Background
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What support and information do people using non-prescriptive AAS recreationally access?
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What support and information do these recreational AAS users say they want?
Methods
Search strategy
Search algorithms | |
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anabolic androgenic OR designer N3 steroid* OR recreat* steroid* OR anabolic steroid* OR anabolic drug* OR Synthe* testosterone OR “Synthe* testosterone” OR “non prescript*” steroid* OR non-prescript* steroid* OR “non-medic*” steroid* OR “non prescri*” N2 steroid* OR non-prescri* N2 steroid* OR “non medic*” N2 steroid* OR non-medic* N2 steroid* OR performance N3 enhanc* drug* or image N3 enhanc* drug* or appearance N3 enhanc* drug* or muscle N3 enhanc* drug* OR muscle N3 develop* drug* or performance N3 develop*drug* OR doping N3 steroid* | |
NOT |
animal* OR mice OR rats OR “guinea pig*” OR spectrometry OR bovine
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AND | Support or advice or help or aid or barrier* or information or guidance or intervention* or “needle exchange* or program*” |
Inclusion criteria | Exclusion criteria |
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Studies including populations such as recreational AAS users, non-competitive AAS-using bodybuilders and weightlifters and, AAS users accessing drug services. | Studies involving participants who compete professionally and any study that focuses on competitive sports/athletes or high school athletes |
Peer-Reviewed Papers^ | Studies on wider drugs prevention interventions or strategies |
Qualitative and Quantitative data | Studies that made passing references to participants seeking information but did not clarify the type of support or information including studies which showed an increase in people using NSPs but did not share exactly what they were using them for |
Studies where participants were asked about where they access support, advice and information to help them manage their substance use and that identified the types of support and information they were seeking. | Specific medical interventions i.e. efficacy of treatments for side effects |
Studies that included data collected on any support (information, advice, service or intervention) designed to support people who use IPED | Studies that focussed on prevention of AAS use and efficacy of such interventions |
Studies that referenced participants attitudes to who they trusted around information but did not specifically state the types of information or support | |
Studies that were solely based on recommendations of professionals as to what support and information was needed but where the voice of the AAS user was absent | |
Articles not in English | |
Studies before the predominance of the internet as a source of information i.e. pre 2001. In 2001 the number of internet users went over 500 million worldwide [32] |
Literature search
Data extraction and analysis
First author, year & reference | Country | Participants defined, (age range/mean), gender | No. of participants | Type of data # | Sources potential bias & limitations | Quality review~ |
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Maycock (2005) [36] | Australia | Used or had used AAS and dealers, men | 42 AAS users, 22 dealers | #Qualitative: Participant observation (147), interviews include longitudinal (10 over 3 years) | Purposive sampling | ** |
Grogan (2006) [37] | UK | Use(d) AAS, 5 men, 6 women | 11 | #Qualitative: interviews | Small sample | *** |
Skårberg (2008) [38] | Sweden | Addiction clinic patients who use(d) AAS, 4 men, 2 women | 6 | Qualitative interviews: case-study | Sought help for AAS use. Small sample | ** |
Kimergård (2014) [39] | England & Wales | AAS users and harm reduction service providers (mean = 34), men | 24 | Qualitative: semi-structured interviews | Bias towards those showing positive health behaviours | *** |
Kimergård (2014) [3] | England & Wales | Used or had used AAS, men | 24 | #Qualitative: semi-structured interviews | same study as above | *** |
Kimergård (2015) [22] | England & Wales | AAS users, men | 24 | #Qualitative: semi-structured interviews | same study as above | *** |
Van Hout (2015) [40] | UK | IPED users, men | 20 | #Qualitative: in-depth interviews | Privileged access recruitment^ | *** |
Dunn (2016) [41] | Australia | Used or had used AAS, 19 men and 2 women | 21 | #Qualitative: semi-structured interviews | Voucher for taking part; one region (non-rural), length of interviews varied | *** |
Griffiths (2016) [42] | Australia | Used or had used AAS, 24 men 2 women | 26 | #Qualitative: semi-structured interviews | – same study as above | *** |
Hanley Santos (2017) [43] | UK | AAS users, 21 men 1 woman | 22 | Qualitative: semi-structured interviews | Bias towards those showing positive health behaviours - £10 given | *** |
Tighe (2017) [44] | Australia | Specialist forum users, (none), unknown | 450 unique avatars | Qualitative: threads from 3 Online forums: 134 threads: 1716 posts | Australian sites yet people from other countries on forums | *** |
Greenway (2018) [45] | UK | AAS Users, male | 8 | Qualitative: interviews | Sample bias, one NSP | *** |
First author, year & reference | Country | Participants defined, (age range/mean), gender | No. of participants | Type of data # | Sources, potential bias & limitations | Quality review~ |
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Parkinson (2006) [5] | USA | AAS users, 494 men 6 women | 500 | Quantitative: web-based questionnaire | Web-based, self-selected, self-report | ** |
Cohen (2007) [48] | US | AAS users (Non-medical), men | 1955 | Quantitative: web-based survey | Online population | *** |
Larance (2008) [49] | Australia | IPED users, men | 60 | #Quantitative: cross -sectional structured Interviews | Self-selecting sample, purposive recruitment strategies, self-reports | *** |
Al-Falasi (2009) [50] | UAE | AAS users (34 male) and non-AAS users (129 male & female), age range not specific | 154 | Quantitative: Self-administered questionnaire | Self-report, small sample size, selective bias | ** |
Bojsen-Møller (2010) [51] | Denmark | General public (incl AAS users), (not given for AAS queries subset), 284 men, 40 women | 374 | Quantitative: Anti-Doping Hotline Enquires: web and phone queries (subset AAS use) | Self-selected, missing data for AAS users’ subset | ** |
Hope (2013) [52] | England & Wales (UK) | Injectors of IPED (NSPs), (n = 347 mean = 28 [not all gave age]), men | 395 | Quantitative: unlinked-anonymous cross-sectional biobehavioural survey (oral fluid sample) | NSPs as settings | *** |
Hope (2013) [19] | England & Wales (UK) | Injectors of IPED (NSPs), (n = 319, mean: 28 [not all gave age]), men | 366 | Quantitative: unlinked-anonymous cross-sectional biobehavioural survey (oral fluid sample) | same study as above | *** |
van Beek (2015) [53] | Australia | Injectors of IPED (NSPs), (mean = 32.6), men | 103 | Quantitative: Self-administered survey | Recruited from 2 public healthcare providers | *** |
Jacka (2017) [54] | Australia | Injectors of IPED, (median 27), men | 100000 occasions | Queensland NSP Minimum dataset | NSPs as settings | *** |
Rowe (2017) [8] | Australia | Injectors of IPED, (mean = 28.8), men | 605 | Quantitative: Self-administered questionnaire | NSPs as settings | *** |
Zahnow (2017) [55] | Global | AAS users, 253 men & 59 women (no exact No. after exclusion criteria applied) | 195 AAS users with adverse effects | Quantitative: Sub-section of global drug survey – online | Self-nominating, online only | ** |
Dennington (2008) [34] |
Australia
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IPED users, 61 men, 1 woman, 7 trans, 24, key informants
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69 (+ 24)
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#Mixed Methods: semi-structured interviews collecting quantitative and qualitative data
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Report: not peer reviewed. Data sets not integrated
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**
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Results
Information and support sought
Type of information / support | Support sought from (if given) | Article reference |
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Acquisition of injecting equipment | Dealer(s) | |
NSPs | ||
Chemist/Pharmacy | ||
Doctor(s) | ||
Friends(s)/Peer(s)/Social Network | ||
Steroid Clinic(s) | ||
Gym/Outreach services in Gyms | ||
Online/Websites | ||
Anti-Aging clinic(s) | [41] | |
Outreach service/Other | ||
Guidance on how to inject and safer injection practices | Dealer(s)/Supplier(s) | |
Friend(s)/Peer(s)/Experienced Gym mate(s)/Other AAS user(s)/Family | ||
Self-taught | [52] | |
NSPs | [51] | |
Online/Websites | ||
Leaflets/Other sources | ||
Personal trainer(s) | [8] | |
Doctor(s)/Nurse(s) | ||
Blood Borne Virus screening~ | Hep B and Hep C | |
Hep B (20%), Hep C (18%) | [19] | |
Hep C (64%) | [55] | |
Hep B (23%), Hep C (22%) | [53] | |
HiV testing~ | HiV | |
HiV (31%) | [53] | |
HiV (64%) | [54] | |
HiV (28%) | [19] |
Harm minimisation and advice
Research and information seeking
Type of information / support | Support sought from (if given) | Article reference |
---|---|---|
Seeking of general information on IPED use: including effectiveness, dosage, the effects, how to use, types of substances/brand | Friend(s)/Experienced user(s)/Training partners/Peers/Other user(s)/Family | |
Online forums* | ||
Underground books/Magazines | ||
Doctor(s)/Medical practitioner(s)/Nurse(s) | ||
Gym contact(s)/Gym trainer(s)/Personal trainers | ||
Dealer(s)/Supplier(s) | ||
Questions to anti-doping hotline/Online service on AAS | [20] | |
Internet/Specialist websites* | ||
Medical journals | [1] | |
NSP(s) | ||
Steroid guides in gyms/Other sources | ||
Research into cycling, stacking and types of substances | Peers/Fellow users | |
Websites | [16] | |
Dealers | [2] | |
Online forums | [17] | |
Self-experimentation | [16] | |
Research into side effects and risk management | People with ‘hands-on’ experience of use/ Steroid guides in gyms/ Underground books/Dedicated websites | [18] |
Questions to anti-doping hotline/Online service on adverse side-effects/ Health risks | [20] | |
Doping tests | Questions to anti-doping hotline/Online service on obtaining positive doping test and penalties | [20] |
Support for health issues
Type of information/support | Support sought from (if given) | Article reference |
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Regular medical check-ups / Unspecified laboratory/Medical tests including blood-tests | Not stated Not stated but bloodwork obtained | [21] [22] |
Doctor(s) Doctors (Liver function test, ECG, Diabetes tests) | [14] | |
Steroid Clinic (service provider information) | [11] | |
Anti-aging clinics | [9] | |
Consultation on specific AAS – related health issues | Doctor Doctor (includes discussion on mood) Doctor (for PCT advice) | [14] [23] |
Specialised addiction clinic (psychological problems) | [13] | |
Sexual health clinics | [5] | |
NSPs NSPs (including < 1% interventions – drug treatment referrals) | [7] | |
Accident & Emergency/walk-in | ||
Anti-aging clinics | [9] | |
Self-treatment and other | [6] | |
Online websites/Forums | [9] | |
Prescribed substances relating to AAS use | Not stated | [6] |
Ideal support
Discussion
Online information
Support services
Barriers to accessing support
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perceived lack of trust or lack of knowledge from professionals
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fear of judgemental reactions
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inability to obtain drugs wanted for PCT
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the need for private health insurance
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cost and difficulty of booking advance appointments
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not wanting to be identified as ‘drug’ users or as visiting such support services