5Steroid use 'on par with heroin' 2007 Steroid 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 There is a particular problem with users aged under 25.
6Drugs injected at registration – all sites 2012 -2013
8Glasgow’s PIEDs Clinic Established in 2009Drop in service – 1 evening per weekStaffed by 2 workers and nurse ( supported by lead medical officer)Based in the GDCC and supported by Turning Point
9Aim 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 complicationsProvide alternatives to PIEDs useTo improve injecting techniquesTo direct individuals to their local pharmacy needle exchanges for future transactions.
11Letting clients know about the service successfulunsuccessfulReferrals from other exchangesGym buddiesDealersForumsGym ownersSupplement StoresPoster displays
12What we offerNeedles and paraphernalia provision, including water for injection.Consultations/assessmentsDiscussions on; ‘harmful’ doses, understanding ‘labels’ and syringe markingsSafer injecting advice and demonstrationsAlternatives such as diet and exerciseWound identificationProduct identificationBlood tests
13Date CollectedHIVNEGHEP BHEP CTest DeclinedNoAbnormal U&EYesAbnormal LFTAbnormal CholestrolAbnormal HormonesRepeat Test
14PIED using groups Image enhancing Athletic/sports Non-athletic trainingOccupationalDysmorphia/self esteem
15Comparison with Street Drugs SimilaritiesdifferencesStigmaMethod of administrationPoly drug useHow boughtDependencySelf perceptionHow boughtLegalitySelf welfareSocial status?Ratio of men to womenNo instant gratification
16Anabolic/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.
18Natural Test production HYPOTHALAMUSGnRHPITUITARYLH FSHTESTESTestosterone
19Common SubstancesAnabolic/Androgenic steroids : to increase bulk, strength and powerOestrogen-blockers: to block symptoms of feminisationDiuretics: to remove excess waterFat-burners: to remove excess fat and “cut up”Growth Enhancers: to promote new cell growthPost-cycle treatments: to stimulate natural testosterone productionInjectable tanning agents: to stimulate pigmentation
20Commonly 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
21Oral 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
23Types of steroids produced Pharmaceutical gradeGood quality but often low in strength and amountsUndergroundMay be poor quality/unsterile often high concentrationsVeterinarianNot designed for human useCounterfeitOften contain no active product and may be unsafe
26hGH hGH (and the IGF-1 that is a result of its use) is the only substance thatcan actually initiate hyperplasia (new cells).GH is produced by the pituitary, IGF-1is produced primarily by the liver inresponse to GHIt requires careful storage, handling andpreparationMany newer peptides also work in a similar way
27Melanotan 2 Melanotan is a hormone that stimulates melanin production Other reported benefits:weight lossincreased libidohealthy spot free skin
28Patterns of UseStacking: taking several different steroids at the same timeCycling: taking multiple doses over a period of weeks or months, stopping, then starting again.Pyramiding: slowly increasing amount of steroids taken over wks, then decreasing the amount slowly‘Addictive’ behavioural patterns are easily identifiable
29Sample stack and cycleCost £200Cost £200Cost £50Cost £45
31What happens after the cycle finishes? After the cycle comes the crashThe body enters a ‘catabolic’ stateTestes become de-sensitisedFSH and LH are not produced/releasedEstrogen level riseLethargy and low mood can set in
33Anabolic 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
34Post Cycle TherapyIdea is to accelerate and restore the body’s endogenous test productionThere are many different views on how this can be achievedHowever, most involve the same drugs………..
35Post Cycle Therapy – Rationale shocks the testicles into action - increasing testicular massHCGNolvadexblocks negative feedback from too much estrogenClomidstimulates the hypothalamusHYPOTHALAMUSGnRHPITUITARYLH FSHTESTESTestosterone
37Risks - AdolescentsOne of the most detrimental thing that could happen is the stunting of growth platesOther complications involve extreme bone pain, liver toxicity, vascular damage, kidney damage, and joint problems
39Risks - 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.
41Risks - Men Shrinking of the testicles - temporary Reduced sperm count - infertilitySexual dysfunctionProstate enlargementBaldnessGynaecomastia - development of breasts
42Risks AllIncreases in LDL (bad cholesterol) and decreases in HDL (good cholesterol)Modification in the left ventricle of the heart, with serious implicationsIncreased risk of developing heart related complications/strokeAcneHigh Blood PressureMood swingsJaundice/liver damagePain in the joints (esp with Winny or hGH)Urinary problems
43Steroid Dependence Fact or Fiction? DSM IV - Drug dependency occurs if:The drug is taken higher doses or for longer than intendedUnsuccessful efforts to stop or cut downExcessive time spent obtaining or using the substanceImportant activities are given upContinued use despite negative health effectsNeed for higher amounts to be taken for the desired effectWithdrawal symptoms occur
44PIED DependanceIf 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?
45Addiction, Dependence and treatment? Talking therapiesContinued use due to fear of muscle loss – CBTDealing with steroid cravings – Relapse PreventionUnwillingness to stop - MIMedical interventionsDepression post cycle – antidepressantsLoss of sexual function - ViagraHypogonadism – HCG & Clomid
46Harm Reduction Advice Use reasonable dosages and stacks Always cycleUse only the safest drugsUse testosterone as a first choice?Avoid toxic oral steroidsAvoid counterfeit and undergroundAlways consider risk and rewardUse proper injecting techGet regular blood testsUse reasonable dosages and stacks