michael evans-brown & jim mcveigh

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The changing nature of performance-enhancing drug use … What are the implications for public health? Michael Evans-Brown & Jim McVeigh

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The changing nature of performance-enhancing drug use … What are the implications for public health?. Michael Evans-Brown & Jim McVeigh. Once upon a time …. - PowerPoint PPT Presentation

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Page 1: Michael Evans-Brown & Jim McVeigh

The changing nature of performance-enhancing drug use …

What are the implications for public health?

Michael Evans-Brown & Jim McVeigh

Page 2: Michael Evans-Brown & Jim McVeigh

Once upon a time …

• “I have recently been approached by a person who is interested in body building and weightlifting and who has asked me if I would consider giving him anabolic steroids. He alleges that a very large percentage indeed of the top flight of both body-builders and weight-lifters take these drugs … He also says that there is a ready availability of these drugs on the ‘black market’” (BMJ, 1967)

• “The amateur organizations with which I am associated have heard of many cases of young weight-lifters and bodybuilders being prescribed anabolic steroids more or less on request from their general practitioners” (BMJ, 1967)

Page 3: Michael Evans-Brown & Jim McVeigh

Then came the 80s …

• “a quantity of an anabolic steroid had disappeared from a hospital pharmacy” (BMJ, 1985)

• “The black market is thriving in the buying and selling of anabolic steroids … they included injectable testosterone, a generous supply of needles, and an advanced hormone.” (Times, 1987)

• ACMD asked to look at the issue … insufficient evidence that steroid use constituted a ‘social problem’

• Pharmacist struck off for supply of Anapolon & Growth Hormone (Times, 1988)

Page 4: Michael Evans-Brown & Jim McVeigh

Then the 90s …

• National study in 21 gyms (1992). 6% of males currently using, 1.4% of females. Most not involved in elite sport

• ACMD reviews issue again (1992–93). Recommends control of steroids under the Misuse of Drugs Act 1971 but simple possession to remain lawful

• Further studies in England & Wales. Some harm reduction services based around providing injecting equipment

• The Government accepts ACMD recommendations, law changed (1996)

Page 5: Michael Evans-Brown & Jim McVeigh

Thereafter …

• A few more studies looked at use in gyms in Wales & England

• Is more growth hormone use being reported?

• Are more using for ‘body image’ reasons?

• Is use starting at a younger age?

• In the past few years, alongside the ‘classic’ drugs, a large number of products have become widely available on the illicit market, particularly on the Internet.

• Will these diffuse to broader groups?

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“I was VERY pleased with the results from melanotan II last year. This year my Mum

and Dad are going to try it too.”

(how common is this?)

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We don’t know much about:

• how many people are using & how long they use for

• which types of people are using and their ages

• why they are using, why they started using, and at what age they started using

• how these drugs are being used (different drugs used, doses taken, duration of use and injecting practices)

Page 13: Michael Evans-Brown & Jim McVeigh

We don’t know much about:

• the illicit market (manufacture, distribution and supply)

• the quality, safety and efficacy of products:

• most are unlicensed

• many are either in pre-clinical or in phase I/II trials

• some licensed products containing the same drug have been withdrawn from the market

• many believed to be manufactured in China with some ‘assembly’ in the UK

Page 14: Michael Evans-Brown & Jim McVeigh

We do know:

• On the Internet the drugs are relatively inexpensive; often offered at “discounted” prices or as part of other offers. Internet sites offer a “one-stop-shop” approach

• Websites are designed to appeal to desires and insecurities

• Some products may lower threshold for use (e.g. nasal spray or oral); although injectable products are not necessarily a barrier

Page 15: Michael Evans-Brown & Jim McVeigh

What this group uses today, others may use tomorrow

• GHB — used started in the late 1980s to increase Growth Hormone secretion

• Noted in study from Clwyd (1996)

• Use diffused to wider group as a ‘legal high’

• 2003 controlled under the Misuse of Drugs Act 1971

• Stimulants?

Page 16: Michael Evans-Brown & Jim McVeigh

What about harms?

• We never had a good evidence base on the harms the ‘classic’ drugs posed, but …

• A key concern for injectable products is sterility and injecting practices (yet, overall we have poor data)

• What do we know about the emerging drugs?

Page 17: Michael Evans-Brown & Jim McVeigh

What should we do?

• ACMD recommends ‘focus on public health’ rather than criminalisation (2010)

• So, let’s focus on that

• It starts with research, but requires support and guidance from policy makers, practitioners and users.