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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
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
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
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 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
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)[email protected]@cddps.nhs.uk