Support for people who use Anabolic Androgenic Steroids: A Systematic Scoping Review into what they want and what they access

BACKGROUND

Since there is a paucity of research on support for people using Anabolic Androgenic Steroids (AAS), we aimed to identify and synthesise the available evidence in this field. Gaining an understanding of the support both accessed and wanted by recreational AAS users will be of use to professionals who provide services to intravenous substance users and also to those working in the fields of public health and social care, with the aim to increase engagement of those using AAS.

METHODS

A systematic scoping review of the literature to explore and identify the nature and scope of information and support both accessed and wanted by non-prescribed AAS users. Any support services or information designed to help people who use AAS were considered.

RESULTS

We identified 23 papers and one report for review, which indicated that AAS users access a range of sources of information on: how to inject, substance effectiveness, dosages and side effects, suggesting this is the type of information users want. AAS users sought support from a range of sources including medical professionals, needle and syringe programmes, friends, dealers, and via the internet, suggesting that, different sources were used dependent on the information or support sought.

DISCUSSION

AAS users tended to prefer peer advice and support over that of professionals, and access information online via specialist forums, reflecting the stigma that is experienced by AAS users. These tendencies can act as barriers to accessing services provided by professionals.

CONCLUSIONS

Support needs to be specific and targeted towards AAS users. Sensitivity to their perceptions of their drug-use and the associated stigma of being classified in the same sub-set as other illicit drug users is relevant to facilitating successful engagement.

Contaminação de suplementos dietéticos usados para prática esportiva: uma revisão de literatura

O objetivo do presente estudo foi revisar a literatura que trata da contaminação dos suplementos alimentares por substâncias consideradas nocivas à saúde ou doping para os atletas. Para tanto, foram revisados artigos científicos indexados nas bases de dados Medline e Scielo. Foi possível observar que algumas investigações detectaram doses excessivas de ingredientes potencialmente tóxicos, não indicados no rótulo e considerados doping. Entre as substâncias proibidas encontradas em alguns suplementos estão os esteróides anabólico-androgênicos e os psicoestimulantes. Neste sentido, é possível alegar que o uso de suplementos dietéticos por praticantes de atividades físico-esportivas, competitivas ou não, carece de maior segurança e deve ser realizado com muito critério.

Structural characteristics of anabolic androgenic steroids contributing to binding to the androgen receptor and to their anabolic and androgenic activities. Applied modifications in the steroidal structure

Anabolic androgenic steroids (AAS) are synthetic derivatives of testosterone introduced for therapeutic purposes providing enhanced anabolic potency with reduced androgenic effects. Androgens mediate their action through their binding to the androgen receptor (AR) which is mainly expressed in androgen target tissues, such as the prostate, skeletal muscle, liver and central nervous system. This paper reviews some of the wide spectrum of testosterone and synthetic AAS structure modifications related to the intended enhancement in anabolic activity. The structural features of steroids necessary for effective binding to the AR and those which contribute to the stipulation of the androgenic and anabolic activities are also presented.

Ventricular tachycardia induced by abuse of ephedrine in a young healthy woman

INTRODUCTION

Ephedrine or ephedra herbal products have occasionally been used to enhance sports performance and energy or to aid weight loss. The most serious side effects are those on cardiovascular function, including acute myocardial infarction, severe hypertension, myocarditis and lethal cardiac arrhythmias.

CASE REPORT

A 19-year-old woman was taking ephedrine to enhance her sports performance. After 10 days of this medication she developed hemodynamically unstable ventricular tachycardia resistant to cardioversion and amiodarone treatment. She converted to sinus rhythm 60 hours later, presumably when the plasma ephedrine level had sufficiently decreased. In an electrophysiological study the ventricular tachycardia could be induced and successfully ablated. There were no recurrences during follow-up of more than a year. The use of ephedrine carries a risk of development of life-threatening arrhythmias.

DISCUSSION

Ephedrine alone cannot be considered as the ultimate cause of tachycardia in our patient; however, it is highly probable that ephedrine triggered the tachycardic attack. The proarrhythmic effect most likely occurred because of underlying idiopathic left ventricular tachycardia. Although the patient could have developed her first attack of ventricular tachycardia at any time in her life, it is highly improbable that the attack following the ephedrine abuse was purely coincidental.

CONCLUSION

Our experience with the reported patient shows that ephedrine alone, or in combination with substances that increase its effects on the cardiovascular system, may also trigger paroxysms of non-ischemic ventricular tachycardia. The use of ephedrine carries a risk of development of life-threatening arrhythmias and should be discouraged.