Anabolic androgenic steroid use population size estimation: a first stage study utilising a Delphi exercise

Wednesday, 23 November, 2022 - 15:00 to 16:30


Harms associated with anabolic androgenic steroids (AAS) use are well-established and a public health concern. Robust estimates of the numbers using AAS are needed to inform responses, however, in most countries these are not available. Due to the comparative rarity and associated stigma, general population surveys are problematic and data availability limits the use of indirect approaches. To address this, the Delphi method was used to refine the parameters needed for indirect estimation from data on attendances at UK needle and syringe programmes (NSP) for AAS use.

An expert panel (n=63) was surveyed three times (n=40, 39, and 37) to refine survey and data informed parameter ranges needed for the estimation of recent AAS use from NSP data. The key parameters were, regional variations in AAS use, and the proportion of men using AAS who only use them orally, of men who inject AAS using NSP, and of the AAS using population who are women. These were then applied to available UK NSP data. Broad agreement was reached on regional variations in use (highest in North West, Yorkshire & Humber, and North East regions of England, and Wales); the proportion of men who only use AAS orally (15%-25%); the proportion of men injecting AAS using NSP (25%-40%); and the proportion of the AAS using population who are women (5%-10%). The majority of the panel thought population survey derived estimates were implausible, and favoured an estimate produced from NSP data: 335,000-763,000 people aged 15-64 years having recently used AAS in UK.

We conclude that previous general population survey-based estimates of recent AAS use appear implausible, with the likely range indicated by NSP data being up to 10-times higher. AAS use in the UK is more common than previously indicated, but further work is needed to refine population size estimation and characteristics.


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