A focused netnographic study exploring experiences associated with counterfeit and contaminated anabolic-androgenic steroids

Abstract

Background: A primary consequence of illicit drug markets and the absence of regulation is the variable quality or purity of the final product. Analysis of anabolic-androgenic steroid seizures shows that these products can contain adulterated products, product not included on the label, or product of unsatisfactory standard. While the potential negative effects of counterfeit anabolic-androgenic steroids (AAS) use is a recognised risk associated with use, no study has explored personal experiences associated with use. The aim of the present study was to use online discussion forums to investigate and explore the experiences associated with the purchase and consumption of counterfeit AAS among consumers. Methods: An online search was conducted to identify online forums that discussed counterfeit or contaminated AAS; three were deemed suitable for the study. The primary source of data for this study was the 'threads' from these online forums, identified using search terms including 'counterfeit', 'tampered', and 'fake'. Threads were thematically analysed for overall content, leading to the identification of themes. Results: Data from 134 threads (2743 posts from 875 unique avatars) was included. Two main themes were identified from the analysis: (1) experiences with counterfeit product and (2) harms and benefits associated with counterfeit product. Conclusions: The use of counterfeit or contaminated substances represents a public health concern. Those who report using performance and image enhancing drugs such as AAS for non-medical purposes report consuming these substances and experiencing harm as a result. Consumers take steps to limit coming into contact with counterfeit or contaminated product, though recognise that many of these have limitations. The implementation of accessible drug safety checking services may provide an opportunity to provide consumers with information to assist them with making healthier choices.

Health service engagement, side effects and concerns among men with anabolic-androgenic steroid use: a cross-sectional Norwegian study

“…In addition, physicians are also often unwilling to prescribe such treatment, not only due to the lack of research on the area but also to AAS' illegal status in the country [62]. However, non-prescribed PCT is common among people who use AAS [39,63], and they seek information online and among peers [29,[32][33][34]. This might be part of the reason why so few seek health services due to ASIH following AAS cessation.…”

“…Other reasons include concerns about stigma [25] or that the problem is not significant enough to seek help [21,[26][27][28]. Many prefer to seek information from peers [29,30] and online sources [31][32][33] on how to avoid and handle side effects [34]. However, in Norway, an anonymous national information service on AAS use, its side effects and the treatment options available, have been helpful for some [35].…”

Fake anabolic androgenic steroids on the black market – a systematic review and meta-analysis on qualitative and quantitative analytical results found within the literature

“…There is a considerable need for programs addressing harm reduction, prevention, and treatment among the AAS user community. Those who report using AAS and other IPEDs for non-medical purposes are aware of the problem with counterfeit drugs and possible health consequences associated with it, and take steps to limit coming into contact with these products [ 73 ]. Unfortunately, there are currently major limitations in identifying these fraudulent products by users and such services may become a cornerstone in accessing this hard-to-access user population [ 73 ].…”

“…Those who report using AAS and other IPEDs for non-medical purposes are aware of the problem with counterfeit drugs and possible health consequences associated with it, and take steps to limit coming into contact with these products [ 73 ]. Unfortunately, there are currently major limitations in identifying these fraudulent products by users and such services may become a cornerstone in accessing this hard-to-access user population [ 73 ]. These harm reduction interventions may be especially effective in this user population as these drugs are used for an average of 20 weeks [ 6 ], compared to recreational illicit drug use that is often only used sporadically.…”

Harm reduction strategies for androgen users: providing appropriate support and improving engagement with healthcare

“…They suggest that, contrary to what is commonly provided, harm reduction should go beyond reducing harms related to BBVs and wider injecting issues, and provide information addressing a wide range of practices and concerns [2 ▪ –5 ▪ ]. Beyond advice and information, additional types of interventions may include substance testing [3 ▪ ,6 ▪ ], psychosocial interventions [3 ▪ ,7 ▪ ] and blood tests that show the physiological impacts of androgen use [8 ▪▪ ,9 ▪▪ ]. Such approaches are suggested to not only help reduce harm through influencing decision-making and improving understanding, but may improve the attractiveness for users of engaging with health services that offer them.…”