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1. Jim McVeigh
Director
Public Health Institute
Anabolic steroids: a global public
health perspective

2. Surveillance data from NSPs (1991 - 2016);
UK survey data (2013- 2016) 1549 IPED users:
demographics, drug use histories, health profiles, risk
behaviour and motivations for use;
HIV, hepatitis B and hepatitis C prevalence data from PHE
surveillance system of people who inject drugs (from1992 -
2016) and two bespoke IPED injector surveys;
Global Drug Survey 2015
Datasources

4. Reproduced from www.ifbb.ru

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Mug shot: Moat was well known to
Northumbria Police, and he
believed they victimised him
Control freak and his reign
of terror: Pumped full of
steroids, sword-wielding
club bouncer Moat thought
he was irresistible
By PAUL SIMS FOR MAILONLINE
UPDATED: 09:41, 5 July 2010
Raoul Moat is an
unpredictable control freak
with a violent temper who
snaps without warning, say
friends and family.
The 6ft-plus ex-nightclub
bouncer, who is addicted to
steroids and anti-
depressants, is so paranoid
that he wired his house up
with CCTV cameras and
microphones, neighbours
said.
He was caught by police
carrying a serrated steel
knuckle duster and a
terrifying 5ft long Samurai
sword and has links to
Newcastle gangsters.
But Samantha Stobbart was
almost blind to his serious flaws, said her half sister, Kelly, 27.
'Sam thought he was the bee's knees,' she said yesterday.
'Her problem was that she could not see above Raoul's chest.
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7. In reality…

8. Anabolic steroids definition
Mimic the effects of testosterone
Testosterone - anabolic & androgenic
Anabolic - growth & development of tissue
Androgenic - secondary male sexual
characteristics

9. Testosterone production

10. PANIC!
PANIC!

11. Berthold 1849
Testosterone

12. 0
0.2
0.4
0.6
0.8
1
1.2
last year
Ever
YP last year
“Have you ever taken anabolic steroids
(steroids) (not prescribed by a doctor) even
if it was a long time ago?”
Anabolic steroid use in last year/ever
Adults ever 356,000 (302,000 – 411,000)
Adults last year 61,000 (38,000 – 83,000)
YP last year 23,000 (5,000 – 40,000)

13. ‘All’ & ‘new’ clients attending agency based NSPs in
Liverpool City Region (1991 to 2011)
0
500
1,000
1,500
2,000
2,500
3,000
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Number
of
Clients
Year of Presentation/Attendance
New AS injecting clients
New other injecting clients
AS injecting clients
Other injecting clients

14. Middlesbrough 67%
Kirklees 60%
Sheffield 62%
Newcastle 52%
Sunderland 60%
Bradford 41%
Halton 86%
Liverpool 83%
Sefton 43%
St Helens 34%
Warrington 86%
Wirral 77%
Manchester 60%
Bolton 52%
NSP clients using anabolic steroids in Northern England
(Kimergard & McVeigh, 2014)

15. Anabolic steroid users accessing NSPs in
Cheshire and Merseyside, UK (1995 and 2015)
(McVeigh & Begley, 2017)

16. Anabolic steroid users attending NSPs in
Liverpool City Region (1995 and 2015)
1995 2015
Number of anabolic steroid NSP clients 553 2446
Proportion of NSP clients 17% 55%
Syringes provided to steroid users 14,293 139,956
Mean syringes per steroid user 26 57
(McVeigh & Begley, 2017)

17. Harms associated with
anabolic steroid use

18. Adverse effects on several organ/systems in particular:
Cardiovascular effects
Haematologic effects
Psychiatric and neuropsychologic effects
Hormonal and metabolic effects
Variety of less frequent effects on various other bodily tissues.
Pope et al, 2013
Adverse Health Consequences of Performance Enhancing Drugs
An Endocrine Society Scientific Statement

19. Bilateral deltoid abscesses pre-operative clinical appearance
Marquis & Maffulli, 2006

20. Marquis & Maffulli, 2006
Intra-operative drainage

21. 2010/11 2012/13
Anti-HIV Prevalence 1.5% (400) 2.0% (249)
Anti-HBc Prevalence 8.7% (400) 2.8% (249)
Anti-HCV Prevalence 5.4% (400) 3.6% (249)
Level of sharing (direct & indirect) 8.9% (392) 13% (243)
Hepatitis B vaccine uptake 24% (375) 40% (246)
Symptom of injection site infection 6.9% (389) 16% (238)
Ever been in prison 17% (377) 24% (247)
Unlinked Anonymous Monitoring Survey of People Who Inject image
and performance enhancing drugs
Hope, McVeigh et al, 2014

22. 22
From Glass R et al Secondary distribution of injecting equipment obtained from needle and syringe programmes
by people injecting image and performance enhancing drugs: England & Wales, 2012-15.
One in three of people using IPEDs
who use NSP distribute equipment
to others

23. Mid-point:
160 participants 1,040 others
Estimated extend of secondary distribution
There were 564 participants in the sample.
160 collected for others.
Minimum:
160 participants 667 others
23
Range of
users
which may
not be
engaging
with NSP
from our
sample
Glass R et al Secondary distribution of injecting equipment obtained from needle and syringe programmes by
people injecting image and performance enhancing drugs: England & Wales, 2012-15.

24. 24
14%
86%
Ever injected a
psychoactive drug
Yes
No 46%
54%
Injected psychoactive drugs
during last year
Yes
No
Hope et al. Drug and Alcohol Dependence 2017;179 :83-86
Injection of psychoactive drugs

25. Prevalence of antibodies to hepatitis C
Overall one in twenty had antibodies
25
1.4%
39%
14%
0% 25% 50% 75% 100%
Never injected a psychoactive drug
Recently (in preceding 12 months)
injected a psychoactive
Previously injected a psychoactive
Hope et al. Drug and Alcohol Dependence 2017;179 :83-86

26. Awareness of having had hepatitis C
26
Hope et al. Drug and Alcohol Dependence 2017;’, 179 :83-86
0 5 10 15 20
Never injected a psychoactive drug
Recently (in preceding 12 months)
injected a psychoactive
Previously injected a psychoactive
Aware Unaware

27. Global phenomenon

28. 993 male
anabolic
steroid users
96
250
525
104
Other 17
Global Drug Survey 2015 (89,509 responses)
Zahnow et al (2017)

29. Region of residence: AAS users as proportion of
GDS participants
Characteristics Total males Ever
used
% of total
males ever
used
Used in the
last 12
months
% of total male
used in last 12
months
Region
Europe 47,424 525 (1.10) 158 (0.33)
North America 3,038 96 (3.06) 27 (0.86)
South Americas 3,133 250 (7.39) 84 (2.48)
Oceania 4,080 104 (2.49) 38 (0.91)
Other 537 17 (3.07) 8 (1.44)
Total 58,212 993 (1.68) 315 (0.53)
Zahnow et al (2017)

30. Global Drug Survey – 993 steroid users
Drug Used in last 12
months
Lifetime use
Cannabis 63.1 87.8
Other drugs * 44.6 71.4
Ecstasy 41.8 61.3
Cocaine 38.7 61.3
Amphetamines 20.6 49.1
LSD 18.1 41.1
Benzodiazepines 28.2 34.8
NPS 14.0 31.0
Opiates 15.3 30.0
* Including magic mushrooms, poppers, nitrous, ketamine and GHB
Zahnow et al (2017)

31. Hope, V. D., McVeigh, J., Smith, J., Glass, R., Njoroge, J., Tanner, C., . . . Desai, M. (2017). Low levels of hepatitis C diagnosis and
testing uptake among people who inject image and performance enhancing drugs in England and Wales, 2012-15. Drug and Alcohol
Dependence, 179, 83-86.
McVeigh, J., & Begley, E. (2017). Anabolic steroids in the UK: an increasing issue for public health. Drugs: Education, Prevention and
Policy, 24.:3, 278-285
Hope, V. D., McVeigh, J., Marongiu, A., Evans-Brown, M., Smith, J., Kimergard, A., . . . Bellis, M. A. (2013). Prevalence of, and risk factors
for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study. BMJ
OPEN, 3(9), 11
McVeigh, J., Beynon, C., & Bellis, M. A. (2003). New challenges for agency based syringe exchange schemes: Analysis of 11 years of
data (1991-2001) in Merseyside and Cheshire, United Kingdom. International Journal of Drug Policy, 14(5-6), 399-405.
Zahnow, R., McVeigh, J., Ferris, J., & Winstock, A. (2017). Adverse effects, health service engagement, and service satisfaction among
anabolic androgenic steroid users. Contemporary Drug Problems 44(1):69-83 01
Hope, V. D., Harris, R., McVeigh, J., Cullen, K. J., Smith, J., Parry, J. V., . . . Ncube, F. (2016). Risk of HIV and Hepatitis B and C Over
Time Among Men Who Inject Image and Performance Enhancing Drugs in England and Wales: Results From Cross-Sectional Prevalence
Surveys, 1992-2013. JAIDS, 71(3), 331-337
Hope, V. D., McVeigh, J., Marongiu, A., Evans-Brown, M., Smith, J., Kimergard, A., . . . Ncube, F. (2015). Injection site infections and
injuries in men who inject image- and performance-enhancing drugs: prevalence, risks factors, and healthcare seeking. Epidemiology and
Infection, 143(1), 132-140.
McVeigh, J., bates, G., & chandler, M. (2015). Steroids and Image Enhancing Drugs 2014 Survey Results. http://www.cph.org.uk/wp-
content/uploads/2015/07/SIEDs-report-GB-JL-10-7-15-Final.pdf
Bates, G., & McVeigh, J. (2016). Image and Performance Enhancing Drugs 2015 Survey Results. Liverpool: Liverpool John Moores
University. http://www.cph.org.uk/wp-content/uploads/2016/07/IPEDs-2015-survey_final1.pdf
Kimergard, A., & McVeigh, J. (2014). Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids
among people using harm reduction services in the UK. BMJ Open, 4(6),
References

32. Jim McVeigh
Director
Public Health Institute
Liverpool John Moores University
0151 231 4512
j.mcveigh@ljmu.ac.uk