Providing Services for Providing Services for Performance Enhancing Performance Enhancing

Drug UsersDrug Users

Ralph HeronRalph Heron

Team ManagerTeam Manager

Harm Minimisation ServiceHarm Minimisation Service

13 &14/10/0513 &14/10/05

Drugs In Sport Clinic and User Support

DISCUS

Providing Services for Performance Providing Services for Performance Enhancing Drug UsersEnhancing Drug Users

AimsAims

Side Effects of PEDSSide Effects of PEDS PEDs and Associated SubstancesPEDs and Associated Substances Overview of DISCUSOverview of DISCUS The Role of Harm MinimisationThe Role of Harm Minimisation

Is it Just SteroidsIs it Just Steroids

The issue is not just about using SteroidsThe issue is not just about using Steroids But about using a wide range of But about using a wide range of

Performance Enhancing DrugsPerformance Enhancing Drugs Steroid use gets the headlinesSteroid use gets the headlines The other substances The other substances (e.g. Insulin, Human Growth Hormone) do (e.g. Insulin, Human Growth Hormone) do

not make the headlines but are used not make the headlines but are used alongside the steroidsalongside the steroids

Body BuildersBody Builders

Body BuildersBody Builders

Body BuildersBody Builders

Body BuildersBody Builders

HistoricalHistorical

Egyptian pharaohs boil hind hooves of ass Egyptian pharaohs boil hind hooves of ass to give a sporting edgeto give a sporting edge

Roman gladiators use strychnine and wine Roman gladiators use strychnine and wine with chariot racers feeding horses with chariot racers feeding horses “mixtures” to make them run faster“mixtures” to make them run faster

Olympians using magic mushrooms in 300 Olympians using magic mushrooms in 300 b.c.b.c.

Vikings renowned for fighting in frenzied Vikings renowned for fighting in frenzied state, fuelled by magic mushroomsstate, fuelled by magic mushrooms

Legendary Knights drink magical potions Legendary Knights drink magical potions from Merlins cupfrom Merlins cup

A Win for Stanozolol!!A Win for Stanozolol!!

Whats Used?

Commonly Used OralsCommonly Used Orals

Oxandrolone - Oxandrolone - Anavar*Anavar* Testosterone Undecanoate - Testosterone Undecanoate - AndriolAndriol Methandienone - Methandienone - Dianabol*Dianabol* Methenolone - Methenolone - PrimobolanPrimobolan Stanozolol - Stanozolol - Winstrol*Winstrol*

*Denotes 17 alpha-alkylated compounds

Commonly Used I.M. A.A.SCommonly Used I.M. A.A.S..

Nandrolone Decanoate - Nandrolone Decanoate - Deca DurabolinDeca Durabolin Methandienone – Methandienone – Dianabol*Dianabol* Boldenone Undecanoate - Boldenone Undecanoate - EquipoiseEquipoise Formebolone - Formebolone - EsicleneEsiclene Trenbolone - Trenbolone - ParabolanParabolan Methenolone - Methenolone - PrimobolanPrimobolan Stanozolol - Stanozolol - Stromba*Stromba* Testosterone Esters - Testosterone Esters - SustanonSustanon (Mix of IV)(Mix of IV)

Testex Testex (Mix of II) (Mix of II)

Androgens and AnabolicsAndrogens and Anabolics

BoldenoneBoldenone Calusterone*Calusterone* ClostebolClostebol Danazol*Danazol* DrostanoloneDrostanolone EpitostanolEpitostanol Ethyloestrenol*Ethyloestrenol* Fluoxymesterone*Fluoxymesterone*

FormeboloneFormebolone Furazabol*Furazabol* MepitiostaneMepitiostane MesteroloneMesterolone Methandienone*Methandienone* Methandriol*Methandriol* MethenoloneMethenolone MethyltestosteroneMethyltestosterone

***Denotes 17 alpha-alkylated compounds

Androgens and AnabolicsAndrogens and Anabolics

MiboleroneMibolerone NandroloneNandrolone NorclostebolNorclostebol Norethandrolone*Norethandrolone* OxaboloneOxabolone Oxandrolone*Oxandrolone* Oxymethalone*Oxymethalone*

PrasteronePrasterone QuinboloneQuinbolone StanoloneStanolone Stanozolol*Stanozolol* TestosteroneTestosterone TrenboloneTrenbolone

* Denotes 17 alpha-alkylated compounds

Not just steroidsNot just steroids

InsulinInsulin EphedrineEphedrine Dehydrating AgentsDehydrating Agents Growth hormoneGrowth hormone HCG (Human Chorionic Gonadotrophin)HCG (Human Chorionic Gonadotrophin) NubainNubain ClomidClomid TamoxifenTamoxifen RecreationalRecreational Drugs Drugs

Effects

Main Positive Effects of Main Positive Effects of P.E.Ds Cited by Service UsersP.E.Ds Cited by Service Users

Increased muscle Increased muscle massmass

Increased strengthIncreased strength Ability to train Ability to train

longer/harderlonger/harder Enhanced Enhanced

appearance appearance Weight gainWeight gain

Increased confidenceIncreased confidence Feeling of wellbeingFeeling of wellbeing Increased aggressionIncreased aggression Feeling powerfulFeeling powerful Increased libidoIncreased libido

Physical Psychological

Main Negative Effects of Main Negative Effects of P.E.Ds Cited by Service UsersP.E.Ds Cited by Service Users

Tender injection Tender injection sitesite

GynaecomastiaGynaecomastia AcneAcne Tissue scarringTissue scarring

Increased Increased aggressionaggression

ParanoiaParanoia Fear of diseaseFear of disease Fear of effects on Fear of effects on

cessation of P.E.D cessation of P.E.D useuse

Physical Psychological

Problems AssociatedProblems Associated

Altered CoagulationAltered Coagulation Increased Haematocrit (HCT)Increased Haematocrit (HCT) InfertilityInfertility Testicular shrinkageTesticular shrinkage Clitoral hypertrophyClitoral hypertrophy Epiphyseal closure in prepubertal childrenEpiphyseal closure in prepubertal children

PsychologicalPsychological PsychosisPsychosis HypomaniaHypomania EuphoriaEuphoria Emotional LabilityEmotional Lability AggressionAggression IrritabilityIrritability Reckless behaviourReckless behaviour Increased libidoIncreased libido Paranoid reactionsParanoid reactions

The Role of Harm Minimisation

The Price Some Will PayThe Price Some Will Pay

““If I had a magic drug that was so fantastic If I had a magic drug that was so fantastic that if you took it once you would win that if you took it once you would win every competition you would enter, from every competition you would enter, from the Olympic decathlon to the Mr.Universe, the Olympic decathlon to the Mr.Universe, for the next five years, but it had one for the next five years, but it had one minor drawback – it would kill you five minor drawback – it would kill you five years after you took it – would you still years after you took it – would you still take the drug?”take the drug?”

Harm MinimisationHarm Minimisation

SStart with lowest dose/stack possibletart with lowest dose/stack possible OOptimise diet and training regimesptimise diet and training regimes UUse low androgenic initiallyse low androgenic initially RRegular investigationsegular investigations SShortest cycle possible with max. time off hortest cycle possible with max. time off

cyclecycle UUse your own, sterile injecting equipmentse your own, sterile injecting equipment CCorrect injecting techniqueorrect injecting technique KKnow your source of gearnow your source of gear

SOURSUCK

Creatine MonohydrateCreatine Monohydrate

Acts as muscle’s capacitorActs as muscle’s capacitor Effective in 70% of usersEffective in 70% of users 5-7lb of lean muscle5-7lb of lean muscle Each dose = 2lb steakEach dose = 2lb steak Take in warm drink with 100g of Take in warm drink with 100g of

carbohydratecarbohydrate Loading phase = 10g for 5/7 then 5g for Loading phase = 10g for 5/7 then 5g for

5/75/7 Maintenance phase = 2g dailyMaintenance phase = 2g daily

DDrugs rugs IIn n SSport port CClinic and linic and UUser ser SSupport upport

The The DISCUSDISCUS Team Team

DISCUS Client

Clinic Co-ordinator

R.M.O.

11 years old this year

Nurse

Sports DieticianWomen’s Outreach

Why DISCUS?Why DISCUS?

Need identified locally in 1993Need identified locally in 1993 50% of needle exchanges were for PED 50% of needle exchanges were for PED

usersusers Prevention of blood borne infectionsPrevention of blood borne infections PED users reluctant to approach existing PED users reluctant to approach existing

“drugs” services“drugs” services Experience within gymsExperience within gyms Gateway service focussing on harm Gateway service focussing on harm

reductionreduction

Services AvailableServices Available

2 Hours per week 2 Hours per week 700 individuals 700 individuals

registered registered Informal and Informal and

confidentialconfidential Full range of injecting Full range of injecting

equipment servicesequipment services Safer injecting adviceSafer injecting advice Responsible Medical Responsible Medical

OfficerOfficer Nursing assessmentNursing assessment

Services Available 2Services Available 2

DieticianDietician Hepatitis A & B vaccinationHepatitis A & B vaccination Regular blood investigations (LFTs, FBC, Regular blood investigations (LFTs, FBC,

Cholesterol etc)Cholesterol etc) ECGECG Body fat analysisBody fat analysis Referral on to other services if/when Referral on to other services if/when

necessarynecessary

Activity Levels 04-05Activity Levels 04-05

0 50 100 150 200 250 300 350 400

Attendees

New

GP

Diet

NX

Bloods

ECG

DISCUS ACTIVITY 04-05

Number 86Number 86

Providing Services for Performance Providing Services for Performance Enhancing Drug UsersEnhancing Drug Users

What can you provideWhat can you provide What can’t you provideWhat can’t you provide Why can’t you provideWhy can’t you provide What is realisticWhat is realistic What are the constraintsWhat are the constraints What are the benefits to service usersWhat are the benefits to service users

Our RoleOur Role

““Substance misusers have the same Substance misusers have the same entitlement as other clients to the services entitlement as other clients to the services provided by the National Health Service. It is provided by the National Health Service. It is the responsibility of all Health Care Workers to the responsibility of all Health Care Workers to provide care for both the general health needs provide care for both the general health needs and drug related problems, whether or not the and drug related problems, whether or not the patient is ready to withdraw from drugs.”patient is ready to withdraw from drugs.”

Where do services for Performance Enhancing Where do services for Performance Enhancing Drug Users fit into this statement????Drug Users fit into this statement????

Department of Health (1999)

Providing Services for Performance Enhancing Providing Services for Performance Enhancing Drug UsersDrug Users

Ralph HeronRalph HeronTeam ManagerTeam ManagerHarm Minimisation Service and DISCUSHarm Minimisation Service and DISCUS

Contact detailsContact details0191 3336032/60310191 3336032/603107747865604 (Mobile and Contact Number for 07747865604 (Mobile and Contact Number for

DISCUS)DISCUS)ralph.heron@cddps.nhs.ukralph.heron@cddps.nhs.uk