Transcript The changing nature of performance

The changing nature of performanceenhancing drug use …
What are the implications for public health?
Michael Evans-Brown & Jim McVeigh
Once upon a time …
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“I have recently been approached by a person who is
interested in body building and weightlifting and who has
asked me if I would consider giving him anabolic steroids.
He alleges that a very large percentage indeed of the top
flight of both body-builders and weight-lifters take these
drugs … He also says that there is a ready availability of
these drugs on the ‘black market’” (BMJ, 1967)
“The amateur organizations with which I am associated
have heard of many cases of young weight-lifters and
bodybuilders being prescribed anabolic steroids more or
less on request from their general practitioners” (BMJ, 1967)
Then came the 80s …
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“a quantity of an anabolic steroid had disappeared from a
hospital pharmacy” (BMJ, 1985)
“The black market is thriving in the buying and selling of
anabolic steroids … they included injectable testosterone,
a generous supply of needles, and an advanced
hormone.” (Times, 1987)
ACMD asked to look at the issue … insufficient evidence
that steroid use constituted a ‘social problem’
Pharmacist struck off for supply of Anapolon & Growth
Hormone (Times, 1988)
Then the 90s …
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National study in 21 gyms (1992). 6% of males currently
using, 1.4% of females. Most not involved in elite sport
ACMD reviews issue again (1992–93). Recommends
control of steroids under the Misuse of Drugs Act 1971
but simple possession to remain lawful
Further studies in England & Wales. Some harm
reduction services based around providing injecting
equipment
The Government accepts ACMD recommendations, law
changed (1996)
Thereafter …
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A few more studies looked at use in gyms in Wales &
England
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Is more growth hormone use being reported?
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Are more using for ‘body image’ reasons?
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Is use starting at a younger age?
In the past few years, alongside the ‘classic’ drugs, a large
number of products have become widely available on the
illicit market, particularly on the Internet.
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Will these diffuse to broader groups?
“I was VERY pleased with the results from
melanotan II last year. This year my Mum and Dad
are going to try it too.”
(how common is this?)
We don’t know much about:
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how many people are using & how long they use for
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which types of people are using and their ages
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why they are using, why they started using, and at what age
they started using
how these drugs are being used (different drugs used,
doses taken, duration of use and injecting practices)
We don’t know much about:
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the illicit market (manufacture, distribution and supply)
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the quality, safety and efficacy of products:
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most are unlicensed
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many are either in pre-clinical or in phase I/II trials
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some licensed products containing the same drug have
been withdrawn from the market
many believed to be manufactured in China with some
‘assembly’ in the UK
We do know:
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On the Internet the drugs are relatively inexpensive; often
offered at “discounted” prices or as part of other offers.
Internet sites offer a “one-stop-shop” approach
Websites are designed to appeal to desires and insecurities
Some products may lower threshold for use (e.g. nasal
spray or oral); although injectable products are not
necessarily a barrier
What this group uses today, others may use
tomorrow
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GHB — used started in the late 1980s to increase Growth
Hormone secretion
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Noted in study from Clwyd (1996)
Use diffused to wider group as a ‘legal high’
2003 controlled under the Misuse of Drugs Act 1971
Stimulants?
What about harms?
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We never had a good evidence base on the harms the
‘classic’ drugs posed, but …
A key concern for injectable products is sterility and injecting
practices (yet, overall we have poor data)
What do we know about the emerging drugs?
What should we do?
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ACMD recommends ‘focus on public health’ rather than
criminalisation (2010)
So, let’s focus on that
It starts with research, but requires support and guidance
from policy makers, practitioners and users.