Performance Enhancing Drugs An increasingly Issue for Drugs Agencies

Performance Enhancing DrugsAn increasingly

Issue for Drugs Agencies

Problems with Terms

Anabolic SteroidsBut not all the compunds that are used are anabolics

Anabolic and Androgenic SteroidsAs above; a wide range of compounds which are used are not AAS

Performance and Image Enhancing DrugsA 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 CompoundsIncludes substances which are not of themselves enhancing performance or image but are used as part of a regime

Sports and Image DrugsMy personal preferred phrase

A Wide Range of Compounds

Anabolic Androgenic Steroids

Ancillary CompoundsAromatise InhibitorsOestrogen blockers

Post cycle treatment compoundse.g Clomid, HCG

Fat burnersephedrine, T3 etc

Diuretics

Tanning Agentse.g. Melanotan ii

Additional compoundsInsulin, Growth HormoneIGF-1

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

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?

Trends

Source: Presentation by Jim McVeigh: NCIDU 2006

Trends

Source: Presentation by Jim McVeigh: NCIDU 2006

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.

Patchy Treatment Routes

Fixed siteNeedle Exchange

Non-injectors

Sourcing via peers,internet

Pharmacy Nxnot all distribute the right equipment in the right quantities

Gym outreach:Limited activity, access problemsnot all users are gym goers Wider drug services

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

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

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

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

An under-serviced population?

Strategy:not a target groupcurrent NTA guidance

Services:opening hourslack of distinct service under-trained staffextent of Nx delivered via Pharmacy Exchange

Resources:reliance on pre-pack equipmentrestrictions on quantities given out

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.

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

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?

Key Development Issues:Ethics

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?

• 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.

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?

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

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?

Further Information

http://injectingadvice.com/ includes a steroid assessment tool and regular articles about SIDs especially with regards injecting behaviour

http://www.muscletalk.co.uk/ - Useful discussion boardwidely used by AAS usersWell moderated

http://www.s.teroids.net - Set up by Jim McVeigh – discussion group for professionalsquiet at the moment

http://www.mickhart.com/ - promoter of AAS in the UK; pro-steroidslots of swearing and casual prejudice

Anabolic Steroids 2009: Llewellyn, W - the reference book on the subject Available on-line, or from Gym Ratz

[email protected]

www.ixion.demon.co.uk

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