ISSUES
: Drugs
Chapter 1: Drug issues
16
that prevention work with people
who use SIEDs needs to address
sexual risks as well as injecting
practices. In their surveys, around
half of people who use SIEDs have
multiple sexual partners but a
similar proportion has never used a
condom.
John Campbell of NHS Greater
Glasgow and Clyde outlined how
his needle and syringe programme
had adapted to the needs of this
group. The injecting equipment
and techniques are distinct from
those used by people who inject
heroin, as steroids and image-
enhancing drugs are injected into
muscle or skin (rather than a vein).
A specialised service (one
evening a week) has been mostly
promoted through word of mouth
recommendations. Black market
steroid dealers have been more
helpful in raising awareness of the
service than the staff of local gyms.
Last year in the Greater Glasgow
area, 3,339 individuals who
injected SIEDs attended a needle
exchange, in contrast to 7,670 who
inject heroin. Whereas people who
use heroin may attend several
times a week, people who use
steroids typically come in much
less frequently. They usually pick
up large quantities of equipment
to cover a cycle of steroid use
and often take material to pass
on to friends. The infrequent visits
mean that these are relatively rare
opportunities for education around
safe use.
Advice is not limited to avoiding
blood-borne viruses – many people
have limited understanding of how
the products work and what side-
effects and harms they should
expect. An important aspect of
the service is to offer blood tests
and give advice on the often
abnormal kidney, liver, cholesterol,
testosterone and oestrogen levels
that a person may have.
In Australia, Jenny Iversen said that
different states have taken different
approaches. Queensland’s policy
on needle and syringe programmes
explicitly states that people using
SIEDs are a key group that the
services must reach, with the aims
of preventing new infections and
of preventing injecting-related
injuries. Educational materials for
people using these products have
been created.
In contrast, New South Wales –
where the patterns of use of SIEDs
are very similar – has chosen to
limit the supply of equipment to
this population, judging them not
to be at sufficiently high risk of
viral infections to warrant ongoing
provision. Costs and a different
financial system to Queensland
appear to be the main reason for
the restrictions.
There is a “need for targeted harm
reduction interventions to address
the sexual health and drug use risks
among those injecting image and
performance-enhancing
drugs,”
concluded Vivian Hope of Public
Health England.
References
Cullen K et al. Risk and vulnerability
among people who inject image
and performance enhancing drugs
in England and Wales 2012–2013:
where should we focus harm
reduction? 24th International Harm
Reduction
Conference,
Kuala
Lumpur, October 2015.
Iversen J and Maher L The harm
reduction response to an increase in
people who inject performance and
image-enhancing drugs attending
needle and syringe programmes
in Australia: a tale of two states.
24th International Harm Reduction
Conference, Kuala Lumpur, October
2015.
Campbell J and Hunter C Identifying
and reducing harm for steroid and
image enhancing drugs (SIEDs)
injectors,
through
innovative
approaches. 24th International
Harm Reduction Conference, Kuala
Lumpur, October 2015.
Hope VD et al. An increase in
the prevalence of blood-borne
infections among men who inject
image and performance enhancing
drugs in the United Kingdom:
1992–2013.
24th
International
Harm Reduction Conference, Kuala
Lumpur, October 2015.
For harm reduction information
on this issue, please visit www.
ipedinfo.co.uk.
22 October 2015
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The above information is
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