The occurrence of non-anatomical therapeutic chemical-international nonproprietary name molecules in suspected illegal or illegally traded health products in Europe: A retrospective and prospective study.

The General European Official Medicines Control Laboratory (OMCL) Network (GEON), co-ordinated by the European Directorate for the Quality of Medicines & HealthCare (EDQM), regularly organises market surveillance studies on specific categories of suspected illegal or illegally traded products. These studies are generally based on a combination of retrospective and prospective data collection over a defined period of time. This paper reports the results of the most recent study in this context with the focus on health products containing non-Anatomical Therapeutic Chemical-International Nonproprietary Name (ATC-INN) molecules. In total 1104 cases were reported by 16 countries for the period between January 2017 and the end of September 2019. The vast majority of these samples (83%) were collected from the illegal market, while only 3% originated from a legal source. For the rest of the samples, categorisation was not possible. Moreover, 69% of all the reported samples were presented as medicines, including sexual performance enhancers, sports performance enhancers, physical performance enhancers and cognitive enhancers or nootropic molecules that act on the central nervous system (CNS). Although the popularity of anabolics, PDE-5 inhibitors and CNS drugs in illegal products has already been reported, the study showed some new trends and challenges. Indeed, 11% of the samples contained molecules of biological origin, that is, research peptides, representing the second most reported category in this study. Furthermore, the study also clearly shows the increasing popularity of Selective Androgen Receptor Modulators and nootropics, two categories that need attention and should be further monitored.

Polydrug use and polydrug markets amongst image and performance enhancing drug users: Implications for harm reduction interventions and drug policy.

BACKGROUND: Over the past two decades, the use of image and performance enhancing drugs (IPEDs) has increased significantly. Once largely confined to professional athletes, IPED use has transcended the elite sporting arena and is now predominantly found among non-elite, recreational gym users. This paper presents research findings from a qualitative study of IPED use and supply in a 'hardcore' bodybuilding gym in the north of England. This article makes an original contribution to the field by providing an in-depth account of the use and supply of IPEDs among this population, demonstrating the intersectionality that exists across IPEDs, diverted medication and both licit and illicit substance use and supply. METHODS: The findings are based on the research team's privileged access to an independent, 'hardcore' body building gym in the north of England. Four fieldworkers undertook overt systematic observations, supplemented by 20 semi-structured interviews. RESULTS: Amongst this sample of bodybuilders, substance use transcended IPEDs to encompass a much broader cocktail of substances all who used IPEDs concomitantly used diverted medication as a means of negating anticipated side-effects, and over half used illegal psychoactive drugs. Furthermore, virtually all of these substances were available to buy via the gym, through fellow gym members and, at times, staff. CONCLUSION: This article draws three main conclusions. (1) We are witnessing a convergence of IPED use and supply with diverted medication and 'traditional' recreational substances. (2) The extensive poly-substance use reported by interviewees in this sample necessitates a review of existing harm reduction advice for IPED users that takes into consideration the full range of substances currently being used. (3) Punitive drug policy reform that aims to reduce IPED markets needs to consider the potential to displace social supply towards more commercially-driven dealing. Harsher drug laws may also risk criminalising and stigmatising IPED users.

Superheroes - Image and performance enhancing drug (IPED) use within the UK, social media and gym culture.

Anabolic androgenic steroids (AAS) are the drug of choice in many cultures of the UK. Whilst there is an abundance of evidence relating to the physiological and psychological effects of steroid abuse on the individual, surprisingly there is a paucity of information relating to the perspectives of steroid users regarding the social impact of steroid use on self and society. The lack of data from steroid users has implications for forensic and legal medicine. Specifically, evidence is limited in terms of the user's voice. This is a crucial omission; the unheard voices of steroid users have much to offer into future research. 24 IPED using participants (using substituted names to protect anonymity), engaged in semi structured interviews to discuss their own personal usage, culture issues, social media and more.

The Availability and Acquisition of Illicit Anabolic Androgenic Steroids and Testosterone Preparations on the Internet.

The lifetime prevalence of anabolic androgenic steroids (AAS) use in the United States is over 1%. Recent reports have suggested AAS can easily be obtained over the Internet without a prescription, but this has been poorly studied. This study focused on determining the availability and ease of purchase for AAS, testosterone, and other non-AAS therapies on the Internet from the perspective of a typical consumer. A Google search was performed and the top-ranking sites offering AAS for sale were individually evaluated for selection of AAS offered, the purchasing process, and additional consumer information to support AAS use. The current results revealed that 87% of sites offered commonly used forms of AAS, injectable testosterone, and non-AAS hormone therapies. Seventy-five percent offered at least one postcycle recovery agent and 62% offered at least one erectile dysfunction medication. No site required a prescription for purchase of any substance, 75% accepted common forms of payment including credit card, and all sites were supplied by unregulated international pharmacies providing shipment to home addresses with disclaimers that consumers are liable to local laws. Seventy-five percent of sites provided specific cycle and stacking recommendations, 62% provided postcycle recovery information, but only one site offered information on non-AAS alternatives. In conclusion, AAS, injectable testosterone, and other non-AAS therapies are readily available and remarkably easy to purchase on the Internet without a prescription. It is of paramount importance that clinicians are aware of this considerable public health problem given the detrimental physiologic effects including infertility and sexual dysfunction.

Social suppliers: Exploring the cultural contours of the performance and image enhancing drug (PIED) market among bodybuilders in the Netherlands and Belgium.

BACKGROUND: This paper explores the understudied phenomenon of performance and image enhancing drug (PIED) markets by examining the structure and formation of the market for PIEDs among bodybuilders in the Netherlands and Belgium. This article specifically seeks to account for individual reasons and motivations for dealing PIEDs within these bodybuilding subcultures. Understanding illicit PIED markets is important for policy decisions as knowledge on the production and distribution of these substances may assist in designing law enforcement efforts, harm reduction initiatives and treatment options. METHODS: This article draws on two years of fieldwork in various bodybuilding settings, 47 semi-structured interviews with individuals who are directly or indirectly involved in the PIED market and 64 PIED dealing cases initiated by criminal justice agencies in the Netherlands and Belgium. FINDINGS: The data indicates that PIED dealing groups and individuals are often driven by motivations stemming from their social and cultural embeddedness in the bodybuilding subculture. Specifically, these PIED dealers are 'over-socialized' into the structure and culture of bodybuilding and follow the cultural scripts that come with their group affiliation and organization. As a result of the cultural context in which these transactions occur, PIED dealing networks among bodybuilders in the Netherlands and Belgium are more likely to consist of friends or 'friends of friends' tied together by threads of collective meaning found within the bodybuilding subculture. CONCLUSION: We argue that efforts seeking to explain the structure, formation and motivations of illicit PIED dealing must learn to appreciate how culture mediates structural forces and thereby influences individual and collective action. Policy makers, health care professionals and other relevant parties should consider a plurality of factors (social, economic and cultural) when designing and evaluating PIED-related interventions such as law enforcement efforts, harm reduction initiatives and treatment options.

The diffusion of performance and image-enhancing drugs (PIEDs) on the internet: the abuse of the cognitive enhancer piracetam.

INTRODUCTION: Performance and image-enhancing drugs (PIEDs), also known as "lifestyle drugs," are increasingly sold on the Internet to enhance cognitive as well as sexual, muscular, attentive, and other natural capacities. Our analysis focuses on the misuse of the cognitive enhancer piracetam. METHODS: A literature review was carried out in PsychInfo and Pubmed database. Considering the absence of peer-reviewed data, review of additional sources of unstructured information from the Internet was carried out between February 2012 and July 2013. Additional searches were conducted using the Global Public Health Intelligence Network (GPHIN), a secure Internet-based early warning system developed by Health Canada and the World Health Organization (WHO), which monitors media reports in six languages, Arabic, Chinese, English, French, Russian, and Spanish. RESULTS: Piracetam is sold via illicit online pharmacies with no need of prescription at low prices. Buyers, mainly healthy individuals, purchase the product to enhance study- and work-related performances as well as for recreational purposes. Its nonmedical use is often associated with the occurrence of side effects such as hallucinations, psychomotor agitation, dysphoria, tiredness, dizziness, memory loss, headache, and severe diarrhoea; moreover, several users declared to have neither felt any cognitive improvement nor psychedelic effects. CONCLUSIONS: This is a new and fast-growing trend of abuse that needs to be extensively monitored and studied also by using near real-time and unstructured sources of information such as Internet news and online reports in order to acquire rapid knowledge and understanding. Products sold online might be counterfeits and this enhances related health risks.

Performance-enhancing drugs on the web: a growing public-health issue.

BACKGROUND AND OBJECTIVES: Today's Internet provides extensive "underground" guidelines for obtaining and using illicit substances, including especially anabolic-androgenic steroids (AAS) and other appearance- and performance-enhancing drugs (APEDs). We attempted to qualitatively characterize APED-related Internet sites. METHODS: We used relevant Internet search terms (eg, "steroids bodybuilding" and "buy steroids online") to assess (i) the numbers of site visitors; (ii) offers of drugs for sale; and (iii) the quality of online medical information. We also chose the examples of (iv) "site-enhancing oils" and (v) "cattle implants" to illustrate the volume of available Internet information as compared with that in the medical literature. RESULTS: We found thousands of sites involving AAS and other APEDs. Most sites presented an unabashedly pro-drug position, often openly questioning the qualifications and motivations of mainstream medical practitioners. Offers of AAS and other APEDs for sale, together with medical advice of varying legitimacy, was widespread across sites. Importantly, many sites provided detailed guidelines for exotic forms of APED use, some likely associated with serious health risks, which are probably unknown to most practicing clinicians. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: It seems important for practitioners to be aware of the extent of this "underground literature," which may strongly influence their patients' decisions about use and abuse of APEDs.