ISSUES
: Drugs
Chapter 1: Drug issues
15
syringe exchange infections such
as HIV and hepatitis and death.
There are psychosocial implications
too. Users can become violent or
aggressive, suffer mood syndromes,
and addiction.
There are also other gender-specific
effects. In males, these include low
sperm count, shrunken testicles,
infertility and growth of breasts. In
females, these include roughening
of the skin, decreased breast size,
deepening of the voice, growth of
body hair, changes to the menstrual
cycle and enlargement of the clitoris.
It has to be noted that the effects
and harms of anabolic use are dose-
dependent. So higher and longer term
use leads to bigger muscles but more
harmful effects.
Laying down the law
Since the 1990s there has been
increasing legislation to combat the
problem. Anabolic steroid use is
illegal in the US, the UK, Australia,
Argentina, Brazil, Portugal and Saudi
Arabia. Though the US passed their
Anabolic Steroid Control Act in 1990,
and Sweden the Act Prohibiting
Certain Doping Substances in 1991,
other countries have been a bit slower
– Norway only banned use in 2013. In
many places they are unregulated and
can be bought in some pharmacies.
An amendment to the US act in 2004
also added prohormones to the list
of controlled substances. These
substances, a kind of precursor to
a hormone (rather than a hormone
itself), can amplify the effect of existing
hormones.
But as the Internet makes obtaining
substances easy, even if illegal, it’s
clear that better ways of dealing
with the problem – and the probable
harmful effect on population health –
will need to be found.
13 March 2014
Ö
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The above information is reprinted
with kind permission from
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Conversation
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Conversation Trust (UK)
Needle and syringe
exchanges need to adapt
to meet the needs of
people who inject steroids
and image-enhancing
drugs
By Roger Pebody
T
he numbers of people
injecting steroids and other
image-enhancing
drugs
has increased significantly in the
last decade and harm-reduction
services need to develop new skills
if they are to help people using
these drugs avoid blood-borne
viruses, the 24th International Harm
Reduction Conference in Kuala
Lumpur was told on Wednesday.
Surveys in the United Kingdom
suggest that rates of HIV and
hepatitis infections are significantly
higher in people using these drugs
than in the general population.
Anabolic steroids are by far the
most frequently used product, but
agencies also report significant
numbers of clients injecting
peptide hormones, human growth
hormone, and melanotan and other
skin tanning agents. Collectively,
they are variously referred to as
steroids and image-enhancing
drugs (SIEDs), performance and
image-enhancing drugs (PIEDs), or
image and performance-enhancing
drugs (IPEDs).
The issue has been best
documented
in
high-income
countries
(the
conference
presentations came from the UK
and Australia), but some experts
believe that this is likely to be a
global phenomenon – for example,
some of those using SIEDs in the
UK were born in Eastern Europe
and South-East Asia.
In both the UK and Australia, those
using the substances are typically
young men (around half are in their
20s). Most are heterosexual, but
between 3% and 7% report sex
with other men. Typically, they have
limited experience of injecting drugs
and tend not to use psychoactive
drugs (except for cocaine, taken
nasally). Nonetheless, both the UK
and Australian surveys suggest that
people using SIEDs are conscious
of the risks of sharing equipment
(4% and 2%, respectively had ever
re-used another person’s needle).
People using these drugs are
described as being “thirsty for
knowledge”, but often seek this
out on online forums where the
information is not always accurate.
A higher than expected rate of HIV
in people using SIEDs in the UK was
first reported in 2013. In the most
recent survey, 2% had HIV, 3% had
antibodies to hepatitis B and 4%
had antibodies to hepatitis C. It
appears that the proportions with
these infections have increased
over time but the numbers taking
part in surveys are small, so it is
hard to be sure.
In contrast, in surveys of people
using SIEDs in Queensland and
New South Wales (Australia), 0.5%
of people using SIEDs were HIV-
positive. This is considerably higher
than in the general heterosexual
population of Australia (around
0.04%) but lower than among
people injecting other drugs (2%)
or gay men (8% to 12%). A larger
number (5%) had antibodies to
hepatitis C.
Given the elevated rate of HIV
infection, the UK researchers argue
