WP1)  What is the extent of AAS use in the UK and are there regional variations?

We analysed a range of available datasets and conducted a survey consisting of three rounds with a panel of 55 experts with diverse backgrounds and expertise. The panel concluded that there are regional variations in use of AAS, with higher levels of use in Wales and the North East and North West of England. There are also geographical variations in the levels of engagement with needle and syringe programme, ranging between 25% and 45% of men who inject AAS in some regions of the UK, compared to 40% and 60% in others. The panel estimated that between 15% and 25% of men who use AAS only use oral products, and there was strong agreement that the number of women using AAS was relatively low, accounting for only 5% of the total population of people using AAS. The panel were asked about four estimates of AAS use, two from the Crime Survey for England and Wales and two estimates for the UK obtained using the data gathered and generated as part of this study. The majority of the panel members felt that an estimated range for the number of men aged 15-64 who use AAS of between 328,000 and 687,000 was most reasonable of these four estimates. However, it was not possible to estimate what the total number of people who use IPEDs was, and there was particular uncertainty regarding the extent of AAS use in the London region and Northern Ireland.

WP2)  What is the current focus of IPEDs research in the UK?

A scoping review of the UK IPED literature identified 87 relevant academic publications, with nearly half (41 publications) focussing on public health (including harm reduction). The varied motivations and characteristics of people who use IPEDs featured in over a third of the publications, highlighting risk behaviours such as the additional use of psychoactive drugs. A common theme throughout the literature was the need to actively engage with people who use IPEDs, in both conducting meaningful research and in the development of health-related interventions. No evaluations of effective interventions were identified.

1) The list of UK anabolic androgenic steroid research papers will be updated and can be found here: https://www.anabolicsteroids.org.uk/acedemic-papers-and-reports-anabolic-steroids-uk/

2) Findings from this work package were published in the Harm Reduction Journal in October 2021. The paper “Generating evidence on the use of Image and performance enhancing drugs in the UK: results from a scoping review and expert consultation by the Anabolic Steroid UK network” can be found here: https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00550-z

WP3)  What are the services and interventions for IPED users in the UK?

The research team contacted major UK substance use service providers, practitioners on Anabolic Steroids UK Network and searched available service listings (e.g., Talk to Frank, Scottish Drug Forum) to identify services that offer specific interventions for people who use (or are contemplating the use of) IPEDs. Only 35 services were identified in the United Kingdom; 24 in England, eight in Scotland, and three in Wales (no services were identified in Northern Ireland). The most-frequently provided IPED-specific service was the provision of specialist information and the availability of staff with specialist IPED-related knowledge. Additional services included a small number of dedicated clinics, the availability of health monitoring and the delivery of outreach services. Several services highlighted the impact of the COVID-19 pandemic on IPED clinics and outreach services and the intention to recommence provision of such services in the future.

WP4)  What are the key factors that may influence the harmful use of IPEDs?

A range of stakeholders including specialist practitioners, academics, public health professionals, policymakers, gym owners, and people who used IPEDs were recruited. They worked with the research team through workshops and interviews to produce a systems map illustrating the influences on harmful image and performance enhancing drug use. This exercise demonstrates the complexity of influencing issues related to the harmful use of IPEDs, with many influential factors acting on IPED users in different settings and at different times. The impact of these factors will vary according to individual characteristics such as risk appetite, beliefs, priorities, cognitive skills, and sense of identity. It highlights how we can think about these factors as part of a connected system rather than separate issues to be addressed individually through interventions.

Dissemination

There are three main methods of dissemination of project findings, to maximise impact at all levels.

Conclusions and recommendations

Together the findings from the four WPs provide evidence of the complexity of IPED use in the UK and the responses required to reduce associated harms. There are geographical variations in the use of IPEDs and significant hidden populations of people who use AAS and a range of additional drugs. There is a broad spectrum of factors that influence the harmful use of these drugs and currently we have little evidence on which to base the development of effective interventions and services. While the UK has an expansive network of NSPs, there are relatively few specialist services targeting this population, for which we now have a plausible estimate of between 328,000 and 687,000 men using AAS. Most interventions for this population are currently limited in aims and approach, and there are no effectiveness evaluations of interventions aiming to prevent or delay initiation of drug use, reduce or mitigate harms, or support cessation in the UK. To reduce harmful IPED use this study establishes the need for a range of effective methods of engagement with IPED users, for example, through assertive outreach and effective engagement with key members of the IPED communities and improving the quality of experiences when accessing generic healthcare services. It supports the need for new interventions to tackle a wider range of harms, while maintaining the prevention of blood borne virus transmission and rigorous evaluations of existing interventions that include consideration of the complexities identified in the system.

Engagement and consultation

Engagement with community members with specific knowledge of IPEDs, their use, the illicit market and associated culture (termed PEAB) has been maintained throughout this process. A total of seven members have been invaluable to all aspects of this project. Their contribution to the three full team meetings and their input to the workshops in work package 4 have helped shape this work. They have all committed to continue to work with this research group as we develop the nest stage of our research. In addition to the PEAB we are extremely grateful to the ongoing advice and guidance of our study steering group comprising Dr April Henning – University of Stirling (Chair), Joe Kean – Change, Grow, Live and Josie Smith – Public Health Wales. Finally, we would like to thank the members of ASUK for your information and support, in particular in relation to both the identification of relevant UK academic literature and IPED services and interventions across the UK.