GP-led research highlights non-prescribed steroids risk

Soon-to-be published research presenting the first epidemiological study on non-prescribed performance- and image-enhancing drugs (PIEDs) reveals ‘significant’ results, according to study lead, Dr Beng Eu.
 
‘This is the first study of this kind, where we are seeing people who are not presenting for treatment but are attending GP clinics and happen to use anabolic-androgenic steroids [AAS],’ Dr Eu told newsGP.
 
‘It is very much a GP-led study done through GP clinics. I think it shows that as GPs, we can do GP-relevant studies and have significant outcomes that can influence how we, and others practice.’
 
Conducted between 2019 and 2021, the study examined users of non-prescribed PIEDs presenting across six general practices in Australia.
 
Results revealed that compared to the average population, these patients were at greater risk of harmful conditions.
 
‘The findings are significant, showing increased rates of polycythaemia, hypertension, liver abnormalities and hyperlipidemia in this population,’ Dr Eu said.
 
‘Another important finding was the average BMI [of 28] − this changes the expectations of GPs of who they think may be using AAS.’
 
The rate of hypertension among PIEDs users also exceeded that of people on prescribed testosterone – which is already well above average – according to the study.
 
Australian Institute of Health and Welfare data indicates that although the prevalence of non-prescribed PIEDs in Australia is relatively low, their use is rising steadily from 0.3% in 2001 to 0.6% in 2016, then to 0.8% in 2019.
 
Data from the Kirby Institute’s Australian Needle Syringe Program national data report shows that the proportion of respondents who reported last injecting PIEDs remained stable at 4−6% between 2016 to 2020, but PIEDs reported as ‘last drug injected’ in NSW over the period 1995−2019 rose from 1% to 10%.
 
A Melbourne-based GP with a special interest in non-prescribed PIEDs, Dr Eu has carried out ongoing advocacy for a harm minimisation approach for users of non-prescribed PIEDs.
 
Part of these efforts included involvement in a recently developed guideline to provide GPs and other health professionals with up-to-date and evidence-based information on how to manage and minimise harm for people who are contemplating, currently using, or wanting to stop non-prescribed AAS and other PIEDs.
 
Dr Eu said there has long been concern that many PIED users are ‘invisible’ when presenting in general practice, mainly due to associated stigma of disclosing their non-prescribed use, and the results of the latest study further emphasise the need for GPs to be aware of patients who use non-prescribed PIEDs.
 
Following the recent death of a personal trainer in his 30s who injected himself with non-prescribed insulin, a NSW coroner is calling for expert-led quality discussions on the harms of misusing PIEDs.
 
The coroner found limited evidence of the prevalence of PIEDs use, as well as gaps in ‘specific educational and treatment strategies and support’ for users.
 
Recognising the importance of GPs establishing harm-minimisation strategies and a trusted relationship with patients who are using, or considering using PIEDs, Dr Eu says that once the conversation starts, these patients are willing to modify their behaviour.
 
‘It is important in advising them but also managing these adverse effects [found from the study] to reduce harm,’ he said.
 
Dr Eu and the research team are continuing to look at the study data for further significant findings and how they can be translated into general practice.
 
‘[To date,] there has been little done to look at the effect of harm reduction in this field and the benefit of this approach is argued about in some medical circles,’ he said.
 
‘I am hoping that we can use the information gained from this study to understand this field better and take the lead in managing these patients better, thus hoping to avoid the more severe adverse events that are seen in hospitals and by specialists as a result of AAS use.’
 
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