The Advisory Council on the Misuse of Drugs (ACMD) will consider the psychological reasons behind a rise in the use of performance and image-enhancing drugs (PIEDs) before implementing any legislative changes, heard those present at an evidence-gathering session in London today. Professor Fabrizio Schifano of the University of Hertfordshire, Chair of the ACMD Working Group on IPEDs, said that the Group would produce a report in the coming year based on evidence from today’s session at the Kia Oval in London, and submitted earlier by stakeholders. UK Anti-Doping (UKAD) today called for the importation and use of certain IPEDs to be made illegal.

Image tops performance as doping motivator

“Image would now outweigh performance enhancement” as a motivator for taking PIEDs, said Colin Gibson, a former National Crime Agency (NCA) National Drugs Expert Witness programme officer specialising in PIEDs. This insight was supported by data from Dr. Lihini Gunawardana of Change, Grow, Live, who has collated data from needle exchange services. Fifty percent of Manchester’s needle exchange programme is now servicing users of PIEDs rather than psychoactive injectable drugs.

This was supported by Jim McVeigh, Director of the Public Health Institute at Liverpool John Moores University, who in 2014 conducted research indicating that steroid use had overtaken heroin use in some northern cities. Data from needle exchange programmes also indicated that PIED use is a northern problem in the UK. However, it was pointed out that some needle exchange programmes are more open to others to users of PIEDs, who often do not want to be associated with users of injectable psychoactive drugs.

“Why would I walk into a room I perceive will be full of smack heads to get needles and bins, when I can go online and buy them for £7.96?” asked former bodybuilder Dave Crosland, who runs Croslands Harm Reduction Services. Anecdotal evidence also suggested that many users of such programmes claimed to be using PIEDs when asking for needles to avoid implicating themselves in illegal activity.

UK a big supplier of PIEDs

It also emerged that the UK is a big supplier of PIEDs to the international market. UKAD’s Pat Myhill cited a study had found that the UK was the biggest supplier of PIEDs to Australia. However, anecdotal evidence was heard that overseas laboratories are often happy to mislabel raw materials to facilitate their import into the UK, so that they can then be synthesised or mixed in the UK for import overseas.

Illicit laboratories are also understood to be a big problem in the UK. Myhill said that UKAD had received intelligence on 309 laboratories operating in the UK. Of those, 135 involved addresses, however only 10% of that total (13 laboratories) were dealt with. Of those, Myhill described 11 (85%) as “fully functioning” laboratories run by underground chemists.

“I am seeking more laboratories”, said Gibson, adding that he now receives reports on one or two new laboratories each week, compared to one or two each year, five years ago. Crosland said he understands that over 200 illicit laboratories are currently producing illicit steroids in the UK. Fifty of those he described as “large scale”, or capable of producing between 2,000 and 10,000 units per week.

The reasons for this prevalence come down to money. Gibson said that for an initial outlay of £2,565, an illicit laboratory can generate profits of £13,435.

Law enforcement

Steroids are classified as a Class C drug under the Misuse of Drugs Act (1971). As such, supply could lead to 14 years imprisonment. However, changes in the law during 2012 mean that it is illegal to import steroids by ordering them from outside the UK, unless they are brought into the country under personal custody. Evidence was presented indicating that due to the classification of steroids and the potential high profits from producing them, operating such a laboratory is perceived as lower risk than operating an illicit laboratory producing Class A drugs.

Myhill said that due to the lower classification of steroids, law enforcement are often unwilling to engage in operations to shut down laboratories. This could be part of the reason why UKAD is keen for regulatory change. Myhill said that UKAD had received over 2,000 reports of PIED use in gyms over the last two years. Of those, 251 related directly to a specific gym with a physical address.

In the last six months, UKAD has received 267 reports from the UK Border Force concerning seizures of PIEDs. Myhill said that the average seizure of PIEDs over the last two years has been 200 per year, indicating that PIED usage in the UK is a growing problem. Of those seizures, 43% were testosterone-related products; 22% were anabolic steroids and 16% concerned Human Growth Hormone (HGH).

User perception

John Campbell, Manager of Glasgow’s PIED Clinic, mentioned that gyms across Glasgow had agreed to put up a poster advertising the dangers of steroid use. However, when they checked back two weeks later, not one of the gyms had put up the poster. Crosland said that many IPED users are reluctant to use state-run needle exchange and advice programmes, as they view them as gathering evidence for the ACMD in order to implement bans on steroids, such as the one UKAD has called for.

Interestingly, Campbell said that users were spending between £200 and £400 per month on HGH, however of 18 to 20 blood tests the Glasgow PIED Clinic carried out on such users, only two showed elevated HGH. This finding was disputed by Gibson and McVeigh, who said that they had never come across fake HGH. McVeigh mentioned that one third of steroid users are now also using HGH. Professor Richard Holt of Southampton University said that demand for medical grade HGH is so high that parents are selling HGH medication prescribed to their children at local gyms.

Underlying both these pieces of evidence is a view that PIED use does not present as dangerous a health risk as use of other drugs. A number of speakers referred to PIED users being more concerned that the products they had bought were not working, rather than the damage such substances could be doing to their body. Others referred to PIED users going to their doctor with health/mental issues, and not relating them to the PIEDs they have been taking.

Crosland painted a frightening picture of a pattern of psychological dependency that appears to be emerging. “People are prioritising PIEDs over food”, he said. “Laboratory owners pay people to promote their products on social media. Use has now become habitual and people give excuses as to why they shouldn’t just stop using PIEDs.” He also outlined that PIED use in the prison population, police and armed forces is “an accident waiting to happen” that needs to be addressed.

Campbell said that analysis of bloods taken from 301 PIED users, post cycle, during 2016 revealed the following:

• 43% had abnormal liver function;
• 43% had abnormal kidney function;
• 41% had abnormal luteinising hormone and follicle stimulating hormone (FSH) levels;
• 39% had abnormal levels of testosterone.

McVeigh also pointed to evidence that HIV prevalence amongst PIED use now equals that of heroin users.

Gap in knowledge

In summing up the day, Professor Schifano referred to a “gap in knowledge” regarding research into the motives behind PIED use in wider society. For example, little research exists into psychological dependency on PIEDs – something that was highlighted as a particular issue in today’s evidence gathering session.

McVeigh said that there is pressure on young males, especially in former industrial towns where the only jobs available were formerly seen as women’s jobs. Often, the gym is the only way for such males to demonstrate the ‘masculinity’ they feel is required from them.

PIED use also continues despite the serious side effects that can result from use. Professor Holt outlined a 1995 Sports Illustrated study of 198 athletes, which asked: ‘You are offered a banned performance-enhancing substance, with two guarantees: 1) You will not be caught. 2) You will win. Would you take the substance?’ Only three said that they would not take the substance.

A supplementary question asked: ‘You are offered a banned performance-enhancing substance that comes with two guarantees: 1) You will not be caught. 2) You will win every competition you enter for the next five years, and then you will die from the side effects of the substance. Would you take it?’ More than half the athletes said yes.

However, today’s evidence suggests that the usage pattern has changed. Athletes are taking PIEDs for image enhancing purposes rather than results on the pitch. The reasons behind such pervasive use need greater research. For this reason, it is perhaps premature to expect legislation any time soon.

• For a timeline of tweets from the ACMD evidence-gathering day on the use of PIEDS, click here.