The age of the steroid selfie

Needle and Syringe Programs (NSP) are:
 an evidence based Public Health Program
young men and steroid use
in western Sydney
 funded for blood borne virus (BBV) prev
 operational in NSW since 1986
 cost effective ($4 saved for every $1 spent)
Julie Page
Clinical Nurse Specialist
Needle and Syringe Program ~ Team Leader
Nepean Blue Mountains LHD
clean injecting equipment
injecting and health related information
referrals into other health agencies
some clinical services
safe sex information
needle clean-up
advocacy and support
International Data ~ Canada, USA, UK
local data ~NDARC, CSRH, Police & Customs
anecdotes from User Orgs (NUAA, AIVL)
most specific to NSP is data from
heroin and other opiates
constantly changing drug trends and
patterns of use (even across LHDs)
to share what we are seeing every day in
western Sydney... and what the data
tells us is happening
Annual NSP Survey (Kirby Institute)
The National NSP Survey:
 is an annual snapshot of NSP clients profile
Nationally 1% in 2004 & 4% in 2008 (Annual NSP Survey)
and their drug use
 provides data showing an in performance &
image enhancing drug (PIED) users,
accessing NSP (in line with International trends)
 male
 employed
 non-smokers
 see themselves as ‘fit and healthy’
 do not see themselves as ‘drug users’
 early 20’s at commencement
(BUT planning begins much earlier)
“…my dad said I had to bring the needles
“…they won’t let me do a parachute jump
until I put on some weight..”
2013 -significant increase PIED users
accessing NSPs (esp in NSW &Qld)
A recent ‘think tank’ in NSW found there is
little local evidence of BBV transmission in
this group = policy conundrum
4 categories
(Dawson, 2001)
 serious about sport (professionals)
 serious about work (security, police etc)
 serious about how they look
 not serious – just want to look good the
easy way~12% inject other drugs
(NSP Survey)
most common are steroids... known as
roids, the gear, juice. They’re synthetic
hormones and mimic effect of testosterone.
Anabolic = muscle growth
Androgenic = masculising effect
used in cycles
2-3 injections per week
8-12 weeks with equal length break
‘stacking’ concurrent drugs or mixing for
certain effect
Most commonly
 Intramuscular injection
or subcutaneous injection
 oral (tablets)
 topical (creams)
tanning ( women)
strip fat
oestrogen symptoms
get rid of fluid
speed metabolism
add bulk
build and repair
Melanotan II
Thyroid meds
Veterinary steroidsGrowth hormone Peptides (Amino Acids)
“ much of the Equipoise should I
“…why does my arm hurt…?”
site injection for immediate
swelling appearance
Short term
 acne
 headaches
 palpitations
 increased BP
 muscle/tendon injury
Mid-longer term
 gynaecomastia
 liver damage
 stunted growth
 mood swings
 baldness
 shrunken testes - impotence
facial hair
clitoral enlargement
deepened voice
hair loss
Is not new …but…
Nerve damage
Blood Borne Virus – HCV HBV HIV
reverse anorexia 1993, became known as
body dysmorphia disorder (Pope, 1993)
2000’s = birth of ‘Body Beautiful’(Hope, et al, 2014 )
media, social media, a ‘health conscious’
society…and instant gratification
NSP is the point of contact with Health
not a homogenous population
PIEDs users don’t identify as NSP clients, but
no appropriate referral pathways at present
need equipment
limited information on long term health
they don’t trust services and resist info
info is gained through gym and internet
increasing rates of BBV over past decade (UK)
Dawson R T, “Drugs in sport – the role of the physician”, Journal of Endocrinology [2001] 170, 55 – 61.
Dunn M, McKay F H & Iversen J Steroid users and the unique challenge they pose to needle and syringe program workers. Drug and Alcohol Review (January
2014), 33, 71–77
Griffiths S, Murray S B,& Touyz S. Disordered eating and the muscular ideal. Journal of Eating Disorders, published online April 25, 2013 doi 10.1186/20502974-1-15
Hope V.D, McVeigh J, Marongiu A, Evans-Brown M, Smith J, Kimergard A, Parry J V, F. Ncube. Injection site infections and injuries among men who inject image
and performance enhancing drugs: prevalence, risks factors, and healthcare seeking.
Hope V D, McVeigh J, Marongiu A, Evans-Brown M, Smith J, Kimergård A, Croxford S, Beynon C M, Parry J V, Bellis M A, Ncube F. 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. Downloaded
from on September 15, 2013 - Published by
PIED use is not spontaneous – opportunity
exists for early intervention and education
right throughout adolescence
Hildebrandt T, Alfano L,& Langenbucher J W. Body image disturbance in 1000 male appearance and performance enhancing drug users. Journal of Psychiatric
Research 44 (2010) 841 - 846
Iversen J, Topp L, Wand H, & Maher L. Are people who inject performance and image-enhancing drugs an increasing population of Needle and Syringe Program
attendees? , Drug and Alcohol Review (March 2013), 32, 205–207
Iversen J, Chow S, Maher L. Australian NSP Survey National Data Report 2009-2013 Prevalence of HIV, HCV and injecting and sexual behaviour among NSP
attendees. Sydney, Kirby Institute UNSW 2014
Lenehan P, Miller T. Anabolic Steroids A guide for users and professionals 04/2014 Exchange supplies
Murray S B, Rieger E, Hildebrandt T, Karlov L, Russell J, Boon E, Dawson R T, Touyz S W. A comparison of eating , exercise, shape and weight related
symptomatology in males with muscle dysmorphia and anorexia nervosa. Body Image 9 (2012) 193 -200
Young A F, Gabriel S,& Hollar J L. Batman to the Rescue! The protective effects of parasocial relationships with muscular superheros on men’s body image.
Journal of Experimental Social Psycology 49 (2013) 173 -177
Image Acknowledgements:
‘batman to the rescue’ Young ,Gabriel & Hollar
Anabolic Steroids Hardcore Info. Exchange supplies