enhancing Drugs But about using a wide range of Performance Enhancing Drugs Steroid use gets the headlines Steroid use gets the headlines The other substances The other substances (e.g. Insulin, Human Growth Hormone) do not make the headlines but are used alongside the steroids (e.g. Insulin, Human Growth Hormone) do not make the headlines but are used alongside the steroids

6. Body Builders

10. Historical  Egyptian pharaohs boil hind hooves of ass to give a sporting edge  Roman gladiators use strychnine and wine with chariot racers feeding horses “mixtures” to make them run faster  Olympians using magic mushrooms in 300 b.c.  Vikings renowned for fighting in frenzied state, fuelled by magic mushrooms  Legendary Knights drink magical potions from Merlins cup

11. A Win for Stanozolol!!

12. Whats Used?

15. Commonly Used Orals  Oxandrolone - Anavar*  Testosterone Undecanoate - Andriol  Methandienone - Dianabol*  Methenolone - Primobolan  Stanozolol - Winstrol* *Denotes 17 alpha-alkylated compounds

16. Commonly Used I.M. A.A.S.  Nandrolone Decanoate - Deca Durabolin  Methandienone – Dianabol*  Boldenone Undecanoate - Equipoise  Formebolone - Esiclene  Trenbolone - Parabolan  Methenolone - Primobolan  Stanozolol - Stromba*  Testosterone Esters - Sustanon (Mix of IV) Testex (Mix of II)

17. Androgens and Anabolics  Boldenone  Calusterone*  Clostebol  Danazol*  Drostanolone  Epitostanol  Ethyloestrenol*  Fluoxymesterone*  Formebolone  Furazabol*  Mepitiostane  Mesterolone  Methandienone*  Methandriol*  Methenolone  Methyltestosterone* *Denotes 17 alpha-alkylated compounds

18. Androgens and Anabolics  Mibolerone  Nandrolone  Norclostebol  Norethandrolone*  Oxabolone  Oxandrolone*  Oxymethalone*  Prasterone  Quinbolone  Stanolone  Stanozolol*  Testosterone  Trenbolone * Denotes 17 alpha-alkylated compounds

19. Not just steroids Insulin Insulin Ephedrine Ephedrine Dehydrating Agents Dehydrating Agents Growth hormone Growth hormone HCG (Human Chorionic Gonadotrophin) HCG (Human Chorionic Gonadotrophin) Nubain Nubain Clomid Clomid Tamoxifen Tamoxifen Recreational Drugs Recreational Drugs

20. Effects

21. Main Positive Effects of P.E.Ds Cited by Service Users  Increased muscle mass  Increased strength  Ability to train longer/harder  Enhanced appearance  Weight gain  Increased confidence  Feeling of wellbeing  Increased aggression  Feeling powerful  Increased libido PhysicalPsychological

22. Main Negative Effects of P.E.Ds Cited by Service Users  Tender injection site  Gynaecomastia  Acne  Tissue scarring  Increased aggression  Paranoia  Fear of disease  Fear of effects on cessation of P.E.D use Physical Psychological

23. Problems Associated  Altered Coagulation  Increased Haematocrit (HCT)  Infertility  Testicular shrinkage  Clitoral hypertrophy  Epiphyseal closure in prepubertal children

24. Psychological  Psychosis  Hypomania  Euphoria  Emotional Lability  Aggression  Irritability  Reckless behaviour  Increased libido  Paranoid reactions

25. The Role of Harm Minimisation

26. The Price Some Will Pay  “If I had a magic drug that was so fantastic that if you took it once you would win every competition you would enter, from the Olympic decathlon to the Mr.Universe, for the next five years, but it had one minor drawback – it would kill you five years after you took it – would you still take the drug?”

27. Harm Minimisation Harm Minimisation  Start with lowest dose/stack possible  Optimise diet and training regimes  Use low androgenic initially  Regular investigations  Shortest cycle possible with max. time off cycle  Use your own, sterile injecting equipment  Correct injecting technique  Know your source of gear SOURSUCK

28. Creatine Monohydrate  Acts as muscle’s capacitor  Effective in 70% of users  5-7lb of lean muscle  Each dose = 2lb steak  Take in warm drink with 100g of carbohydrate  Loading phase = 10g for 5/7 then 5g for 5/7  Maintenance phase = 2g daily

29. Drugs In Sport Clinic and User Support The DISCUS Team DISCUS Client Clinic Co-ordinator R.M.O. 11 years old this year Nurse Sports DieticianWomen’s Outreach

30. Why DISCUS?  Need identified locally in 1993  50% of needle exchanges were for PED users  Prevention of blood borne infections  PED users reluctant to approach existing “drugs” services  Experience within gyms  Gateway service focussing on harm reduction

31. Services Available 2 Hours per week 2 Hours per week 700 individuals registered 700 individuals registered Informal and confidential Informal and confidential Full range of injecting equipment services Full range of injecting equipment services Safer injecting advice Safer injecting advice Responsible Medical Officer Responsible Medical Officer Nursing assessment Nursing assessment

32. Services Available 2 Dietician Dietician Hepatitis A & B vaccination Hepatitis A & B vaccination Regular blood investigations (LFTs, FBC, Cholesterol etc) Regular blood investigations (LFTs, FBC, Cholesterol etc) ECG ECG Body fat analysis Body fat analysis Referral on to other services if/when necessary Referral on to other services if/when necessary

33. Activity Levels 04-05

36. Number 86

37. Providing Services for Performance Enhancing Drug Users What can you provide What can you provide What can’t you provide What can’t you provide Why can’t you provide Why can’t you provide What is realistic What is realistic What are the constraints What are the constraints What are the benefits to service users What are the benefits to service users

38. Our Role  “ Substance misusers have the same entitlement as other clients to the services provided by the National Health Service. It is the responsibility of all Health Care Workers to provide care for both the general health needs and drug related problems, whether or not the patient is ready to withdraw from drugs.”  Where do services for Performance Enhancing Drug Users fit into this statement???? Department of Health (1999)

39. Providing Services for Performance Enhancing Drug Users Ralph Heron Team Manager Harm Minimisation Service and DISCUS Contact details 0191 3336032/6031 07747865604 (Mobile and Contact Number for DISCUS) ralph.heron@cddps.nhs.uk