Understanding and responding to anabolic steroid injecting and hepatitis C risk in Australia: A research agenda

Background As far as we are aware, no previous systematic review and synthesis of the qualitative/descriptive literature on polypharmacy in anabolic-androgenic steroid(s) (AAS) users has been published. Method We systematically reviewed and synthesized qualitative/descriptive literature gathered from searches in electronic databases and by inspecting reference lists of relevant literature to investigate AAS users’ polypharmacy. We adhered to the recommendations of the UK Economic and Social Research Council’s qualitative research synthesis manual and the PRISMA guidelines. Results A total of 50 studies published between 1985 and 2014 were included in the analysis. Studies originated from 10 countries although most originated from United States (n = 22), followed by Sweden (n = 7), England only (n = 5), and the United Kingdom (n = 4). It was evident that prior to their debut, AAS users often used other licit and illicit substances. The main ancillary/supplementary substances used were alcohol, and cannabis/cannabinoids followed by cocaine, growth hormone, and human chorionic gonadotropin (hCG), amphetamine/meth, clenbuterol, ephedra/ephedrine, insulin, and thyroxine. Other popular substance classes were analgesics/opioids, dietary/nutritional supplements, and diuretics. Our classification of the various substances used by AAS users resulted in 13 main groups. These non-AAS substances were used mainly to enhance the effects of AAS, combat the side effects of AAS, and for recreational or relaxation purposes, as well as sexual enhancement. Conclusions Our findings corroborate previous suggestions of associations between AAS use and the use of other licit and illicit substances. Efforts must be intensified to combat the debilitating effects of AAS-associated polypharmacy.

This paper considers the way that social stigma impacts both on injecting drug user (IDU) populations and operates within them and the consequences this has for prevention and harm reduction amongst IDUs. The research from which this paper is drawn was a city case study, itself part of a larger national study to evaluate the efficacy of needle exchanges throughout England and Wales. Not initially part of the issues being explored, the interviews consistently pointed to concerns of stigma, and in this sense the theme was emergent from the qualitative process itself. The primary findings relating to this issue were: IDUs concern for being recognised or 'seen' as IDUs affected service uptake and/or their interaction with services; 'normal' IDUs moreover tended to stigmatise those IDUs they believed to be 'worse' than them--primarily the homeless--despite the fact that their own behaviour was often less than 'responsible' itself. In these ways 'stigma', whether being accepted or expressed by these different groups militated against the 'harm reductive' goals of Safer Injecting Services. It is concluded that much can be done to reduce stigma related to IDU and drug use in general and that this may result in improved service efficacy and a reduction in associated drug related harms. It is also concluded that many IDUs seek to enhance their own self-esteem and reinforce their own sense as 'responsible members of society' rather than the outsiders they often feel themselves to be by attributing stigmatised behaviours on other 'lesser' IDUs. This practice may also contribute to them militating against their own guilt regarding their own risky behaviours, however in so doing the goal of harm reduction may be further undermined.

Anabolic androgenic steroids are synthetic derivatives of testosterone, which is the primary male sex hormone. Anabolic androgenic steroids are used to enhance athletic performance and appearance. Adverse effects include those on the liver, serum lipids, psyche/behavior and reproductive system. Androstenedione is an anabolic androgenic steroid used to increase blood testosterone levels for the purposes of increasing strength, lean body mass and sexual performance. However, there is no research indicating that androstenedione, or its related compounds, significantly increases strength and/or lean body mass in humans by increasing testosterone levels. The long-term health effects of prolonged androstenedione supplementation are unknown. Dehydroepiandrosterone (DHEA) is a weak androgen also used to elevate testosterone levels, and is advertised as an anti-obesity and anti-aging supplement capable of improving libido, vitality and immunity levels. However, research demonstrates that DHEA supplementation does not increase serum testosterone concentrations or increase strength in men, and may acutely increase testosterone levels in women, thus producing a virilizing effect.