17 October 2012

Anabolic Steroid Users, Needle Exchange and the Peril of Publicity

There have been a fair few media stories over the past few years about the increase in Needle Exchange usage by people using Performance Enhancing Drugs – especially anabolic androgenic steroids.
A classic of the genre is this one from the BBC: http://www.bbc.co.uk/news/uk-england-bristol-19650743. In truth through, the stories are highly interchangeable – usually some statistics about increased usage from a Needle Exchange, comments from drugs workers and experts, and some comment from a user about their use.

Inaccuracies and sensationalist reporting aside, the ongoing news stories originating from Needle Exchanges about steroid use is something or a double-edged sword.

On the one hand, needle exchanges and drug projects need to ensure that they retain the funds and resources that allow them to continue. As the welcome downward trend in heroin injecting continues, it is essential that funders and commissioners are aware that other populations need access to needle exchange. And so identifying and publicising the level of service usage – and the level of need is essential.

Indeed, some services, researchers, harm reduction advocates and academics are clearly of the mind that highlighting the level of use is one of the key tools for securing the funds required to develop and expand services to steroid users. Such expansion could include better specialist services – highly trained staff, opportunities to have blood analysis undertaken and better health care. To secure such funding, demonstrating a level of need is essential.
In order to do this, agencies need to record drug of choice. It also helps to identify and respond to trends, and also so that they can ensure staff are trained and resources. The agency needs the profile of their clients, funders demand it and resources hinge on it.

People who use Anabolic Androgenic Steroids often view the situation differently. They are acutely conscious that their drugs of choice occupy an unusual position within the Misuse of Drugs Act 1971. The drugs are currently legal to possess, even if not prescribed, putting them in a privileged position compared to most other Controlled Drugs. There have been changes to this in the past year – introducing a requirement to be in personal possession at the point of importation, but the removal or a requirement for the drugs to be “in medical form” to be lawful. These changes make it theoretically harder to purchase and import high quality “licensed” products on-line, whilst making the possession of counterfeit or underground products now wholly lawful.

As such some people using steroids think that they have a vested interest in keeping steroids “off the radar” and trying to reduce the extent to which it comes to wider public attention and certainly off the agenda of legislators. Even the argument that better evidence of need could result in better service provision cuts little ice here. Whilst we don’t know the exact figure, a fair proportion of people injecting steroids elect to purchase their elected equipment on-line rather than using needle exchanges. For some this is merely practical: not all needle exchanges give out the range or quantity of equipment that some users want. Others just don’t want to be seen using needle exchanges. A few argue that if they can afford it they should buy it rather than using a free service they view as being in greater need. But of the needle-exchange refuseniks, a fair few are making a very deliberate decision not to use needle exchanges to avoid contributing to statistics which could reveal the nature and extent of steroid use.

One of the recurring responses, from moderators on a leading UK body-building website makes the case thus:
Steroid users should never, EVER use an exchange.
Steroids are class C atm. They govt are always looking for the next "vote winner". Let's re-classify steroids to 'save the children' will be the call. How will they manipulate this change? From spurious data and figures that would be used to drive home a message to joe public that "the UK has a massive steroid problem". Look how many users there are compared to year xxxx etc etc. The more people using exchanges, the more convincing their argument, even when you and I both know relatively speaking it is no-where near problematic proportions.
As such, needle exchange discussion is not encouraged on [this bulletin board.]
Judging by the various threads and discussions this view is on the increase with more and more people electing to use on-line suppliers rather than needle exchanges.
In an (admittedly) small on-line poll less than one in four people using injectables said that they used pharmacy exchange all the time. A staggering 63% voted “I never have, and never will use an exchange.”

Given the track record of Government on drug prohibition, I can’t help feeling that some of the concerns of those who caution against needle exchange are well founded. One would hope that a rational Government would recognise that criminalising and driving a group underground would be counter productive. So far, in no small part due to careful presentation of evidence by leading lights in the UK, the ACMD has shied away from rescheduling steroids and the Government, despite the obvious temptation of the Olympics, has not seen an urgent need to do so. But against an ongoing drip-drip-drip of negative steroid media stories, I wonder how long until the status of steroids is renewed again.

Why, some will ask, does it matter if steroid injectors don’t use needle exchange? If this population can afford and are willing to purchase their own equipment, why should agencies be at all concerned?

Some workers (and indeed some commissioners) have endorsed this approach, saying that needle exchange isn’t really “for” steroid users and as such if they can afford their own equipment they should really buy it not use Needle Exchange.

Personally I have no truck with this analysis. I don’t remember a similar argument for means testing needle exchange being made for other drugs. Needle exchange is intended to be available to all who inject non-medical drugs, because of the public health need of such a service, irrespective of ability pay.

We want people to use services because that way we can ensure people get advice about injecting technique, access to advice, woundcare, BBV testing and vaccinations. Certainly many steroid injectors have a good understanding of what they are taking and how to use it. Others don’t and they need access to this information.

Not all steroid users are sourcing equipment on line; almost a quarter, for whatever reasons, needle exchange represents an essential source of equipment.

So here’s the catch 22.

In order to demonstrate need and to attract funding to provide great services agencies need steroid injectors to attend. But those same injectors are concerned about attending and being counted because, rather than seeing this resulting in better services, they fear that the aggregated statistics will be used to justify criminalising steroid use.

Agencies don’t help their case by stressing the confidential nature of their service and then ending up all over the front pages of the local press, highlighting how much steroid use has increased. If there were ever a way of reinforcing the fear that use of needle exchange puts steroids more firmly in the public eye and increases risk of prohibition, this is surely it.

So what’s the solution? In the short term, needle exchanges and other commentators need to think carefully about the pros and cons of highlighting increases in steroid use to the media. Not, I should stress, because this directly impacts on UK policy, but because the same steroid users who read the papers today are the ones who, tomorrow may be disinclined to use needle exchange.

More fundamentally, it highlights the importance of drugs policy being independent of political ideology. If users feel that they can’t trust how statistical data is being used, and they can’t believe in an evidence-based drugs policy it’s hardly surprising that they will seek to keep their use “off-radar.” Rather than viewing wider recognition of use as a way of garnering resources and better services, it is viewed with great fear.

People using anabolic androgenic steroids and discussing this issue on forums are deeply suspicious of the use of statistics and research by needle exchanges and how it impacts on the media and wider policy. Agencies need to recognise and respond to this suspicion and work to undo the damage.


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