jim mcveigh acting director centre for the use of anabolic ... · (steroid user, competing...

Jim McVeigh

Acting Director

Centre for

Public Health

Liverpool

John Moores

University

The Use of Anabolic Androgenic Steroids &

Associated Drugs in the UK:

Characteristics & Concerns

Better than

well

The Fountain of Youth, Lucas Cranach the Elder (1546)

40 years of Action Man

Beyond a pill for every ill

The use of anabolic androgenic steroids &

associated drugs in the UK

People

Products

Problems

Policy

General Population

0

0,2

0,4

0,6

0,8

1

1,2

last year

Ever

Drug (2014/15) Last year Ever

Anabolic steroids 73,000 293,000

Heroin 27,000 223,000 CSEW, 2015

“Have you ever taken anabolic steroids (steroids) (not

prescribed by a doctor) even if it was a long time ago?”

Adults (16-59 year olds) reporting the use of

anabolic steroids in the last year or ever

11 years 12 years 13 years 14 years 15 years Total

Anabolic steroids

0.1 0.2 0.3 0.9 0.2 0.3

Proportion of boys who have taken

drugs in the last year, 2010

NatCen, 2012

‘All’ & ‘new’ clients attending agency based NSPs in

Cheshire & Merseyside (1991 to 2011)

Cheshire & Merseyside NSP clients

seen in 2013/14

Proportion of NSP clients using

enhancement drugs Middlesbrough 67%

Kirklees 60%

Sheffield 62%

Newcastle 52%

Sunderland 60%

Bradford 41%

Halton 86%

Liverpool 83%

Sefton 43%

St Helens 34%

Warrington 86%

Wirral 77%

Manchester 60%

Bolton 52%

Products

Proportion n

Anabolic Steroids 57% 226

Anti-oestrogens 23% 92

Clenbuterol 15% 60

Ephedrine 20% 78

Thyroid Hormones 9% 37

PDE5i (Viagra / Cialis) 6.6% 26

Oral use in the previous year

Hope, McVeigh et al 2014

Proportion n

Anabolic Steroids 86% 340

Growth Hormone 32% 128

HCG 16% 62

Insulin injected 5.6% 22

Other PIED (inc. EPO, IGF-1 and Nubain)5.1% 20

For full extent of polypharmacy see: Sagoe et al

Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis

Injected in the previous year

Hope, McVeigh et al 2014

Prevalence of growth hormone use

amongst anabolic steroid users

Human enhancement drugs

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…

Problems

Causality

Weight-lifter student, 24, died of heart

attack ‘triggered by his use of

anabolic steroids’

17th July 2015

Adverse effects on several organ/systems in particular:

Cardiovascular effects

Haematologic effects

Psychiatric and neuropsychologic effects

Hormonal and metabolic effects

Variety of less frequent effects on various other bodily tissues.Pope et al, 2013

ADVERSE HEALTH CONSEQUENCES OF

PERFORMANCE- ENHANCING DRUGS:

AN ENDOCRINE SOCIETY SCIENTIFIC

STATEMENT

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)

Much longer periods of use such as 20 weeks “on” are

common

25% “blast & cruise”

Custom made mega doses of testosterone (eg 600mg/ml)

High levels of psychoactive drug use, in particular cocaine.

Up to half of anabolic steroid users having used cocaine in

the previous 12 months

Small numbers injected drugs other than enhancement drugs

Small numbers drinking alcohol at extremely high levels

The regimes

“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)

Substandard & counterfeits drugs

The strange case of GHRP-6

“We aim for a high standard….”

EU PEPTIDES

We Are Sorry For The Inconvenience

Currently Our Site Is Under Construction

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

.

Supplements – they are safer!

Abbate et al, 2014

Supplements – they are safer!

Injecting

The risk of blood-borne virus transmission among

people who inject image- and performance-

enhancing drugs may be lower than among groups

who inject other drugs.

Is that true?

2010/11 2012/13

Anti-HIV Prevalence 1.5% (400) 2.0% (249)

Anti-HBc Prevalence 8.7% (400) 2.8% (249)

Anti-HCV Prevalence 5.4% (400) 3.6% (249)

Level of sharing (direct & indirect) 8.9% (392) 13% (243)

Hepatitis B vaccine uptake 24% (375) 40% (246)

Symptom of injection site infection 6.9% (389) 16% (238)

Ever been in prison 17% (377) 24% (247)

Unlinked Anonymous Monitoring Survey of People Who Inject image and

performance enhancing drugs

Hope, McVeigh et al, 2014

Policy

ACMDAdvisory Council on the Misuse of Drugs

Consideration of the Anabolic SteroidsSeptember 2010

Legislation

Commissioners and providers should ensure users of image or

performance enhancing drugs are provided with the equipment they

need… at times and in places that meet their needs (e.g. outreach

services in gyms or outside normal working hours), and by properly

trained staff.

…any substance used with the intention of enhancing image or

performance (except under medical supervision). It includes:

anabolic steroids, growth hormones and novel drugs (such as those that

stimulate secretion of growth hormone), IGF-1 and analogues, human

chorionic gonadotrophin, melanotans, botulinum toxin and dermal fillers

etc

NICE seeks to limit the spread of blood borne

viruses among steroid users

TURNING EVIDENCE INTO PRACTICE

Providing effective services for people who use image and performance enhancing drugs

Briefing for commissioners in local areas, who are responsible for services to prevent and treat harms caused by image and performance enhancing drugs (IPEDs) and injecting drug use. The content is drawn from published evidence, guidance, and expert consensus.

Guidance for commissioners

Drug misuse and dependence: UK

guidelines on clinical management

Produced by the Department of Health (England), the Scottish Government, Welsh Assembly Government and Northern Ireland Executive

Clinical management

Service expectation

“...the drug service is just a handy

place to get your needles, literally

that is all” (Steroid user, NSP)

Kimergård & McVeigh

Obtaining information on anabolic steroids

“...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)

“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

Hope, V. D., Harris, R., McVeigh, J., Cullen, K. J, . . . Ncube, F. (2015). Risk of HIV and hepatitis B and C over time among men who inject image and performance enhancing drugs in England and Wales: results from cross-sectional prevalence surveys, 1992-2013.. Journal of acquired immune deficiency syndromes.

McVeigh, J., Bates, G., & Chandler, M. (2015). Steroids and Image Enhancing Drugs 2014 Survey Results. Centre for Public Health, LJMU

Sagoe, D., McVeigh, J., Bjornebekk, A., Essilfie, M. -S., Andreassen, C. S., & Pallesen, S. (2015). Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis. SATPP, 10.

Stensballe, A., McVeigh, J., Breindahl, T., & Kimergard, A. (2015). Synthetic growth hormone releasers detected in seized drugs. ADDICTION, 110(2), 368-369.

Abbate, V., Kicman, A. T., Evans-Brown, M., McVeigh, J., Cowan, D. A., Wilson, C., . . . Walker, C. J. (2015). Anabolic steroids detected in bodybuilding dietary supplements - a significant risk to public health. DTA, 7(7), 609-618.

Kimergard, A., & McVeigh, J. (2014). Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study. HRJ, 11.

Kimergard, A., Breindahl, T., Hindersson, P., & McVeigh, J. (2014). The composition of anabolic steroids from the illicit market is largely unknown: implications for clinical case reports. QJM-An international journal of medicine, 107(7), 597-598.

Breindahl, T., Evans-Brown, M., Hindersson, P., McVeigh, J., Bellis, M., Stensballe, A., . . . Kimergard, A. (2015). Identification and characterization by LC-UV-MS/MS of melanotan II skin-tanning products sold illegally on the Internet. DTA, 7(2), 164-172.

Hope, V. D., McVeigh, J., Marongiu, A., Evans-Brown, M., Smith, J., . . . Ncube, F. (2015). Injection site infections and injuries in men who inject image- and performance-enhancing drugs: prevalence, risks factors, and healthcare seeking. Epidemiology and infection (1), 132-140.

Kimergård, A., Mcveigh, J., Knutsson, S., Breindahl, T., & Stensballe, A. (2014). Online marketing of synthetic peptide hormones: Poor manufacturing, user safety, and challenges to public health. DTA, 6(4), 396-398.

Evans-Brown, M., Kimergard, A., McVeigh, J., Chandler, M., & Brandt, S. D. (2014). BODYBUILDING SUPPLEMENTS Is the breast cancer drug tamoxifen being sold as a bodybuilding dietary supplement?. BMJ, 348,

Kimergard, A., & McVeigh, J. (2014). Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK. BMJ OPEN, 4(6).

Hope, V. D., McVeigh, J., Marongiu, A., Evans-Brown, M., Smith, J., Kimergard, A., . . . Ncube, F. (2013). Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study. BMJ Open, 3, e003207.

References

Jim McVeigh Acting Director

Centre for Public Health

Liverpool John Moores University

0151 231 4512

j.mcveigh@ljmu.ac.uk

www.cph.org.uk

twitter @mcveigh_jim

Are other countries experiencing increased risk behaviour in

relation to regimes, growth hormone and novel peptide

hormones?

What is the perception of the market in relation to illicit

products amongst various groups eg Enforcement &

regulation, health professionals, user populations?

What are the perceived risks related to blood borne viruses?

QUESTIONS