michael evans-brown & jim mcveigh
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The changing nature of performance-enhancing drug use … What are the implications for public health?. Michael Evans-Brown & Jim McVeigh. Once upon a time …. - PowerPoint PPT PresentationTRANSCRIPT
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The changing nature of performance-enhancing drug use …
What are the implications for public health?
Michael Evans-Brown & Jim McVeigh
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Once upon a time …
• “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)
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Then came the 80s …
• “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)
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Then the 90s …
• 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)
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Thereafter …
• A few more studies looked at use in gyms in Wales & England
• Is more growth hormone use being reported?
• Are more using for ‘body image’ reasons?
• 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.
• Will these diffuse to broader groups?
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“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?)
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We don’t know much about:
• how many people are using & how long they use for
• which types of people are using and their ages
• 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)
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We don’t know much about:
• the illicit market (manufacture, distribution and supply)
• the quality, safety and efficacy of products:
• most are unlicensed
• many are either in pre-clinical or in phase I/II trials
• 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
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We do know:
• 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
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What this group uses today, others may use tomorrow
• GHB — used started in the late 1980s to increase Growth Hormone secretion
• 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?
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What about harms?
• 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?
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What should we do?
• 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.