Exploring the experiences of general practitioners working with patients who use performance and image enhancing drugs

Dunn, Matthew; Piatkowski, Timothy; Whiteside, Bianca; Eu, Beng

doi:10.1016/j.peh.2023.100247

Cited by 27 publications

(21 citation statements)

References 40 publications

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“…Similarly to previous studies, the most common reasons for not seeking professional help was not considering the side effects to be of treatment demanding nature [23,26,27], or the belief that physicians lacked knowledge on the topic of AAS [21][22][23]40]. As some physicians might not have adequate knowledge on AAS or routines of mapping use among their patients [23,53,54], people who use AAS tend to seek information from each other or elsewhere, in settings which is often referred to as "bro-science" in different online drug communities [55]. The bro-science culture has been perceived as a safe online environment for sharing AAS expertise, exercise and diet advice, as well as recommendations on physical and mental health self-monitoring [31,56,57].…”

Section: Discussionmentioning

confidence: 83%

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

Henriksen

Havnes

Jørstad

et al. 2023

Subst Abuse Treat Prev Policy

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Background Recreational use of anabolic-androgenic steroids (AAS) is a public health concern world-wide associated with a range of physical and psychological side effects. Still, people who use AAS tend to be reluctant to seek treatment. This study aims to explore use characteristics, treatment-seeking behaviour, side effects and associated health concerns among men with AAS use. Methods The study includes cross-sectional self-report data from 90 men with a current or previous use of AAS exceeding 12 months, where 41 (45.6%) had sought treatment at least once during their lifetime, and 49 (54.4%) had not. Health service engagement was examined with descriptive statistics on reasons for contacting health services, transparency about AAS use, satisfaction with health services and reasons for not seeking treatment. Furthermore, experienced side effects and health concerns were compared between the treatment seeking and the non-treatment seeking group, using two-sample t-tests and Chi2 or Fisher exact tests for numerical and categorical variables, respectively. Results All 90 AAS-using men reported side effects from AAS use. Treatment seekers were significantly younger, experienced more side effects including gynecomastia, excessive sweating, fatigue, depression and anxiety, and expressed more concern for testosterone deficiency. Preventive health check-up was the most common reason for seeking treatment (n = 22, 53.7%), and 38 men (93%) were transparent about AAS use during consultations with health professionals. The main reported reasons for not seeking healthcare services were that the experienced side effects were not considered to be of treatment demanding nature (n = 39, 79.6%) and the belief that healthcare providers had scarce knowledge about AAS use and its health impacts (n = 12, 24.5%). Conclusions Reluctance to seek treatment among people who use AAS, despite having associated side effects and health concerns, may contribute to continued health risks. It is important to fill the knowledge gap on how to reach and treat this new patient group, and policy makers and treatment providers need to be educated on how to meet their treatment needs.

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Section: Discussionmentioning

confidence: 83%

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

Henriksen

Havnes

Jørstad

et al. 2023

Subst Abuse Treat Prev Policy

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“…Notably, numerous healthcare practitioners participate in delivering healthcare to illicit drug users, yet there exists substantiated evidence indicating that certain professionals exhibit stigmatising attitudes (Butler & Sheridan, 2010). In Australian samples, healthcare professionals operating within general healthcare contexts perceive the provision of care to individuals with drug and alcohol-related issues as a challenging and disagreeable endeavour (Happell & Taylor, 2001; Pinikahana et al, 2002), and this attitude extends to those who use AAS (Dunn et al, 2023; Jacka et al, 2020). Upon drawing these data together with existing work, the challenging nature was echoed in the present data, often framed as an element of “fear” expressed by healthcare providers.…”

Section: Discussionmentioning

confidence: 99%

“…As components of larger research projects (Dunn, Piatkowski, Lamon, et al, 2023; Dunn, Piatkowski, Whiteside, et al, 2023; Piatkowski, Hides, et al, 2022; Piatkowski, Lamon, et al, 2023; Piatkowski, Neumann, et al, 2023), a series of semi-structured interviews were performed with several subsamples of individuals regarding AAS, including users and healthcare providers. The present study draws on a subset ( N = 24) of these.…”

Section: Methodsmentioning

confidence: 99%

“…Instead, this approach has failed to effectively deter AAS use but has intensified the seriousness of the AAS consumption experience and associated risks. First, we contend that it has impeded access to essential medical services and information by discouraging both users and healthcare professionals from engaging in discussions about AAS use (Dunn, Piatkowski, et al, 2023; Piatkowski, Hides, et al, 2022). Specifically, the criminalisation of AAS may have contributed to this therapeutic barrier (Piatkowski et al, 2022) by creating an atmosphere of stigma and fear among healthcare professionals.…”

Section: Introductionmentioning

confidence: 99%

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Beyond the law: Exploring the impact of criminalising anabolic–androgenic steroid use on help-seeking and health outcomes in Australia

Piatkowski,

Gibbs,

Dunn

2023

Journal of Criminology

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This study aimed to investigate how Anabolic–Androgenic Steroid (AAS) users and healthcare professionals perceive the criminalisation of AAS on users’ ability to seek help and, ultimately, what effect this has on the health outcomes for these consumers. This study triangulated the views ( N = 24) of male ( n = 8) and female ( n = 7) AAS users ( Mage = 35.4, SD = 9.1), as well as healthcare providers ( n = 9), regarding how the criminalisation of AAS had an impact on consumers’ health behaviours and help-seeking. Data were analysed thematically. An overarching narrative was developed regarding the “politicogenic drug effects” which emerge from the illegality of AAS with three overarching themes. First, participants expressed challenges in seeking help and support due to the stigma and fear associated with the illegal nature of AAS use. This fear stemmed from the criminalisation of AAS and the potential legal consequences. Participants also highlighted the social challenges and the need for secrecy surrounding AAS use, which further hindered open discussions and engagement with healthcare providers. The cohort emphasised the close-knit social networks among AAS users, offering support and shared experiences but also entangled in the criminality associated with AAS use. Moreover, participants acknowledged the difficulties in promoting harm reduction initiatives due to the need for secrecy and the potential social and economic disadvantages. The escalation of AAS criminalisation that has impacted both consumers and healthcare professionals has exacerbated the challenges associated with their interaction, further impeding a relationship already fraught with obstacles. Consequently, users remain entrenched within the illicit market, with few options for harm reduction intervention. The study advocates for a rethinking of AAS policies, considering a potential reclassification aligned with the United Kingdom's Class C framework to destigmatise use and promote harm reduction. This shift would require comprehensive research to assess its impact on public health, user behaviour, and harm reduction outcomes.

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“…The prominence of health professionals in the identified cases may be due to the regulatory oversight that exists for these professionals when prescribing and dispensing scheduled substances. In one study with general practitioners in Australia who work with PIED consumers [22], participants discussed the balance between healthcare delivery and establishing and maintaining rapport on the other hand, with ethical‐legal issues on the other; the possibility of being summoned by the medical board loomed over the decisions these participants made.…”

Section: Discussionmentioning

confidence: 99%

Investigating the methods and characteristics of the trafficking of performance and image enhancing drugs in Australia

Dunn,

Bright,

Fletcher

2023

Drug and Alcohol Review

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IntroductionUsing case law, the aims of this study were to document the methods for trafficking of performance and image‐enhancing drugs (PIED) into Australia, and the characteristics of individuals and groups involved.MethodsData was collected from judges' sentencing comments. Searches were conducted using the Australasian Legal Information Institute database across all states in Australia, for the period of January 2010 to December 2021. After removing duplicates and cases which did not meet the inclusion criteria, 31 cases were included in the analysis.ResultsAcross the 31 cases, 37 individuals were named as being involved in the supply and/or trafficking of PIEDs, with three cases involving an unknown number of individuals. One case named four actors involved in the supply and/or trafficking of PIEDs, three cases involved three actors, four cases involved two actors and 17 cases involved one actor. In 20 of the 31 cases, individuals operated alone. Over half (19 of the 37) of the individuals were health professionals. The majority (n = 17) of cases involved prescription as the method of acquisition, while seven cases involved the importation of PIEDs.Discussion and ConclusionThe small number of cases identified, with the majority involving only a single actor, and half of the cases involving those in the medical profession. The findings suggest that discrete occurrences of trafficking involves individuals or small groups that do not appear to be linked to large‐scale networks or networks involving the supply and trafficking of other illicit substances.

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Exploring the experiences of general practitioners working with patients who use performance and image enhancing drugs

Cited by 27 publications

References 40 publications

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

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

Beyond the law: Exploring the impact of criminalising anabolic–androgenic steroid use on help-seeking and health outcomes in Australia

Investigating the methods and characteristics of the trafficking of performance and image enhancing drugs in Australia

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