The modes of administration of anabolic-androgenic steroid (AAS) users: are non-injecting people who use steroids overlooked?

Abstract

Introduction: There is increasing public health concern about the use of anabolic-androgenic steroids (AAS). Understanding of drug use patterns and practices is important if we are to develop appropriate risk-reduction interventions. Yet, much remains unclear about the modes of administration adopted by AAS users.

Methods: We used data from a sub-sample of participants from the Global Drug Survey 2015; males who reported using injectable or oral AAS in their lifetime (n?=?1008).

Results: Amongst our sample, approximately one third (35.62%) reported using only injectable AAS during their lifetime while 35.84% reported using only oral, with less than one third (28.54%) using both.

Conclusion: These findings suggest there may be a sub-population of individuals who only use AAS orally. Needle and syringe programmes (NSPs) are currently the primary point of health service engagement; forming the main healthcare environment for medical and harm reduction advice on steroids. Yet, NSP-based resources are unlikely to reach or be appropriate to those who do not inject AAS. While there is a general need for health services to be more accessible when it comes to AAS use, non-injectors are an overlooked group that require attention.     

Anabolic steroids detected in bodybuilding dietary supplements – a significant risk to public health

Twenty‐four products suspected of containing anabolic steroids and sold in fitness equipment shops in the United Kingdom (UK) were analyzed for their qualitative and semi‐quantitative content using full scan gas chromatography‐mass spectrometry (GC‐MS), accurate mass liquid chromatography‐mass spectrometry (LC‐MS), high pressure liquid chromatography with diode array detection (HPLC‐DAD), UV‐Vis, and nuclear magnetic resonance (NMR) spectroscopy. In addition, X‐ray crystallography enabled the identification of one of the compounds, where reference standard was not available. Of the 24 products tested, 23 contained steroids including known anabolic agents; 16 of these contained steroids that were different to those indicated on the packaging and one product contained no steroid at all. Overall, 13 different steroids were identified; 12 of these are controlled in the UK under the Misuse of Drugs Act 1971. Several of the products contained steroids that may be considered to have considerable pharmacological activity, based on their chemical structures and the amounts present. This could unwittingly expose users to a significant risk to their health, which is of particular concern for naïve users. Copyright © 2014 John Wiley & Sons, Ltd.     

Polypharmacy,Infectious Diseases,Sexual Behavior,and Psychophysical Health Among Anabolic Steroid-Using Homosexual and Heterosexual Gym Patrons in San Francisco's Castro District

Background: Limited studies based in England and Australia reported misuse of anabolic-androgenic steroids (AAS) among homosexual men to enhance body image. Anecdotally, AAS are also being misused by homosexual men in the United States. Since many AAS and certain performance enhancing drugs (PEDs) are administered via injection, this poses a potential vector for the spread of infectious disease in an already at-risk population. Objectives: This study compared and contrasted homosexual and heterosexual male gym clients regarding use of AAS and PEDs, use of alcohol and illicit drugs, seroprevalence of infectious disease, engagement in risky injection practices and sexual behaviors, and presence of psychiatric conditions. Methods: Recruitment and data collection occurred outside four exercise gyms in the San Francisco Castro District area between October 25, 2014 and March 10, 2015. Two hundred and twenty homosexual men and 73 heterosexual men completed the 114-item cross-sectional survey. Results: Ten percent of homosexual men reported lifetime AAS use. Homosexual men had almost four times more sexual partners and were over 14 times more likely to knowingly have unprotected intercourse with a known HIV positive person than heterosexual men. In addition, a quarter of homosexual men who injected drugs admitted to sharing used syringes or needles with another person. Conclusions/Importance: The current study is the first to confirm AAS use among homosexual men in the United States. Homosexual men partook in high-risk sexual behaviors and injection practices which may place them at greater risks for contracting and spreading HIV and other infectious diseases.     

Use of anabolic androgenic steroids in substance abusers arrested for crime

Background

Use of anabolic androgenic steroids (AASs) has been associated with both violent crime and the use of illicit drugs. The scientific literature on polysubstance abuse as a confounder for AAS-related violence is sparse and ambiguous. With the intent of further investigating this issue, we have gathered data concerning drug abuse and AAS experience among substance abusers who have been arrested for a variety of crimes.

Methods

Data were collected from structured interviews with substance abusers (n = 3597) apprehended at two remand prisons in Sweden from 2002 through 2008. Analyses concerned type of criminal act, primary drug used during the past year, and experience of AAS use.

Results

Those stating AAS experience (n = 924, 20 women and 904 men) were more often apprehended for violent crimes (OR = 1.65). This association remained significant after controlling for age and sex (OR = 1.28). AAS users and non-users claimed similar primary substances of use during the past year, with the exception of benzodiazepine use, which was more common in the AAS group (OR = 2.30), although this did not affect the frequency of violent crime. Among AAS-experienced participants, there was no difference in violent crime incidence between current users and former users.

Conclusions

Study results suggest that AASs do not function as a proximal trigger for violence but still involve an increased risk for violence in users of illicit drugs. These findings also suggest that AAS use is highly overrepresented in women who commit crimes.     

Public opinion on needle and syringe programmes: avoiding assumptions for policy and practice

Despite evidence for their effectiveness, harm reduction services such as needle and syringe programmes (NSPs) are highly vulnerable to perceptions of community disapproval. This paper reviews Australian research on community attitudes to harm reduction services and its impact on research, policy and practice. The literature on community attitudes to NSPs in Australia comprises a small number of representative national samples and surveys of local communities affected by specific services. Despite these extremely limited data, negative community attitudes are often cited by policy-makers and health professionals as a primary constraint on policy-making. The main finding of this literature review is that community perceptions of NSPs are largely positive. Also, support for NSPs was not synonymous with condoning drug use. The failure of policy-makers and politicians to recognise positive community attitudes to NSPs has led in some instances to hasty political responses to adverse media reports, including the closure of services. This literature review showing positive community attitudes to harm reduction services should embolden researchers, practitioners and policy-makers to challenge such reactionary responses. Further, this evidence should be used in countering negative publicity surrounding these services. [Treloar C, Fraser S. Public opinion on needle and syringe programmes: avoiding assumptions for policy and practice. Drug Alcohol Rev 2007;26:355 - 361]     

Trends in non-medical use of anabolic steroids by U.S. college students: results from four national surveys

This study assessed the prevalence, trends, and student- and college-level characteristics associated with the non-medical use of anabolic steroids (NMAS) among U.S. college students. Data were collected through self-administered mail surveys, from 15,282, 14,428, 13,953, and 10,904 randomly selected college students at the same 119 nationally representative colleges in 1993, 1997, 1999 and 2001, respectively. The prevalence of lifetime, past-year and past-month NMAS was 1% or less and generally did not change significantly between 1993 and 2001, with one exception: past-year NMAS increased significantly among men from 1993 (0.36%) to 2001 (0.90%). Multiple logistic regression analyses revealed that lifetime and past-year NMAS were associated with student-level characteristics such as being male and participation in intercollegiate athletics. Lifetime and past-year NMAS were also positively associated with several risky behaviors, including cigarette smoking, illicit drug use, drinking and driving, and DSM-IV alcohol use disorders. Nearly 7 out of every 10 lifetime non-medical users of anabolic steroids met past-year criteria for a DSM-IV alcohol use disorder. Although the overall prevalence of NMAS remained low between 1993 and 2001, findings suggest that continued monitoring is necessary because male student-athletes are at heightened risk for NMAS and this behavior is associated with a wide range of risky health behaviors. The characteristics associated with NMAS have important implications for future practice and research.     

The development of peer educator-based harm reduction programmes in Northern Vietnam

Introduction. Injecting drug use remains an important risk factor for transmission in Vietnam, with an estimated 50% of the 290 000 people living with HIV/AIDS reporting injecting drug use as a risk factor. Despite this, effective harm reduction interventions are generally lacking. This paper describes the implementation of peer-based harm reduction programmes in two rural provinces of Vietnam. Design and Methods. Peer educators were trained in basic HIV prevention, including harm reduction. After significant preparation work with the Provincial AIDS Committees of Bac Giang and Thanh Hoa and other relevant national, provincial and local authorities, the interventions were commenced. Harm reduction interventions were delivered through outreach as well as on-site. This included needle and syringe distribution and collection. Results. Community advocacy occurred throughout the life of the project. Local authorities and peers believed that while there was a general reduction in stigma and discrimination, legal barriers associated particularly with the carrying of injecting equipment remained. This impacted upon the ability of peer educators to work with their clients. Conclusion. Peer-based delivery of harm reduction intervention is acceptable. Harm reduction interventions, including needle and syringe programmes, are feasible and acceptable in these two rural Vietnamese provinces. Community acceptance and uptake of these interventions is key to successful expansion across the region. Active participation by families of drug users seems crucial. This initiative demonstrates that despite a difficult policy environment, peer-delivered needle and syringe programmes are feasible within a rural Asian environment as long as there is adequate local political and community support. [Walsh N, Gibbie TM, Higgs P. The development of peer educator-based harm reduction programmes in northern Vietnam. Drug Alcohol Rev 2008;27:200-203]     

Daily Exercise and Anabolic Steroids Use in Adolescents: A Cross-National European Study

Aim: The aim of this paper is to investigate the association between anabolic steroid (AS) use and intensive physical exercise among adolescents. Design/setting: The 1999 cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD). Data collection by standardized methodology using anonymous self-administered questionnaires completed in the classroom. Participants: National probability samples of a total of 18,430 16-year-old high school students from six European countries (Bulgaria, Croatia, Cyprus, Greece, the Slovak Republic, and the U.K.) Measurements: Besides AS use and physical exercise, questionnaire items selected for this study included tobacco, alcohol, and illicit drug use, indicators of other deviant behavior (self-harming thoughts and behavior, truancy, aggressive behavior), friends' use of AS, and perceived availability. Backward elimination with likelihood ratio tests was used to select the variables to be retained in a mutlifactorial model. Interactions of other independent variables with country were checked. Findings: Logistic regression analysis of lifetime AS users compared to nonusers showed that the odds of lifetime AS use are 1.4 times higher for students who exercise almost daily and 1.8 times higher for boys compared to girls. Significant associations of AS use were also found with current frequent alcohol use, lifetime use of tranquilizers/sedatives and cannabis, and with the perceptions of friends' use of AS and of easy availability of the substance. Conclusion: Findings indicate that daily exercising appears to increase the risk of anabolic steroid use in adolescents. However, a more general pattern of closely interlinked deviant types of behavior, such as other drug use and aggressive behavior, is prominent. Preventive interventions are needed targeted towards adolescents involved in intensive exercise and sport. These should take into account both the idiosyncrasy and setting of the sporting culture and the special characteristics of this group.     

Syringe Disposal Bins: The Outcomes of a Free Trial for City Traders in an Inner-City Municipality Australia

Community responses toward discarded syringes have the potential to threaten the sustainability of harm reduction interventions. Many retailers in the central business district of Melbourne, Australia, have expressed concern about drug use and the associated discarded syringes. The Melbourne City Council has responded to these concerns through a variety of strategies. One such strategy was a 6-month free trial of syringe bins for businesses (2003–2004). The MCC commissioned an external evaluation of the trial. Eighteen business representatives and six key informants undertook semistructured interviews to monitor issues arising throughout the trial. Syringe disposal bins are a useful option for facilitating appropriate syringe disposal; 11 of the 13 businesses that participated in the trial continued with the maintenance of the syringe disposal bins beyond the free trial period.     

High-dose anabolic steroids in strength athletes: Effects upon hostility and aggression

Six male strength athletes, three illicit anabolic steroid users and three non-steroid users were monitored over several months as they underwent normal training and competition routines. Subjects completed the Profile of Mood States (POMS) questionnaire, Buss-Durke Hostility Inventory and the Rosenweig Picture Frustration Test on four occasions: two on-drug periods and two off-drug periods for the steroid users and equivalent test periods for the non-users. Steroid presence was monitored objectively by gas chromatography coupled to mass spectrometry. Whilst those drugs declared by the athletes were confirmed in the “on-drug” samples and most of the “off-drug” samples, clear steroid traces were apparent in some supposed off-drug sessions. This complicated data interpretation and may partially explain why steroid users were significantly more hostile and aggressive at all times compared to the non-users. Despite this, self-rated aggression did increase significantly in steroid users during their acknowledged on-drug periods. Multiple drug use or “stacking” in particular caused severe hostility/aggression; one steroid user also admitted to attempted murder during a previous steroid-taking phase.     

Support for non-prescribed anabolic androgenic steroids users: a qualitative exploration of their needs

Abstract

Anabolic Androgenic Steroids (AAS) are used by the general population (particularly male gym users) for their anabolic effects (increased muscle mass). Few studies have sought AAS users’ views on what information and support they need. This study focuses on ideal support wanted by people who use AAS. Interviews were conducted with 23 self-declared adult AAS users. Using thematic analysis, six themes were identified aligned to support and information wanted by AAS users: (1) specific types of information wanted: managing risks, (2) mechanisms for communication of advice, (3) specific types of support wanted: medical and emotional, (4) stigmatisation of people who use AAS, (5) paying for support services, (6) legality of AAS use.

Integral to the support was that it should be considered within the context of use and identity. Support needs to be specific, targeted towards AAS users ensuring that balanced and evidenced-based advice is given. Sensitivity to AAS users’ perceptions of their drug-use and the stigma of being classified in the same sub-set as other illicit drug users is relevant to facilitating successful engagement. Furthermore, there is a need to consider the emotional issues surrounding AAS use and how to meet these needs.     

Five years of needle syringe exchange in Manipur, India: programme and contextual issues

This paper reviews the performance of the syringe exchange programmes (SEPs) in Manipur, northeast India, with the objective of identifying good practice, and areas that require improvement. The paper also examines contextual and structural factors in Manipur that inhibit optimal functioning of SEPs and hinder behaviour change, and argues that these factors need to be addressed as part of any endeavour aimed at improving services and programme coverage in the future.     

Qualitative accounts of needle and syringe cleaning techniques among people who inject drugs in Sydney,Australia

Introduction and Aims. Cleaning needles/syringes is an important second‐line harm reduction strategy, yet there is limited information on practices employed by people who inject drugs in Australia. This study attempts to identify and assess cleaning practices in terms of the techniques involved and the social contexts in which cleaning takes place. Design and Methods. As part of an exploratory qualitative study in south‐west Sydney, in‐depth interviews and simulated cleaning exercises were conducted with 12 people who inject drugs. Interviews were digitally recorded and transcribed verbatim. Open coding was used to inductively classify data into themes, and data were examined for patterns and variations in the relationships within and between themes. Results. Data indicate that cleaning and reuse of needles/syringes was common in this small sample. The most frequently utilised reagent was cool water. While all participants reported cleaning and reusing only their own equipment, none of the techniques demonstrated would have been sufficient to deactivate human immunodeficiency virus or hepatitis C virus. Discussion and Conclusions. Results suggest that even where cleaning of needles and syringes is widespread, people who inject drugs may not engage in efficacious cleaning. The combination of the complexity of current cleaning messages and a lack of accurate information about efficacious techniques are likely to contribute to poor cleaning practice. Australia could benefit from the development of a nationally consistent cleaning message; however, the evidence would suggest that this would need to be accompanied by strategies designed to simplify and disseminate this information in order to increase the uptake of efficacious cleaning methods by people who inject drugs [Nathani J, Iversen J, Shying K, Byrne J, Maher L. Qualitative accounts of needle and syringe cleaning techniques among people who inject drugs in Sydney, Australia. Drug Alcohol Rev 2010]     

Induction of micronuclei in V79 cells by the anabolic doping steroids tetrahydrogestrinone and trenbolone

The synthetic steroid tetrahydrogestrinone is a new “designer drug” and was recently detected to be illegally used in sports. It is chemically closely related to trenbolone that is known as an animal growth promoter. The potencies of trenbolone, tetrahydrogestrinone and testosterone to induce micronuclei in V79 cells in vitro were determined. CREST analysis was employed to differentiate between aneugenic or clastogenic mechanisms. Cytotoxicity and an influence on the cell cycle were assessed in parallel. Incubations with testosterone, at concentrations between 3 and 300 μM, failed to induce micronuclei. By contrast, tetrahydrogestrinone and trenbolone increased the rate of micronuclei significantly, up to a doubling of the micronuclei rate of untreated controls. Tetrahydrogestrinone and trenbolone displayed a bell-shaped dose-response curve, with maximal effects observed at 3 and 30 μM, respectively. The micronuclei induced by tetrahydrogestrinone and trenbolone were predominantly kinetochor (CREST) positive, pointing to an aneugenic mode of action. This may be related to the specific structure of both molecules with a system of activated double bonds. As the genotoxic effect of tetrahydrogestrinone at a chromosomal level appears at a low concentration range, it cannot be ruled out that tetrahydrogestrinone presents a genotoxic hazard on a chromosomal level under conditions of its current misuse in sports.     

Development of an enhanced needle and syringe programme: the First Step programme pilot

The First Step programme is a new approach to needle and syringe exchange services established to help intravenous drug users reduce harmful drug use behaviours, provide psychoeducation and act as a point of transition enhancing access to other health and community services. The First Step assertive treatment approach was implemented in a medium-sized community area health service and evaluated over an 18-month period. A pilot evaluation of staff training was also conducted, demonstrating a significant improvement in staff skills in assertive outreach, needs assessment, engagement, psychoeducation and referral. Measures of drug-related harm showed the benefits of new early engagement-enhancing psychoeducational interventions, with increases in needles distributed and returned and greater referrals to drug and alcohol and other health services. Training needle and syringe workers towards a more assertive community outreach role gives them the ability to provide psychoeducation and harm minimization strategies and act as a conduit for intravenous drug users to enter treatment. [Hudoba M, Grenyer BFS, O'Toole M. Development of an enhanced needle and syringe programme: the First Step programme pilot. Drug Alcohol Rev 2004;23:295-297]