The project provides Harm Minimisation advice, guidance and support, and referral pathways into structured treatment for those using Performance & Image Enhancing Drugs - specifically steroids (PIED). It also focuses on the Recovery of individuals from other substances commonly associated with Steroid use such as GHB and Ketamine.
The project works both within drug services, through the front of house engagement and needle exchange provision, but also provides in reach support within a number of pro body building and mainstream gyms in the Kirklees area. Our provision clearly follows NICE guidance in regards to Harm Minimisation and Needle Exchange scheme provision distribution, alongside Psychosocial and Pharmacological Interventions guidance aswell.
We also provide training to other professionals such as Gym and sports centre managers and within Gyms personal trainers to bolster the knowledge of PIED and the pathways into treatment.
Aims and objectives
- To develop and maintain a robust Lifeline Kirklees service response to PIED use within Kirklees
- To highlight the use of image and enhancement drugs as a public health issue in Kirklees
- To prompt local research and response to the issues of PIED use Objectives:
- To broaden access to advice and treatment for steroid users, many of whom can have reservations about accessing drug services
- To proactively engage with steroid users in order to increase understanding of safe practices and the wide range of health risks associated with steroid use
- To increase Lifeline's understanding of the range, sourcing, distribution and types of steroids used in the community
- To develop a greater understanding of user trends and likely demands for steroid support within the community - including the likely health and societal impacts of increased use
- To develop a system for clear communication of information and advice relating to steroid use i.e. safe injecting, harm minimisation, substance awareness and management, health care and risks associated with steroid use - risks which commonly include heart disease, impacts to the immune system, high cholesterol and blood pressure, liver and kidney damage, increased injury, hormonal imbalance, nausea, diahorrea, prostate enlargement, testicular shrinking, growth of breast tissue, mood swings, aggression, increased libido, reduced inhibitions, psychological addiction, water retention, increased hair growth, hair loss, greasy skin etc.
- To bring together key individuals involved in Public Health and the Gym and Fitness Industry to tackle the challenges PIED use can bring to an area.
Reasons for implementing your project
In 2007/08 Lifeline Kirklees needle exchange workers started to see an increase in the number of steroid clients. Staff knowledge around the substance was limited so in 2008 we received formal training around the substance.
In March 2009, Jim McVeigh, Head of Substance Use at John Moores University, reported a 2000% increase in the number of steroid users attending needle exchange (NX) services between 1991-2006; and that from 2006-2009, new clients injecting steroids outnumbered new injectors of all other drugs combined. Mr McVeigh also notes a high level of peer distribution of injecting equipment, suggesting that steroid users attending NX services may only be the 'tip of the iceberg'.
We have continued to see year in year the number of steroid clients increasing from approximately 40% of our total Needle Exchange client base in 2010 to just over 56% in 2013, and a continued increased into 2014.
We also concur with Jim McVeigh that these figures underrepresent as some people do collect for their friends as well as themselves. We are also aware that a lot of steroid/PIED users buy directly from the internet. There is also a network within Gyms whereby some Personal Trainers and other Steroid Users are supplying for money various Paraphernalia. As a result of this we have supported a number of steroid users to understand fully Harm Minimisation messages so that there are good clear peer messages in the Steroid community delivered by peers.
How did you implement the project
In partnership with the North Kirklees Gym, and the University of Huddersfield Research Department, we held a Steroid Seminar. Attended by a mix of commissioners and services from across the Yorkshire and Humber region, the seminar gave us an opportunity to raise the importance of seeing steroid use as harmful, and helped attendees understand fully the range of interventions we as a service could provide, and should be offered to clients. On the day we had several individuals from the Body Building communities and gym services speaking to delegates about real issues they had faced and the importance of putting the right interventions in place such as outreach and correct advice. In line with NICE recommendations 6 and 7 we felt there was a real need to raise the importance of this issue, and the associated harms that can prevail such as Hepatitis C. In line with PH52 recommendation 10, we have consolidated a further relationship with Kirklees Active Leisure (KAL), who run and manage 12 gyms. We have put in place a robust training programme starting with all senior managers to raise the awareness of the problem, then with the middle managers to get them on board and see the importance of us being actively in their gyms, to now having a bi-annual programme in place were we train the Personal Trainers who are offering services face to face with potential Steroid users.
The total number of transactions made to steroid clients from June 2012 to June 2013 was = 1426 - The following stats are from 12 pharmacies that provide needle exchange in the Kirklees area. Again these are from June 2012 to June 2013: Total number of new Steroid User registrations = 247. Total number of Steroid related transactions conducted at pharmacies = 9106
We have re-visited the other private Gym's in Kirklees and now have 3 with an interest in replicating the types of services we provide, one of these is also a mixed martial arts centre which will open up a new clientele for us to deliver interventions to. As a result of our seminar we have also been providing direct sessions to clients within Prison settings, and have recently held a session at Wealstun HMP with the inmates.
Key learning points
Lifeline Kirklees is commissioned by Kirklees Public Health, through the Head of Health Improvement Commissioning Manager - Tony Cooke.