Anabolic steroid use and use of other image- and performance-enhancing drugs on the rise – A new substance use disorder

Background
The problematic use of anabolic androgenic steroids (AAS) and other image- and performance-enhancing drugs (IPEDs) has become a major substance use disorder. The development of a substance dependence is common among users of AAS - one out of three that begin using these substances are affected. These substances are widely used with the motivation to achieve personal image- and sports-performance goals. IPEDs comprise different groups of substances, with AAS most often used. These substances are banned by the World Anti-Doping Agency (WADA) and prohibited under the US controlled substances act. The global lifetime prevalence of AAS use is estimated to be as high as 1-5% in the general population and up to 30% among recreational gym users – predominantly males in recreational sports are affected. The problematic use of these substances should be considered a growing, and serious, risk for public health. Many factors exist that make the use of these substances an integrated part of addiction medicine, such as but not limited to complex user patterns, various motivations to use these substances, extensive poly-drug use, misinformation among users, as well as a higher risk of communicable diseases (i.e., HIV, viral hepatitis, and sexually transmitted infections). Furthermore, acute, and long-term side effects of IPED use are multiple and complex, and affect all levels of health – physical, mental, and social well-being. Most users commonly experience side effects, but only a minority of them will attend medical care – most often due to fear of stigma and perceived lack of knowledge from health care professionals. The acquisition of IPEDs most often occurs from unregulated drug markets, which leads to substantial counterfeiting of substances that can leave users at an unpredictable risk when consuming them.
MethodsIn Summer 2023, a pioneering integrated care network (pilot project) for users of AAS and other IPEDs was established in Zurich (Switzerland) in collaboration of the Arud – center for addiction medicine, the institute of primary care at the University of Zurich, as well as the drug information center in Zurich (DIZ). This network comprises of prevention, harm reduction, and therapy with the aim to improve access to care for these users. Importantly, specialized interdisciplinary medical care services as well as drug checking services for users of these substances were established.
Results
Data analysis of this pilot project is currently ongoing. Primary results from this pilot period will be outlined at Lisbon Addictions 2024.
Conclusions
The results of this pilot project will give novel insight into characteristics of users of AAS and other IPEDs, as well as support the future roll-out of care structures for these users on a larger scale and in other world regions.