PERFORMANCE AND IMAGE ENHANCING DRUGS

1

John Campbell

Presentation Overview

Reasons for use

How Steroids

work

Common Steroids

How they are taken

RisksHarms

Reducing harm

PCT

The Law

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Prevalence and Trends

Poor UK survey Data

Small area or location studies

Glasgow accurate NEO data

Steroid Comparison - 4 Years

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

55%

60%

65%

New Steroid User Steroid Needles Issued Total Steroid UserVisits

Details

Per

cent

age

04/05 05/06

06/07 07/08

Steroid use 'on par with heroin' 2007Steroid 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 2004. There is a particular problem with users aged under 25.

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Drugs injected at registration – all sites 2012 -2013

Amph

etam

ines

Cocai

ne

Crack

Heroi

nPied

s

Mel

anot

an0

500

1000

1500

2000

2500

3000

20 180 34

2599

982

160

Drugs Injected at Registration

Series1

7

      

New Registrations GDCC 2012 – 2013 (drugs injected)

Amphetaime

Cocaine

Tanning Agent (e.g. melanotan)

Heroin

PIEDs (e.g. steroids, growth hormone)

0 100 200 300 400 500

3

9

52

179

461

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

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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.

9

Letting clients know about the service

SUCCESSFUL UNSUCCESSFUL

Referrals from other exchanges

Gym buddies Dealers Forums

Gym owners Supplement Stores Poster displays

11

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 tests12

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Date Collected

HIV NEG NEG NEG NEG NEG NEG

HEP B NEG NEG NEG NEG NEG NEG

HEP C NEG NEG NEG NEG NEG NEG

Test Declined

No No No No No No

Abnormal U&E

No No No Yes No No No

Abnormal LFT

No Yes No No Yes Yes No

Abnormal Cholestro

l

No No Yes No Yes No No

Abnormal Hormone

s

Yes Yes Yes Yes Yes Yes Yes

Repeat Test

No No No No No No No

PIED using groups

Image enhancing

Athletic/sports

Non-athletic training

Occupational

Dysmorphia/self esteem

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

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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.

How Steroids work

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HYPOTHALAMUSGnRH

PITUITARYLH FSH

TESTES

Testosterone

Natural Test production

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

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

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

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

Recent example of counterfeit

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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

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

Melanotan 2

Melanotan is a hormone that stimulates melanin production

Other reported benefits:• weight loss• increased libido • healthy spot free skin

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 6-12wks, then decreasing the amount slowly

‘Addictive’ behavioural patterns are easily identifiable

Sample stack and cycle

29Cost £200 Cost £200 Cost £50 Cost £45

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

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

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32

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 160

5

10

15

20

25

30

35

40

45

50

natural testSteroid TestEstrogen

Steroid crash -low Test

Test

Level

8 Week Cycle

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

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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………..

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Post Cycle Therapy – Rationale

HCGshocks the

testicles into action -

increasing testicular mass

Nolvadexblocks

negative feedback from

too much estrogen

Clomidstimulates

the hypothalamu

s

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HYPOTHALAMUSGnRH

PITUITARYLH FSH

TESTES

Testosterone

HARMS

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

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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.

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Risks - Men

Shrinking of the testicles -

temporary

Reduced sperm count - infertility

Sexual dysfunction

Prostate enlargement

Baldness

Gynaecomastia - development of

breasts

Risks All

Acne

High Blood Pressure

Mood swings

Jaundice/liver damage

Pain in the joints (esp with Winny or hGH)

Urinary problems

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

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 occur43

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?

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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

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Harm Reduction Advice

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

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