Research update (Friday, 24 October 2008)

[mjevansbrown]

Larance B, Degenhardt L, Copeland J, Dillon P. Injecting risk behaviour and related harm among men who use performance- and image-enhancing drugs. Drug Alcohol Rev. 2008 Sep 29:1-8.

Introduction and aims. Performance- and image-enhancing drugs have the potential to be a significant public health issue. Detailed data on PIEDs injection are difficult to obtain because of the illicit and unsupervised way in which many PIEDs are used, and the hidden nature of the group. Our study examines the patterns of use, risk behaviours and related harm associated with PIEDs injection. We also report the ways in which PIEDs users currently seek injecting equipment and harm-reduction advice. Design and method. Data were obtained via a structured questionnaire administered in face-to-face interviews with 60 men who used PIEDs (primarily anabolic androgenic steroids) for non-medical purposes. Results. Although the rates of needle sharing were low (5%), the men more frequently reported re-use of needles/equipment, injecting from a shared container (bladders, vials, etc.), injecting other illicit drugs, injecting insulin and targeting small muscle groups. Self-reports of being hepatitis C antibody positive were associated with lifetime use of heroin and injection of other illicit drugs. All HIV positive participants were gay/bisexual men. Participants reported a range of other injection-related injuries and diseases such as fevers, scarring and abscesses. 'Risky' injectors (38% of participants) were more likely to initiate PIEDs use at a younger age, use PIEDs in a larger number of cycles per year and report involvement in a violent/aggressive incident than 'low risk' injectors and report involvement in a violent/aggressive incident than 'low risk' injectors. Participants mainly reported seeking information about PIEDs from internet sites (62%) and friends (55%). Conclusions. An over-reliance on personal networks and internet forums limits this groups' access to objective harm reduction advice and primary care services. Targeted, PIEDs-specific interventions are needed.

Blond A. Impacts of exposure to images of ideal bodies on male body dissatisfaction: a review. Body Image. 2008 Sep;5(3):244-50.

Research suggests that young men's body dissatisfaction increases when they see images of attractive muscular men. This article provides the first extensive review of experimental studies exposing men to advertisements or commercials featuring idealized male bodies. Impacts on body dissatisfaction were evaluated by calculating and analyzing effect sizes from 15 studies. The effect sizes indicate that exposure to images of idealized male bodies has a small but statistically significant negative impact on men's body dissatisfaction. Three studies suggest that young men who are dissatisfied with their bodies are at increased risk for negative self-evaluations when exposed to idealized images. Two studies suggest that men who are satisfied with their bodies may be protected against negative impacts from seeing such images.

Martin NM, Abu Dayyeh BK, Chung RT. Anabolic steroid abuse causing recurrent hepatic adenomas and hemorrhage. World J Gastroenterol. 2008 Jul 28;14(28):4573-5.

Anabolic steroid abuse is common among athletes and is associated with a number of medical complications. We describe a case of a 27-year-old male bodybuilder with multiple hepatic adenomas induced by anabolic steroids. He initially presented with tumor hemorrhage and was treated with left lateral hepatic segmentectomy. Regression of the remaining tumors was observed with cessation of steroid use. However, 3 years and a half after his initial hepatic segmentectomy, he presented with recurrent tumor enlargement and intraperitoneal hemorrhage in the setting of steroid abuse relapse. Given his limited hepatic reserve, he was conservatively managed with embolization of the right accessory hepatic artery. This is the first reported case of hepatic adenoma re-growth with recidivistic steroid abuse, complicated by life-threatening hemorrhage. While athletes and bodybuilders are often aware of the legal and social ramifications of steroid abuse, they should continue to be counseled about its serious medical risks.

Kanayama G, Hudson JI, Pope HG Jr. Long-term psychiatric and medical consequences of anabolic-androgenic steroid abuse: a looming public health concern? Drug Alcohol Depend. 2008 Nov 1;98(1-2):1-12. Epub 2008 Jul 2.

BACKGROUND: The problem of anabolic-androgenic steroid (AAS) abuse has recently generated widespread public and media attention. Most AAS abusers, however, are not elite athletes like those portrayed in the media, and many are not competitive athletes at all. This larger but less visible population of ordinary AAS users began to emerge in about 1980. The senior members of this population are now entering middle age; they represent the leading wave of a new type of aging former substance abusers, with specific medical and psychiatric risks. METHODS: We reviewed the evolving literature on long-term psychiatric and medical consequences of AAS abuse. RESULTS: Long-term use of supraphysiologic doses of AAS may cause irreversible cardiovascular toxicity, especially atherosclerotic effects and cardiomyopathy. In other organ systems, evidence of persistent toxicity is more modest, and interestingly, there is little evidence for an increased risk of prostate cancer. High concentrations of AAS, comparable to those likely sustained by many AAS abusers, produce apoptotic effects on various cell types, including neuronal cells--raising the specter of possibly irreversible neuropsychiatric toxicity. Finally, AAS abuse appears to be associated with a range of potentially prolonged psychiatric effects, including dependence syndromes, mood syndromes, and progression to other forms of substance abuse. However, the prevalence and severity of these various effects remains poorly understood. CONCLUSIONS: As the first large wave of former AAS users now moves into middle age, it will be important to obtain more systematic data on the long-term psychiatric and medical consequences of this form of substance abuse.

Dodge T, Jaccard JJ. Is abstinence an alternative? Predicting adolescent athletes' intentions to use performance enhancing substances. J Health Psychol. 2008 Jul;13(5):703-11.

The present study incorporated the behavioral alternative of abstinence into the Theory of Reasoned Action to test whether abstinence contributed to the prediction of intentions to use performance enhancing substances (PES). Adolescent athletes (N = 241) completed a questionnaire about the use of legal and illegal PES. Approximately 2.5 percent of adolescents reported having tried an illegal PES and 17 percent reported having tried a legal PES. Results showed that attitudes and norms associated with abstinence contribute to the prediction of behavioral intentions over and above that of attitudes and norms associated with using both legal and illegal PES.

Day CA, Topp L, Iversen J, Maher L; Collaboration of Australian NSPs. Blood-borne virus prevalence and risk among steroid injectors: results from the Australian Needle and Syringe Program Survey. Drug Alcohol Rev. 2008 Sep;27(5):559-61.

No abstract available