With increasing numbers of people across the country injecting themselves with steroids, the National Institute for Health and Care Excellence (NICE) has updated its guideline on the provision of needle and syringe programmes for adults and young people with new recommendations about services for those who use image and performance enhancing drugs.

Conservative estimates suggest almost 60,000 people aged between 16 and 59 in England and Wales have used anabolic steroids in the last year[1]. But needle and syringe programmes have reported rapidly increasing numbers of steroid users attending their services.

Needle and syringe programmes were successfully introduced during the ‘80s and ‘90s in the face of the UK's AIDS epidemic. They now face the challenge of a change in the type of people who inject substances.

David Rourke, Harm Reduction Lead for CRI's Arundel Street Project - a needle and syringe programme in Sheffield, explained:

“We run a weekly clinic for steroid users but we have people coming through the door on a daily basis, with at least seven new clients a week. We know there are many more people out there who are not using needle and syringe programmes because this group of users do not see themselves as drug users. Traditionally they are more sexually active than users of heroin or crack, so there is more potential for the spread of infections through sex.”

Research shows that people who inject image and performance enhancing drugs are at an increased risk of blood-borne viruses and bacterial infections - 1.5% have tested positive for HIV. Public Health England has warned that men who inject anabolic steroids are also at greater risk of developing viral hepatitis.

Needle and syringe programmes aim to stop people sharing potentially contaminated injecting equipment by providing them with sterile needles,syringes and other equipment. They have successfully helped to limit the spread of infectious blood-borne diseases such as HIV and Hepatitis B and C.

David Rourke added: “This guideline gives front-line workers clear recommendations on how to support image and performance enhancing drug users. Up to now this has been a grey area; services around the country have been patchy to say the least.

“In Sheffield we are lucky to have a special programme for those who use steroids to access information and support but I know of some areas where there is nothing.

“People who inject steroids are potentially using them without the correct education or the correct equipment and this can lead to more and more people injecting unsafely, which can put not just their own life, but the lives of those around them, at risk. Those who use steroids should be able to get the same support as anyone else who injects drugs. This guideline will make sure that services across the country are at the high standard they should be.”

Professor Mike Kelly, Director of the NICE Centre for Public Health, said: “Needle and syringe programmes have been a huge success story in the UK, they are credited with helping stem the AIDS epidemic in the ‘80s and ‘90s. However, we are now seeing a completely different group of people injecting drugs. They do not see themselves as ‘drug addicts'; quite the contrary, they consider themselves to be fit and healthy people who take pride in their appearance.

“Since we last published our guideline on needle and syringe programmes in 2009, we've seen an increase in the use of image and performance enhancing drugs such as anabolic steroids. We've also heard anecdotal evidence that more teenagers are injecting these image and performance enhancing drugs too. We're updating our guideline to make sure all of these groups of people are considered in the planning and delivery of needle and syringe programmes. These services must continue to be configured in the most effective way to reach and support the people who need them the most, wherever they live, and protect their health as much as possible.”

Dr Fortune Ncube, Consultant Epidemiologist and Head of Blood-borne Virus Section HIV & STI Department, at the Public Health England National Centre for Infectious Disease Surveillance and Control (CIDSC), said: “Anyone who injects drugs is at risk of HIV and other blood-borne viruses, regardless of the substance they inject.

“Our recent research suggests that levels of HIV and hepatitis infection among men using image and performance enhancing drugs have increased since the 1990s.

“We must maintain and strengthen public health interventions focused on reducing injection-related risk behaviours to prevent HIV and hepatitis infections in this group. This includes ensuring easy access for those who inject image and performance enhancing drugs to voluntary confidential testing services for HIV and hepatitis and vaccination against hepatitis B, as well as to appropriate sterile injecting equipment through needle and syringe programmes.”

New or updated recommendations in this updated guideline include:

• Commissioners and providers of needle and syringe programmes should ensure services provide users of image or performance enhancing drugs with the equipment they need. Services should be provided at times and in places that meet their needs (e.g. by offering outreach services in gyms or outside normal working hours), and by properly trained staff.
• Organisations should develop local, area-wide policies to provide services that meet the needs of young people aged under 18 (including young people under 16) who inject drugs. This should include thinking about how to achieve the right balance between protecting the young person and providing them with advice on harm reduction and other services.
• Services should be co-ordinated so that people who need injecting equipment can get it when they need it.

Ends

For more information call the NICE press office on 0845 003 7782 or out of hours on 07775 583 813.

Notes to Editors

About the guideline

A copy of the guideline update for needle and syringe programmes, will be available from Wednesday 9^th April 2014. Please contact the NICE press office for an embargoed copy of this guideline.

Drugs

The term ‘drugs' is used in this guideline to mean: opioids (for example, heroin); stimulants (for example, cocaine) either separately or in combination (speedballing); novel psychoactive substances (‘legal highs', for example, mephedrone); image- and performance-enhancing drugs (see below); and other drugs (for example, ketamine).

Image-and performance-enhancing drugs

The term ‘image and performance enhancing drugs' is used in this guideline to mean any substance injected with the intention of enhancing image or performance (except under medical supervision). It includes:

• anabolic steroids, growth hormone and novel drugs (such as those that stimulate secretion of growth hormone, IGF-1 and analogues, and human chorionic gonadotrophin) melanotans, bremelanotide, botulinum toxin and dermal fillers.

About NICE

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