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Gym users and abuse of prescription drugs
Julien Baker, Michael Graham, Bruce Davies
Health and Exercise Research Unit, University of Glamorgan, Pontypridd,
South Wales UK
Journal of the Royal Society of Medicine, vol 99, july 2006, 331-332.
Anabolic steroids are synthetic derivatives of naturally
occurring testosterone. According to surveys and media
reports, androgenic anabolic steroid use is widespread.[1]
In 1991, data from the National Household Survey on
Drug Abuse indicated that there were more than one
million users in the USA.[2] Steroids became controlled
drugs in America in 1990 and in the UK in 1996, but
the most recent data suggest that their use has
increased.[3,4]
Current estimates indicate that there are as many as
three million steroid users in the USA and that
2.7%–2.9% of young American adults have taken them at
least once in their lives.[5] Surveys in the American field
indicate that use among community weight trainers
attending gyms and health clubs is 15%–30%.[4] In the
UK, the majority of use was by non-competitive
recreational bodybuilders or non-athletes, who use these
drugs for cosmetic purposes.[1]
Self-image in obesity, as a consequence of media
attention focusing on clinical and public health implications,
leads us to comment on a number of possible explanations
for the progressive increases observed. The prevalence of
abuse of certain prescription medicines amongst health-club
attendees has dramatically increased in the UK. The nontherapeutic
use of such medicines was previously considered
to be restricted to the professional athlete or recreational
bodybuilder. As a consequence of the internet revolution,
steroid abuse is becoming challenged by the more expensive
designer drugs, particularly growth hormone.
The first nation-wide survey for steroid abuse in the UK
surveyed 21 gyms throughout Britain, and found that 8% of
respondents admitted having taken them at some time: 5%
of these were current users; 9.1% were men; and 2.3%
were women.[6] A survey of 100 steroid abusing athletes
conducted in three South Wales counties,[7] reported high
rates of polypharmacy (80%). In addition to an increase in
abuse, 20% reported needle sharing utilizing hazardous
injection techniques, which included injection site pain, and
the reusing of needles.[8] Steroid abuse has continued,
despite the advertising campaigns by successive governments,
highlighting the risks of contracting serious diseases
such as HIV, hepatitis B and C.
Bodybuilders have been described as suffering from an
altered perception of body image, leading to psychopathology.
[9] Bulimia nervosa is an eating disorder characterized by
eating binges, vomiting, laxative and/or diuretic abuse and
prolonged fasting. Some patients with anorexia nervosa also
manifest bulimia. There has been a link established between
bulimia nervosa, anorexia nervosa and bodybuilding, related
to perception of body image. Unrealistic, muscular male,
and slim female body ideals, put individuals at risk for
negative body images, resulting in low esteem, unhealthy
eating and exercise habits. Some individuals resort to drugtaking
to counteract their altered body images.
Anorectics, have been publicly on trial in the USA and
surreptitiously on trial in the UK, for some time now. The
pharmaceutical manufacturing giants must demonstrate that
a drug’s benefit outweigh its risks. Expenditures by the
pharmaceutical industry for direct-to-consumer advertising
have increased dramatically from $1.8 billion in 1999, to
$4.2 billion in 2004.[10] What are the chances of the medical
profession adhering to its maxim 'first do no harm', when
the source of the problem appears to have no degree of
accountability?
In 2005, in male and female health club attendees,[3] we
observed significant increases in the use of the following
drugs: diuretics (10%), thyroxine (10%), insulin (14%),
clenbuterol (21%), tamoxifen (22%), human chorionic
gonadotrophin (11%), growth hormone (24%) and
ephedrine (44%). The study indicated that steroids were
still the most abused drug. It would seem that both sexes
are at risk, with 7% of users being female.
Clenbuterol,
ephedrine and thyroxine, abused by bodybuilders as a
training stimulant and to increase metabolic rate and induce
lipolysis, were associated with palpitations and caused
extrasystoles, during functional exercise electrocardiography.
Their use had increased by 3%, 2% and 6%,
respectively.
Insulin, abused by bodybuilders to increase
total body mass, had increased by 14%. This accounted for
several individuals suffering from hypoglycaemia in bodybuilding
competitions, resulting in emergency rehabilitation
with glucose drinks. One such subject confessed to taking
70 international units of insulin, under the presupposition
that he was taking 7 IU, on two separate occasions, 1 week
apart, and suffered the consequences.
Tamoxifen, abused by bodybuilders to prevent
gynaecomastia had increased by 10%.
Human chorionic
gonadotrophin, abused by bodybuilders to stimulate the
testes, when withdrawing from their exogenous androgens,
was the only drug to have decreased and had diminished by
4%.
Diuretics, abused by bodybuilders to counteract the
adverse water retention of both steroids and growth
hormone, had increased by 6% and had accounted for
several bodybuilders suffering severe muscle cramps and
collapsing on stage in competitions.
Growth hormone,
abused by bodybuilders to induce lipolysis and in the belief
that it enhances muscle mass and strength, had increased by
18%: it accounted for less severe side effects, such as
muscle weakness, carpal tunnel syndrome, water retention
and headaches.
The results of our survey corroborate the research
undertaken in the USA, which demonstrated several trends
in the non-medical use of androgenic anabolic steroids. The
recent results of this American survey[4] reveal several trends
in the non-medical use of steroids. Nearly four out of five
users are non-athletes who take these drugs with the sole
intention of improving physical appearance.
Steroid users
are taking larger doses than previously recorded, with more
than half the respondents using a weekly dose in excess of
1000 mg. Close to 100% of steroid users surveyed admitted
to self-administering by intramuscular injection, with
approximately 1 in 10 users reporting hazardous injection
techniques. An 89% majority of users obtain drugs from
aberrant sources, with more than 50% admitting to the use
of drugs manufactured in back-street laboratories.
Polypharmacy
is practised by more than 95% of steroid users
surveyed. One in four users takes growth hormone and
insulin, suggesting that the use of adjuvant anabolic agents is
rising. Nearly 100% of steroid users experience subjective
side effects suggesting that concern over health risks does
not influence the patterns of drug use.
Awareness of the psychological reasons for use is the
first step in an attempt to providing the counselling and
then appropriate medical treatment required.
References
1 Lister S, McGrory D. Quest for the body beautiful that can cause
serious harm. The Times 3 May 2005
2 Yesalis CE, Kennedy NJ, Kopstein AN, et al. Anabolic–androgenic
steroid use in the United States. JAMA 1993;270:1217–21
3 Baker JS, Graham M, Davies B. Steroid and prescription medicine
abuse in the health and fitness community; a regional study. Eur J Inter
Med 2006 (in press)
4 Parkinson AB, Evans NA. Anabolic androgenic steroids: a survey of
500 users. Med Sci Sports Exerc 2006;38:644–51
5 National Institute on Drug Abuse. About anabolic steroid abuse. NIDA
Notes 2000;15:15
6 Korkia P, Stimson GV. Anabolic Steroid Use In Great Britain: An
Exploratory Investigation. London: The Centre for Research on Drugs
and Health Behaviour, 1993
7 Evans N. Gym and tonic: a profile of 100 male steroid users. Br J Sports
Med 1997;31:54–8
8 Grace FM. Baker JS, Davies B. Anabolic androgenic steroid (AAS) use
in recreational gym users—a regional sample of the Mid-Glamorgan
area. J Sub Use 2001;6:189–95
9 Pope H, Phillips K, Olivardia R. The Adonis Complex—The Secret Crisis
Of Male Body Obsession. New York: The Free Press, 2000: 11
10 R &D spending. In: Integrated Promotional Services and CMR. Fairfield:
IMS Health, 2004
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[Definitie:] "An ergogenic aid is any substance or phenomenon that enhances performance."
(Wilmore and Costill) 
