Shared learning database

Manchester Health and Wellbeing Service
Published date:
April 2014

The Pump Clinic is a confidential service / intervention designed to engage with and offer specialist advice and information to users of Performance and Image Enhancing drugs. We offer a basic health screen including Biochemical and Hormonal analysis to help Steroid users to reduce the harm from their drug use. We also offer a full Needle and Syringe Programme with advice on safer injecting, as well as access to confidential Blood Borne Virus testing. This service directly aligns with Recommendation 10 in the NICE guidance: Provide equipment and advice to people who inject image and performance-enhancing drugs.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

- To engage Anabolic Androgenic Steroid (AAS) users in behaviour change that subsequently reduces the risk and associated harms that occur as a result from the use of supraphysiological doses of Anabolic Androgenic Steroids and associated Image Enhancing drugs.
- To provide the appropriate types and quantities of Injecting Equipment to AAS users in order to reduce the risk of Blood Bourne Virus (BBV) transmission.
- To provide BBV testing, Safer sex advice and Condoms to promote sexual health.
- To encourage AAS users to attend the NSP service by offering basic health screening and advice.

Reasons for implementing your project

Over the course of the last ten years the number AAS users attending the NSP service went up from approximately 5% to 50%. AAS users were very reluctant to engage with NSP workers. We spoke to some of the service users and found (anecdotally) that they were unwilling to spend time in the NSP service due to the associated stigma of attending a service they saw as being for injecting drug users who used opiates, cocaine and amphetamine. There was also a perception that NSP workers did not have detailed knowledge of AAS. We decided to offer a specialist AAS user service as a pilot, to see if it was a viable solution. The service quickly became very successful with the AAS using community and has attracted many new service users. Many new clients attended who had previously never attended NSP services before. The service is open to residents and those who work of the city of Manchester.

How did you implement the project

I undertook the relevant Phlebotomy training at a local hospital in order to offer blood testing services We developed a leaflet / flyer to distribute at local gyms in order to promote the service and is included in the supporting material. I engaged with a number of Gym owners in the area to discuss the aims and objectives of the clinic. Initially there was some resistance but we reassured potential clients that the service was confidential and that they could remain anonymous. No records would be added to NHS databases and their GP would not be informed of their attendance. The biochemistry and hormone testing service incurred extra costs. The blood tests cost approximately £10-30 / client depending on which tests are ordered. This was funded through the needle exchange budget which covers equipment costs, training and resources specific to drugs harm reduction and public health. NHS clinical governance processes enable the clinic and workers to carry out phlebotomy procedures in accordance with local and national standards of best practice. The phlebotomy training attended was provided at The Christie, Manchester and cost approximately £60 for a 2 hour session. Following this, the trainee would need their first 10 samples audited by RGN at their own service.

Key findings

We monitor progress informally through ongoing appointments, asking clients if they made any behaviour changes based on the advice given. This is very hard to measure as it relies on self-reporting but we are confident that many clients have significantly reduced their dosages and the number of cycles of AAS since attending the clinic. We also have managed to refer a number of clients (approximately 5%) through to their GP for further cholesterol monitoring for suspected Hypercholsteremia. A number of clients have ceased using AAS due to the results and advice they have received. We see 20-40 clients / week.

Key learning points

Any specialist services offered to AAS and PIED users should be confidential, low threshold and follow harm reduction principles. PIED users don't see themselves as having a drug problem and are unsuitable for referral to abstinence or recovery based services for treatment We have observed that an important element of the clinic is the access to blood tests and feedback on the results in relation to behaviour change. This approach is optimised within a clinical work area with supportive governance frameworks. Staff do not need to be 'clinical workers' but should be trained, supported and supervised by someone who has clinical training.

There is a strong stigma associated with needle exchange services, which are perceived to be for Intravenous drug users, this deters many PIED using clients. I have found that access to clients has been relatively easy, once they know the service exists. The online bodybuilding community advocates for blood testing and this generates interest in the service. A large number (50%) of clients that have attended have never used NSP services prior to attending. I have had enquiries from Bristol, Hull, Grimsby, Cardiff, London, Liverpool, Leeds and all of the boroughs surrounding Manchester. Unfortunately I have had to refuse these clients, but it demonstrates that PIED using clients are happy to engage in these types of services if they perceive they are specifically for them and can attend confidentially.

Contact details

Gary Beeny
Needle and Syringe Programme Worker
Manchester Health and Wellbeing Service

Is the example industry-sponsored in any way?