Illicit Drug Use Among Gym-Goers: a Cross-sectional Study of Gym-Goers in Sweden

Association of anabolic androgenic steroid use with perimortem polypharmacy, antemortem prescription drug use, and utilization of health care services - A Finnish triple register study of forensic autopsy cases

Anabolic androgenic steroid (AAS) use has previously been associated with complex polysubstance use that may increase morbidity and mortality among these individuals. In this study we aimed to further describe the features of perimortem polysubstance use, antemortem central nervous system (CNS) drug use and health care service utilization of AAS using males that suffer premature death. The main sample included all cases that were screened for AAS in connection with forensic autopsy between 2016-2019 and tested positive (n = 16). The control samples included autopsy cases that were screened for AAS but tested negative (n = 30) and randomly selected, age and sex matched autopsy cases not suspected of having used AAS but were otherwise fully toxicologically investigated (n = 43). Postmortem toxicological results were used for perimortem polysubstance use prevalence and severity estimation. Antemortem CNS drug use was calculated from a national register of reimbursed prescription medicines, and health care utilization from public health care registers, covering the last five years of life. Perimortem polysubstance use was prevalent in all groups, but the AAS positive had a tendency for greater CNS drug polypharmacy and the highest number of antemortem CNS drug purchases during the last five years of life, with a median of 14.5 purchases/person, vs. 1/person in the AAS negative and 0/person in the random group (Kruskal-Wallis H test, p < .001). Yearly medical contacts increased in all groups as death approached. Our findings suggest that prescription CNS drug use may play a significant role in polysubstance use disorders of AAS using males that suffer premature death.

Police officers' perspective on doping and prevention among recreational athletes: a cross-sectional study

Introduction

The use of anabolic androgenic steroids among recreational athletes has received growing attention in recent decades. Several countries have implemented bans on doping; however, recreational athletes and other subpopulations continue to use doping substances. Recognizing that the police play a crucial role in preventing the use and dealing of doping substances in Sweden, efforts have been made to intensify police interventions and enhance collaboration with other key actors. This study examined police officers' perceptions of doping as defined in Swedish law, related problems, and suggestions for effective prevention of doping in the society.

Methods

A cross-sectional survey study was conducted using a web survey of police officers (N = 597). Data were analyzed using descriptive statistics and free-form text responses were analyzed using content analysis.

Results

Participant responses to the survey (73.7% response rate) indicated that approximately 62.6% thought that doping is a societal problem, and approximately 26% perceived that the availability of doping substances has increased over the past three years. A total of 95.6% of respondents believed that doping occurred in connection with other crimes such as intimate partner violence (88.2%) and drug-related crimes (88.0%). Further, 96.3% of respondents perceived that it was their duty to prevent doping, but 63.8% indicated that doping-related work was not prioritized within their local police district.

Discussion

Police officers perceived doping as a societal problem and expressed motivation to counteract it, highlighting increased knowledge, legislative changes, intensified doping prevention in gyms, and commitment from other societal actors to increase the effectiveness of doping prevention. Suggestions for increasing the efficiency of doping prevention included education and increased knowledge at all levels in the police organization, intensified prevention efforts at gyms, legislative changes to permit simplified doping test procedures, and breach of secrecy for postal items. There was also a suggestion for further engagement from other actors, such as healthcare workers, school officials, and non-governmental organizations.

Female doping: observations from a data lake study in the Hospital District of Helsinki and Uusimaa, Finland

BACKGROUND

Doping is a well-recognized risk factor for several potentially severe health effects. Scientific literature concerning the need for medical treatment for such adversities is still sparse. This is especially true for women, due to lower doping use prevalence compared to men. Our study explored the nature of medical contacts and deviance in red blood cell parameters of female patients with doping use in Finnish specialized health care.

METHODS

This was a retrospective register study. The study sample was gathered from the Hospital District of Helsinki and Uusimaa, Finland (HUS) Datalake. An exhaustive search for doping related terms was performed to find patients with doping use documentation within free-text patient records. Medical record data was supplemented with laboratory data and medical diagnoses covering a total observation time of two decades. Statistical analysis included Fisher's Exact Test and one-way ANOVA.

RESULTS

We found 39 female patients with history of doping use and specialized health care contacts in the HUS-area between 2002-2020. At initial contact (i.e., the first documentation of doping use), the mean age of these patients was 33.6 years (min 18.1, max 63.5, SD 10.6). The most frequently used doping agents were anabolic androgenic steroids (AAS). The initial contacts were significantly more often acute in nature among patients with active doping use than among patients with only previous use (no use within one year; p = 0.002). Psychiatric and substance use disorder (SUD) morbidity was high (46.2% and 30.8%, respectively). Eight patients (20.5%) had received specialized health care for acute poisoning with alcohol or drugs, and nine (23.1%) for bacterial skin infections. Less than 45% of patients with active AAS use presented with off-range red blood cell parameters.

CONCLUSIONS

Our findings suggest that female patients with a history of doping use encountered in specialized health care may exhibit high psychiatric and SUD related morbidity. Also, majority of patients with AAS use had red blood cell parameters within-range. Further studies are required to assess the generalizability of these findings to patients within primary health care services, and to determine the usefulness of hematological parameters as indicators of AAS use in female patients.

Facilitators and barriers in preventing doping among recreational athletes: A qualitative interview study among police officers

Background

Doping is a societal problem associated with health problems, violence, and other crimes, especially when combined with alcohol and drugs. Elite, as well as recreational athletes who exercise in gyms may use doping to enhance their performance and/or improve their appearance. According to Swedish law, manufacturing, selling, supplying, possessing, and using anabolic androgenic steroids and growth hormones is forbidden. Exceptions apply if these substances are used for medical purposes and prescribed by doctors. As doping is illegal, the police authority is vital in counteracting doping.

Aim

We aimed to identify facilitators and barriers to effective doping prevention at gyms by examining police officers' views on doping as a societal problem, their experiences of doping prevention efforts, and their perceptions on what enables or hinders doping prevention.

Methods

Interviews with police officers (n = 15) were conducted from December 2021 to May 2022. The interviews were recorded and transcribed verbatim. A targeted content analysis of the material was performed.

Results

Facilitators for effective doping prevention involving the police included the recognition of doping as a societal problem; mobilization of key actors; motivated police management and officers; adequate resource allocation; collaboration between the police, gyms, and other relevant authorities; and skills development for police and other professions. Barriers to effective doping prevention included a lack of knowledge about doping, time-consuming processes around the detection and collection of evidence in doping offenses, and competing tasks for police officers.

Conclusion

Doping prevention should become more efficient by taking advantage of existing facilitators and removing remaining barriers. This study could guide recommendations linked to the police organization and the surrounding society regarding doping prevention.

Refined Analysis of a Cross-Sectional Doping Survey Among Recreational Triathletes: Support for the Nutritional Supplement Gateway Hypothesis

Introduction: The current literature provides no consensus that nutritional supplements (NS) may provide a gateway to doping. In particular, studies in recreational athletes are lacking. Within a previous cross-sectional empirical study, our group provided first evidence that the use of NS may provide a gateway for the use of doping substances in recreational triathletes. For the present paper, we refine the analysis of the triathletes’ survey in order to provide evidence for a NS gateway hypothesis in recreational athletes.

Methods: A self-report, paper-and-pencil questionnaire was distributed to a sample of 2,997 competitive ironman and half-ironman (n = 1,076; 36.1%) triathletes. The randomized response technique (RRT) was used to assess the 12-month prevalence estimate for the use of doping substances. The prevalence for the use of NS was assessed by using direct questioning. Two-tailed (α = 0.05) large-sample z-tests were performed to assess whether the estimated prevalence for the use of doping substances differs significantly between users and nonusers of NS.

Results: The 12-month prevalence estimate for the use of doping substances is significantly higher in athletes who report using NS (20.6%) compared to those who do not (11.4%; z = 2.595, p = 0.0097).

Conclusion: The present results are consistent with the hypothesis that the use of NS provides a gateway to the use of doping substances. Therefore, doping prevention concepts should not primarily focus on preventing the use of doping substances per se, but should start one step earlier, namely by the use of NS.

Anabolic androgenic steroid abuse in the United Kingdom: An update

Anabolic androgenic steroids (AASs) are prescribed for medical conditions related to low testosterone. Abuse of AASs has surged as they become recognised as potent image enhancement drugs. The primary goal of most abusers is to obtain a more attractive outward appearance. Abuse is complex. There are a vast range of AAS substances illegally available, the nature of their true composition is difficult to evaluate. Users follow dosing patterns which incorporate a number of different AASs, in addition to other pharmaceutical substances believed to complement the desired physical effects or manage unwanted effects. Animal work and medical case reports suggest potential to cause serious hepatotoxicity, plus possible neurotoxicity, nephrotoxicity and damage to the cardiovascular and reproductive systems. As the long-term AASs users reach maturity, further controlled experimentation, with larger sample sizes, is required. Data gathering should be directed towards the most vulnerable group of AAS users, females and adolescent boys.

Determinants of the Intention to Use Performance-Enhancing Substances Among Portuguese Gym Users

The purpose of this study is to examine the determinants of the intentions to use prohibited performance-enhancing substances (PES) and to test the Theory of Planned Behavior's usefulness in predicting self-reported PES use in both genders. A convenience sample of Portuguese gym users (n = 453) completed an anonymous web-based survey. Structural equation modeling, multigroup analysis, and t-test with the Welch correction for heterokedastic variances were used. At the structural level, results support attitudes, beliefs, and subjective norms in predicting intentions to PES use in gym users, with subjective norms being its strongest predictor. Moreover, results showed a significant association between self-reported PES use and intentions to use. The predictive model was invariant across genders; however, compared to males, females believed less in the performance-enhancing effects of PES, were less prone to the influence of significant others, and had weaker intentions to use these substances. Psychological strategies should be based on subjective norms, alongside beliefs and attitudes, toward PES use as these variables influence the intention to use PES in this particular population.

Prevalence of Performance-Enhancing Substance Use and Associated Factors among Portuguese Gym/Fitness Users

Background: Nowadays, doping is not confined to elite sport, it is also spread throughout gymnasia and fitness centers, and it is seen as a public health concern. Studies focusing on performance-enhancing substances (PES) use among gym users are few and mostly concern the practice of bodybuilding and the use of anabolic-androgenic steroids (AAS), without providing information about social indicators to further explore why this specific population use these substances. Objectives: To investigate the extent of PES use and examine the way social indicators, exercise profile and gym modalities influence the use of these substances among a sample of gym users. Methods: Cross-sectional descriptive study, among a convenience sample of 453 Portuguese gym users, recruited directly by five institutional gyms´ email and Facebook. Data were collected via a structured web-based survey, between October and November 2017. Multiple binary logistic regression, the Chi-Square test or Monte Carlo Simulation or Fisher's Exact test were used. The odds ratios and their respective 95% confidence intervals were calculated. Results: 11,1% of gym users reported the use of prohibited PES, which varies significantly according to gender, education, exercise profile and type of practice. Gender was associated with the class of PES used. Polypharmacy was a common practice among users, increasing the risk of side-effects. Peer effect and media appear to be strikingly important in the misuse of PES. Conclusion: Results provide precise insight into the specific factors associated with PES use, which could support prevention strategies in gym/fitness context.

Physical Activity and the Development of Substance Use Disorders: Current Knowledge and Future Directions

Physical activity and exercise are positive health behaviors that have been shown to reduce the risk of physical and psychological diseases. There is a strong rationale that physical activity could be a protective factor against the development of substance use disorders (SUDs), which include some of the most common mental health conditions such as tobacco and alcohol use disorder. This review examined the epidemiological literature to describe the associations of physical activity and substance use across the lifespan. The findings indicated that physical activity is positively associated with current and future alcohol use but negatively associated with tobacco and other drug use, with the strongest support originating from adolescent and young adult samples. Considerably less data exist on physical activity and other drug use in later life. Limitations in previous studies, such as the indeterminate measurement of physical activity and absence of clinical substance use disorder endpoints, should be addressed in future investigations to provide clarity regarding the strength and directions of these relationships among different substances and populations.

Defining the Construct of Synthetic Androgen Intoxication: An Application of General Brain Arousal

Synthetic androgens (i. e., anabolic-androgenic steroids) are the primary component to the majority of problematic appearance and performance enhancing drug (APED) use. Despite evidence that these substances are associated with increased risk for aggression, violence, body image disturbances, and polypharmacy and can develop a pattern of chronic use consistent with drug dependence, there are no formal definitions of androgen intoxication. Consequently, the purpose of this paper is to establish a testable theory of androgen intoxication. We present evidence and theorize that synthetic androgen intoxication can be defined by a pattern of poor self-regulation characterized by increased propensity for a range of behaviors (e.g., aggression, sex, drug seeking, exercise, etc.) via androgen mediated effects on general brain arousal. This theory posits that androgens reduce threshold for emotional reactivity, motor response, and alertness to sensory stimuli and disrupt inhibitory control over the behaviors associated with synthetic androgen use. These changes result from alteration to basic neurocircuitry that amplifies limbic activation and reduces top-down cortical control. The implications for this definition are to inform APED specific hypotheses about the behavioral and psychological effects of APED use and provide a basis for establishing clinical, legal, and public health guidelines to address the use and misuse of these substances.

Being in control? A thematic content analysis of 14 in-depth interviews with 2,4-dinitrophenol users

BACKGROUND

2,4-Dinitrophenol (2,4-DNP) is a compound with multiple industrial purposes. Currently unlicensed for human consumption, it is used by the gym-going population for drastic, short-term body fat loss. Nonetheless, physiological mechanisms can lead to potentially fatal hyperthermia. Reported fatal incidents have caused concern and highlighted the need for intervention. Understanding decision-making leading to 2,4-DNP use alongside the perceived outgroup attitudes is vital to forming effective harm minimisation policies targeting current and potential users. First-hand accounts from this elusive population are scarce.

METHODS

Fourteen novel and experienced users (13 male, 1 female) were recruited via "snowballing" techniques. Semi-structured interviews were conducted, comprising 28 questions. Thematic content analysis was conducted using 37 codes.

RESULTS

Four characteristic themes emerged: 1. Users considered the Internet to be a crucial multifunctional resource directly impacting their 2,4-DNP use. 2. Users "respected" 2,4-DNP, proactively taking harm reduction measures. 3. Attitudinal polarisation towards 2,4-DNP within the gym-going community was consistent in all accounts. 4. Users perceived outgroup populations to have inherently negative attitudes towards their use. These themes fell under the all-encompassing theme of "being in control".

CONCLUSION

For the first time, this study offers a rich detail of attitudes toward 2,4-DNP use by giving a collective voice to users. The element of control over every aspect of the users' life appears to be a significant contributor to the successful risk-management of 2,4-DNP use. In the absence of an established safe upper limit and effective regulatory control, education is critical to harm minimisation.