The popular image of the use of doping substances remains focused on sports people and on use in gyms. Increasingly, concern is being expressed that the use of doping substances may be gaining popularity in other settings. Some studies have suggested that homosexual men and young fashion-conscious individuals may be encouraged to use these substances for cosmetic purposes (Korkia and Stimson, 1993).
Commenting on the health risks associated with doping substances is problematic, although I will attempt this in the next chapter. Very few good epidemiological data exist. The range of health effects associated with AS use range from cosmetic changes to more serious and potentially life-threatening conditions. There is therefore an urgent need to identify what is known about the risk of health consequences resulting from the use of
doping substances. Such information is of paramount importance in the design of educational material and for ensuring that interventions effectively target high-risk behaviours.
Considerable concern exists about the risks associated with the injection of AS and associated drugs. The context in which injections occur is likely to influence both the risks associated with the behaviour and the public health interventions that are likely to be appropriate (Best and Midgely, 1999).
One of the main observations that can be made from a review of the literature (Haupt and Rovere, 1984; Brower et al., 1994; Yesalis and Cowart, 1998) on the use of AS is how poorly understood are both the social implications and the epidemiology in comparison with other forms of drug consumption (Shapiro, 1992).
This is a concern because the prevalence of use of doping substances and involvement in illicit drug supply is found among certain groups such as night-club security staff and this may represent an opportunity for crossover between the growing illicit drugs market and the market for AS (Maycock, 1999). The patterns of use are often complex, involving multiple substances taken in sophisticated regimes. It is also important to realise that the use of these drugs does not necessarily carry with it the same negative connotations
and social stereotypes as the use of other illicit substances. It also remains unclear what will be the most effective strategies for reducing the use of these drugs or reducing the associated harms.
Anabolic steroid use can be viewed as a public policy issue. Public policy making is commonly depicted in terms of a natural logical sequence. From this perspective information about a troubling social issue is highlighted and then documented. It then becomes the role of public policy makers to assess the problem and its causes and to respond to the problem using policy tools such as initiating or adapting laws to deal with the issue. They would then continue to respond to the issue until it was alleviated. This is called the ‘rationality perspective’ and is the type of process that the public would expect to be in place to deal with social and health problems such as AS misuse (Rochfort and Cobb, 1994).
However, this somewhat simplistic approach does not appear to be mirrored in reality. Dery (1984) states that problems do not simply exist, they are not ‘objective entities in their own right’. Rational decision making rarely exists in reality. However, the model remains important as it allows researchers to identify barriers to rational decision making. It is often factors other than the objective conditions that are responsible for an issue’s place in the policy makers’ hierarchy. These factors will include the intensity of the issue,
advocacy and the relevance of competing issues. How does this apply to the issue of AS use?
Traditionally, the use of performance-enhancing drugs (PEDs) has been seen as an issue affecting sport alone. Its depiction in the media generally revolves around major sporting events such as the Olympic games or occasions when sportspeople have tested positive for a banned substance. These flurries of media coverage rarely address the social impact of AS use or the health risks to the wider population. The issue of PEDs, therefore, remains firmly focused within a sporting context in the public consciousness.
There are many perceptions of any particular problem and its place in the public consciousness (Peters and Marshall, 1993). It is only relatively recently that ‘problem definition’ has been studied as a means of trying to pull together all of the threads that have an impact on issue identification and policy formulation. Decision makers do not see problems in isolation but in a policy context. This involves a number of policies on related issues. The perceived problems may have generated a continually changing set of policies that have evolved over a period of time. In the case of AS and related substances, it is firmly placed in the context of existing drug policy. Therefore, any investigation into the position of AS in a policy context must also look at how it fits into present-day drug policy.
It is difficult to place AS within the UK’s drug policy agenda. This is partly because in the early part of the 1990s drug policy was dominated by reducing or preventing the spread of viral infections, such as HIV, by intravenous drug injectors (Advisory Council on the Misuse of Drugs (ACMD), 1988, 1989, 1993). Anabolic steroids did not feature prominently because little research had been done on the extent of AS use and the fact that AS is not injected intravenously. However, some commentators were able to foresee
problems related to the transmission of viral infections connected with AS use (Scott and Scott, 1989; Nemechek, 1991). In the latter part of the 1990s drug policy became driven by crime and criminality (Stimson, 2000). Although there has been an association made between AS use and violence (Choi et al., 1990; Schulte et al., 1993), no research has as yet identified an association with AS use and acquisitive crime. The use of AS has therefore
not appeared to rate a high position in the current drug policy agenda.
The only attempt by central government to address the issue of the use of AS and other performance-enhancing drugs was the change in the legal status in 1996. There are concerns that the laws could have pushed AS use further underground. Since the legislation was introduced there does not seem to be a slow down in the number of AS users in the UK; in fact the opposite seems to be true. There have been no attempts by the government to educate users or potential users of AS about the dangers inherent in their
use or even to provide health professionals with information or guidance not only about the legislation but also about the health issues and treatment of AS users. If this has been an attempt to legislate the issue away, it has obviously failed.
It may be that in future one of the factors influencing the provision of services will be the sheer number of users and the potential for the spread of infections such as HIV. As has been described previously, the number of AS users attending needle exchanges has grown steadily over the past decade. If this trend continues, and it shows no sign of slowing down, then it may be that it is more cost-effective to provide separate services for AS users than dilute and place a strain on the existing services designed for opiate users.
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