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CENTRE FOR PUBLIC HEALTH FA C U LT Y O F E D U C AT I O N , H E A LT H & C O M M U N I TY L I V E R P O O L J O H N M O O R E S U N I V E R S I TY 3rd National Intelligence Network meeting on the health harms associated with drug use 29th January Image & Performance Enhancing Drugs Emerging Trends What do we actually know about anabolic steroid use in the UK? Prevalence Characteristics of users Very little Reasons for use Efficacy Methods regimes & risks Some A bit Limited Mostly flawed Harms Effective drug prevention Patchy Nothing at all Effective harm reduction Intuitive Anabolic steroid use facts Approx 25% first use in teens Users more likely to use orals before injecting (??) More likely to have been to prison (17%) Small numbers injected drugs other than IPEDs Cycles longer & approx 25% ‘blast & cruise’ Nobody knows what they are taking! In the last 12 months 47% snorted cocaine 12% used amphetamine Oral use in previous year Proportion n Anabolic Steroids 57% 226 Anti-oestrogens 23% 92 Clenbuterol 15% 60 Ephedrine 20% 78 Thyroid Hormones 9% 37 6.6% 26 PDE5i (Viagra / Cialis) Hope, McVeigh et al Injected in previous year Proportion n Anabolic Steroids 86% 340 Growth Hormone 32% 128 HCG 16% 62 Insulin injected 5.6% 22 Melanotan 8.6% 34 Other PIED (inc. EPO, IGF-1 and Nubain) 5.1% 20 Hope, McVeigh et al Prevalence of growth hormone use amongst anabolic steroid users The new stuff… 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 Melanotan . 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% Kimergård, McVeigh et al 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 Kimergård, McVeigh et al. The old stuff…Dinitrophenol - It’s back ‘No dieting… No self-denial… No strenuous exercises… You can have the slender figure of Youth’. ‘Literally burns the fat away’. ‘Sounds too good to be true? Yet it is true’ Unpredictable responses & narrow therapeutic window In just 2 years, 160 reported cases of cataracts and at least 10 deaths Advert for Dilux-Redusols containing dinitrophenol, 1936. Metabolic poison Motivation to use steroids “People who hadn’t seen me since school would come up to me and go, ‘Oh my God, you look massive, you look fantastic’ “ (Steroid and growth hormone user aged 36) “I like to increase my strength, and now it’s more for conditioning” (Steroid user and doorman aged 35) “I think I started weight training more seriously as I was losing my hair because I think I started to suffer a loss of confidence” (Steroid user aged 35) The market “You can’t get anything pharmaceutical grade, everything is ‘underground’” (Steroid user, competing bodybuilder and gym owner aged 45) “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) “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) Kimergård & McVeigh Obtaining information on anabolic steroids “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) “...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) “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 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) “Working as a doorman I get provoked every night” Steroid user and doorman aged 35) Kimergård & McVeigh Blood borne viruses “No bodybuilders that I know share. I mean you hear of what are called druggies, people who use other stuff. I don’t mix in those circles to be honest” (Steroid user, NSP) Kimergård & McVeigh Service expectation “...the drug service is just a handy place to get your needles, literally that is all” (Steroid user, NSP,) Kimergård & McVeigh Enhancement Drugs & Public Health 9th April 2014 Liverpool CONTACT DETAILS Jim McVeigh Acting Director Centre for Public Health 0151 231 4512 [email protected] www.cph.org.uk Twitter @mcveigh_jim