Performance Enhancing Drugs An increasingly Issue for Drugs Agencies

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 Ancillary Compounds Aromatise Inhibitors Oestrogen blockers Anabolic Androgenic Steroids Fat burnersephedrine, T3 etc Post cycle treatment compoundse.g Clomid, HCG Diuretics Additional compoundsInsulin, Growth HormoneIGF-1 Tanning Agentse.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. 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 Nxnot all distribute the right equipment in the right quantities Fixed siteNeedle Exchange Gym outreach: Limited activity, access problemsnot 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 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 board widely used by AAS users Well moderated http://www.s.teroids.net - Set up by Jim McVeigh – discussion group for professionals quiet at the moment http://www.mickhart.com/ - 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 kfx@ixion.demon.co.uk www.ixion.demon.co.uk