Transcript Glasgow Addiction Services

John Campbell
1
Reasons for
use
How Steroids
work
The Law
Common
Steroids
PCT
Reducing
harm
How they are
taken
Harms
Risks
2

Poor UK survey Data

Small area or location studies

Glasgow accurate NEO data
Steroid Comparison - 4 Years
04/05
05/06
06/07
07/08
65%
60%
55%
50%
Percentage
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
New Steroid User
Steroid Needles Issued
Details
Total Steroid User
Visits
Steroid 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 2004. There is a particular problem with users
aged under 25.
Drugs Injected at Registration
3000
2599
2500
2000
Amphetamines
1500
1000
500
0
Cocaine
982
20
180
34
Crack
160
Heroin
Pieds
Melanotan
6
New Registrations GDCC 2012 – 2013 (drugs injected)
461
PIEDs (e.g. steroids, growth hormone)
179
Heroin
52
Tanning Agent (e.g. melanotan)
9
Cocaine
3
Amphetaime
0
100
200
300
400
500
7

Established in 2009

Drop in service – 1 evening per week

Staffed by 2 workers and nurse ( supported by
lead medical officer)

Based in the GDCC and supported by Turning
Point
8

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 complications

Provide alternatives to PIEDs use

To improve injecting techniques

To direct individuals to their local pharmacy needle
exchanges for future transactions.
9
SUCCESSFUL




Referrals from other
exchanges
Gym buddies
Dealers
Forums
UNSUCCESSFUL



Gym owners
Supplement Stores
Poster displays
11

Needles and paraphernalia

provision, including water
for injection.
Safer injecting advice and
demonstrations

Alternatives such as diet and

Consultations/assessments

Discussions on; ‘harmful’

Wound identification
doses, understanding

Product identification

Blood tests
‘labels’ and syringe
markings
exercise
12
Date
Collected
HIV
NEG
NEG
NEG
NEG
NEG
NEG
HEP B
NEG
NEG
NEG
NEG
NEG
NEG
HEP C
NEG
NEG
NEG
NEG
NEG
NEG
Test
Declined
No
No
No
No
No
No
Abnormal
U&E
No
No
No
Yes
No
No
No
Abnormal
LFT
No
Yes
No
No
Yes
Yes
No
Abnormal
Cholestrol
No
No
Yes
No
Yes
No
No
Abnormal
Hormones
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Repeat Test
No
No
No
No
No
No
No
13
Image enhancing
Athletic/sports
Non-athletic
training
Occupational
Dysmorphia/
self esteem
SIMILARITIES





Stigma
Method of
administration
Poly drug use
How bought
Dependency
DIFFERENCES







Self perception
How bought
Legality
Self welfare
Social status?
Ratio of men to women
No instant gratification
15
•
•
They are synthetically produced variants of the
naturally occurring male sex hormone
testosterone. “Anabolic” refers to musclebuilding, 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.
Natural Test
production
HYPOTHALAMUS
GnRH
PITUITARY
LH FSH
TESTES
Testosterone
18

Anabolic/Androgenic steroids : to increase bulk, strength and power

Oestrogen-blockers: to block symptoms of feminisation

Diuretics: to remove excess water

Fat-burners: to remove excess fat and “cut up”

Growth Enhancers: to promote new cell growth

Post-cycle treatments: to stimulate natural testosterone production

Injectable tanning agents: to stimulate pigmentation





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

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

Pharmaceutical grade
Good quality but often low in strength and amounts

Underground
May be poor quality/unsterile often high concentrations

Veterinarian
Not designed for human use

Counterfeit
Often contain no active product and may be unsafe
24
Miscellaneous
Fat Burners
Anti-estrogen & PCT
Human Growth Hormone
Ephedrine
Human Chorionic
Gonadotrophin
GHRP 2 & 6
Clenbuterol
Nolvadex (tamoxifen)
CJC 1295
T3
Clomid Citrate
LR3
T4
Arimidex
IGF -1
ECA stack
Insulin
Letrozole
Melanotan 1&2
Viagra

hGH (and the IGF-1 that is a result of
its use) is the only substance that
can actually initiate hyperplasia (new cells).

GH is produced by the pituitary, IGF-1
is produced primarily by the liver in
response to GH

It requires careful storage, handling and
preparation
Many newer peptides also work in a similar way
Melanotan is a hormone that
stimulates melanin production
Other reported benefits:
• weight loss
• increased libido
• healthy spot free skin




Stacking: taking several different steroids at the same time
Cycling: taking multiple doses over a period of weeks or months,
stopping, then starting again.
Pyramiding: slowly increasing amount of steroids taken over 612wks, then decreasing the amount slowly
‘Addictive’ behavioural patterns are easily identifiable
Cost £200
Cost £200
Cost £50
Cost £45
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Cost £320
Cost £80
Cost £160 Cost £100
Cost £1000
Cost30£70

After the cycle comes the crash

The body enters a ‘catabolic’ state

Testes become de-sensitised

FSH and LH are not produced/released

Estrogen level rise

Lethargy and low mood can set in
31
8 Week Cycle
50
Steroid crash -low Test
45
40
35
T
e
s
t
30
L
e
v
e
l
20
natural test
25
Steroid Test
Estrogen
15
10
5
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16
32


“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
33

Idea is to accelerate and restore the body’s
endogenous test production

There are many different views on how this can
be achieved

However, most involve the same drugs………..
34
HYPOTHALAMUS
GnRH
PITUITARY
LH FSH
TESTES
Testosterone
35
•
•
One of the most detrimental thing that could
happen is the stunting of growth plates
Other complications involve extreme bone pain,
liver toxicity, vascular damage, kidney damage,
and joint problems
38
•
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.
40

Shrinking of the testicles temporary

Reduced sperm count - infertility

Sexual dysfunction

Prostate enlargement

Baldness

Gynaecomastia - development of
breasts

Acne

High Blood Pressure

Mood swings

Jaundice/liver damage


Pain in the joints (esp with
Winny or hGH)
Urinary problems



Increases in LDL (bad
cholesterol) and decreases in
HDL (good cholesterol)
Modification in the left ventricle
of the heart, with serious
implications
Increased risk of developing
heart related
complications/stroke
DSM IV - Drug dependency occurs if:
 The drug is taken higher doses or for longer than intended

Unsuccessful efforts to stop or cut down

Excessive time spent obtaining or using the substance

Important activities are given up

Continued use despite negative health effects

Need for higher amounts to be taken for the desired effect

Withdrawal symptoms occur
43



If 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?
44
Talking therapies

Continued use due to
fear of muscle loss –
CBT
Medical interventions




Dealing with steroid
cravings – Relapse
Prevention
Unwillingness to stop MI

Depression post cycle –
antidepressants
Loss of sexual function Viagra
Hypogonadism – HCG
& Clomid
45
Avoid counterfeit and underground
Use reasonable dosages and stacks
Avoid toxic oral steroids
Get regular blood tests
Use testosterone as a first choice?
Use proper injecting tech
Use only the safest drugs
Always cycle
Always consider risk and reward
46