06/08/2014 Needle and Syringe Programs (NSP) are:  an evidence based Public Health Program young men and steroid use in western Sydney  funded for blood borne virus (BBV) prev  operational in NSW since 1986  cost effective ($4 saved for every $1 spent) Julie Page Clinical Nurse Specialist Needle and Syringe Program ~ Team Leader Nepean Blue Mountains LHD  clean injecting equipment injecting and health related information referrals into other health agencies some clinical services safe sex information needle clean-up advocacy and support  International Data ~ Canada, USA, UK  local data ~NDARC, CSRH, Police & Customs  anecdotes from User Orgs (NUAA, AIVL)  most specific to NSP is data from        stimulants  heroin and other opiates  constantly changing drug trends and patterns of use (even across LHDs) to share what we are seeing every day in western Sydney... and what the data tells us is happening Annual NSP Survey (Kirby Institute) 1 06/08/2014 The National NSP Survey:   is an annual snapshot of NSP clients profile Nationally 1% in 2004 & 4% in 2008 (Annual NSP Survey) and their drug use  provides data showing an in performance & image enhancing drug (PIED) users, accessing NSP (in line with International trends) Primarily  male  employed  non-smokers  see themselves as ‘fit and healthy’  do not see themselves as ‘drug users’  early 20’s at commencement (BUT planning begins much earlier) “…my dad said I had to bring the needles back..” “…they won’t let me do a parachute jump until I put on some weight..” 2013 -significant increase PIED users accessing NSPs (esp in NSW &Qld)  A recent ‘think tank’ in NSW found there is little local evidence of BBV transmission in this group = policy conundrum 4 categories (Dawson, 2001)  serious about sport (professionals)  serious about work (security, police etc)  serious about how they look  not serious – just want to look good the easy way~12% inject other drugs (NSP Survey) most common are steroids... known as roids, the gear, juice. They’re synthetic hormones and mimic effect of testosterone. Anabolic = muscle growth Androgenic = masculising effect 2 06/08/2014         used in cycles 2-3 injections per week 8-12 weeks with equal length break ‘stacking’ concurrent drugs or mixing for certain effect Most commonly  Intramuscular injection or subcutaneous injection  oral (tablets)  topical (creams) testosterone  tanning ( women) strip fat oestrogen symptoms get rid of fluid speed metabolism cheaper add bulk build and repair testosterone  Fakes Melanotan II Insulin Tamoxifen Diuretics Thyroid meds Veterinary steroidsGrowth hormone Peptides (Amino Acids) testosterone  testosterone  “..how much of the Equipoise should I use…?” “…why does my arm hurt…?” site injection for immediate swelling appearance Short term  acne  headaches  palpitations  increased BP  muscle/tendon injury Mid-longer term  gynaecomastia  liver damage  stunted growth  mood swings  baldness  shrunken testes - impotence 3 06/08/2014 …Women…      facial hair clitoral enlargement deepened voice amenorrhoea hair loss       Is not new …but…   Infection Abscess Allergy Nerve damage Blood Borne Virus – HCV HBV HIV reverse anorexia 1993, became known as body dysmorphia disorder (Pope, 1993) 2000’s = birth of ‘Body Beautiful’(Hope, et al, 2014 ) media, social media, a ‘health conscious’ society…and instant gratification  NSP is the point of contact with Health  not a homogenous population  PIEDs users don’t identify as NSP clients, but  no appropriate referral pathways at present need equipment  limited information on long term health  they don’t trust services and resist info  info is gained through gym and internet outcomes  increasing rates of BBV over past decade (UK) 4 06/08/2014 Dawson R T, “Drugs in sport – the role of the physician”, Journal of Endocrinology [2001] 170, 55 – 61. Dunn M, McKay F H & Iversen J Steroid users and the unique challenge they pose to needle and syringe program workers. Drug and Alcohol Review (January 2014), 33, 71–77 Griffiths S, Murray S B,& Touyz S. Disordered eating and the muscular ideal. Journal of Eating Disorders, published online April 25, 2013 doi 10.1186/20502974-1-15 Hope V.D, McVeigh J, Marongiu A, Evans-Brown M, Smith J, Kimergard A, Parry J V, F. Ncube. Injection site infections and injuries among men who inject image and performance enhancing drugs: prevalence, risks factors, and healthcare seeking. Hope V D, McVeigh J, Marongiu A, Evans-Brown M, Smith J, Kimergård A, Croxford S, Beynon C M, Parry J V, Bellis M A, Ncube F. Prevalence of and risk factors for, HIV, Hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross sectional study. Downloaded from bmjopen.bmj.com on September 15, 2013 - Published by group.bmj.com PIED use is not spontaneous – opportunity exists for early intervention and education right throughout adolescence Hildebrandt T, Alfano L,& Langenbucher J W. Body image disturbance in 1000 male appearance and performance enhancing drug users. Journal of Psychiatric Research 44 (2010) 841 - 846 Iversen J, Topp L, Wand H, & Maher L. Are people who inject performance and image-enhancing drugs an increasing population of Needle and Syringe Program attendees? , Drug and Alcohol Review (March 2013), 32, 205–207 Iversen J, Chow S, Maher L. Australian NSP Survey National Data Report 2009-2013 Prevalence of HIV, HCV and injecting and sexual behaviour among NSP attendees. Sydney, Kirby Institute UNSW 2014 Lenehan P, Miller T. Anabolic Steroids A guide for users and professionals 04/2014 Exchange supplies Murray S B, Rieger E, Hildebrandt T, Karlov L, Russell J, Boon E, Dawson R T, Touyz S W. A comparison of eating , exercise, shape and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa. Body Image 9 (2012) 193 -200 Young A F, Gabriel S,& Hollar J L. Batman to the Rescue! The protective effects of parasocial relationships with muscular superheros on men’s body image. Journal of Experimental Social Psycology 49 (2013) 173 -177 Image Acknowledgements: ‘batman to the rescue’ Young ,Gabriel & Hollar Anabolic Steroids Hardcore Info. Exchange supplies LocalFitness.com.au http://en.wikipedia.org/wiki/File:Dexter_Jackson_IFBB_2008_Australia_4.jpg http://en.wikipedia.org/wiki/File:Nikki_Fuller.jpg http://en.wikipedia.org/wiki/File:Five_day_old_Abscess.jpg 5