THE EXPERIENCES OF HEALTHCARE PROFESSIONALS WITH PIED CONSUMERS AND THE EXPERIENCES OF PIED CONSUMERS WITH HEALTHCARE PROFESSIONALS: A SYSTEMATIC LITERATURE REVIEW

The aim of this review was to amalgamate the extant literature that has investigated the experiences of healthcare professionals with PIED consumers and the experiences of PIED consumers with healthcare professionals, with a specific focus on medical practitioners. A systematic search was undertaken to identify studies that explored the experiences and perspectives of healthcare providers working with clients who use PIEDs, as well as to identify studies that explored the experiences and perspectives of PIED consumers with healthcare providers. Ten studies were included, of which four explored the experiences of healthcare providers with PIED consumers, and six explored the experiences of PIED consumers with healthcare providers. A sizeable proportion of healthcare providers come into contact with PIED consumers, with these interactions mostly related to consumers asking for information, though a small but significant proportion indicate they have been asked to prescribe doping agents. Of the six studies which focused on the consumer experience, five focused on PIED consumers; these studies found that while large proportions reporting accessing a medical practitioner, larger proportions did not, with the doctor’s lack of knowledge cited as one reason. More research is needed to investigate how they come into contact with this group of consumers, their level of knowledge and any training that they may need. Given the harms associated with PIED use, and the lack of disclosure of use to healthcare providers, more research is needed to understand the barriers and facilitators for consumers to accessing health care

Food security among asylum seekers in Melbourne

OBJECTIVES: This research explores food insecurity among asylum seekers who are members of the Asylum Seeker Resource Centre (ASRC) in Melbourne, Australia. METHODS: Structured person-assisted questionnaires were conducted with 56 asylum seekers. The questionnaires examined issues around access to food, cultural appropriateness of available food, transport issues, use of the ASRC Foodbank and questions about general health. RESULTS: Findings suggest that: 1) almost all asylum seekers in this study were food insecure; 2) most of the asylum seekers using the ASRC Foodbank have no access to food other than that provided at the centre; and 3) the reason that most asylum seekers are food insecure is related to structural problems associated with limitations imposed by different visas. CONCLUSIONS AND IMPLICATIONS: The ability of asylum seekers to achieve food security is limited by their restricted access to welfare and government or work-related income. Given that the current policy situation is likely to continue, providers such as the ASRC will find continuing demands on their services and increasing pressures to provide more than a 'supplemental' food supply

Voices represented and voices silenced: Represented voices in the media coverage of the implementation of a supervised injecting facility

BACKGROUND: Victoria's first medically supervised injecting room (MSIR) has remained controversial despite mounting evidence in support of the facility. The opposition to a policy idea is subject to a myriad of factors including the media. Favouring the opinions of various actors, the media are a fundamental element of the narrative formation process. In this article, we examine the voices represented and voice silenced in print news media and the possible effects of such reporting. METHODS: A quantitative content and qualitative thematic analysis of Victorian print media (n=645) focusing on the implementation and continued operation of North Richmond Community Health's medically supervised injecting room was conducted. RESULTS: The representations of the MSIR were debated by three predominant actors - politicians, public, and residents. Politicians largely relied on the 'saving lives' rhetoric when supporting the facility. In addition, competing representations of 'public amenity' were presented by both advocates and proponents of the MSIR. We found the voices of people who inject drugs were inadequately represented within the data. Instead, overdose statistics were featured as were discursive descriptions of people who inject drugs such as 'addicts', 'junkies', and 'druggies'. CONCLUSION: Despite people who inject drugs being the population the MSIR is designed to benefit, their experiences and voices were lacking, highlighting social power structures, denying the silenced power, and obstructing social change. Overdose rates were consistently presented as numbers, negating personal experiences and lacking meaningful debate. Further, negative discourse referring to people who inject drugs may have implications regarding internalised and externalised stigma and drug policy

Coaching the drug coach: An invited commentary in response to Gibbs et al. anabolics coaching: Emic harm reduction or a public health concern?

Coaching the drug coach: An invited commentary in response to Gibbs et al. anabolics coaching: Emic harm reduction or a public health concern

Investigating the capacity of Australian drug information systems to detect changes in anabolic-androgenic steroid use and harms

Objective: The objective of this study was to explore the capability of drug information and surveillance systems to detect and monitor trends in steroid use in Australia. Method: Surveys and systems from Australia were reviewed. Information such as the main purpose of the survey, frequency and method of data collection, population surveyed, capacity to collect information on steroid use, and prevalence of use in the target population was collected. Findings: Six surveys were identified. Two of the largest surveys are conducted at a general population level and approximately triennially, with the others conducted annually. Each is designed for a specific purpose and targets a specific group. Each has, to some extent, the capacity to collect information on steroid use. One survey (the Australian Needle and Syringe Programme Survey) is not designed to collect information on drug use per se yet appears to be the best at capturing potential changes in steroid use. Conclusions: Australia does not have a survey able to detect an increase in steroid use. The one survey which provides the most readily available annual data regarding use and harm is not designed specifically for this purpose. Previous recommendations to annually monitor steroids have not been implemented

“I Feel Like I’m Walking the Line; One Side It’s Manageable, the Other Side It’s F**king prison”: exploring the Dual Nature of User-Manufacturers of Image and Performance Enhancing Drugs

“I Feel Like I’m Walking the Line; One Side It’s Manageable, the Other Side It’s F**king prison”: exploring the Dual Nature of User-Manufacturers of Image and Performance Enhancing Drug

“I Feel Like I’m Walking the Line; One Side It’s Manageable, the Other Side It’s F**king prison”: exploring the Dual Nature of User-Manufacturers of Image and Performance Enhancing Drugs

This Bourdieusian study interrogates the practices of an Australian-based “user-manufacturer” of image and performance enhancing drugs (IPEDs). Extending the concept of illicit drug “user-dealers”, we draw upon a case study of an IPED user-manufacturer, “Meiko”, to interrogate steroid-user habitus, the importance of reputation and community trust, and the minimization of risk through referral-only interactions and low-profile branding. Findings reveal a user-manufacturer community engaged in domestic production of IPEDs, aided by Chinese suppliers of raw powders who have set up facilities in Australia. This research highlights the complex dynamics underlying the underground market for IPEDs, emphasizing the interplay between cultural, economic, and bodily capital, and the strategic responses of user-manufacturers to their social context while challenging traditional notions of rational choice

‘My mind pretty much went to mush’: A qualitative exploration of trenbolone in the performance and image enhancing drug community

Introduction: There are a variety of harms associated with anabolic–androgenic steroids (AAS), with some AAS associated with an increased risk profile for users. Despite potentially different risk profiles, these harms are seldom discussed with respect to specific compounds although recent ethnographic research has identified a need to do so. Specifically, myth has developed among users with trenbolone reportedly having more dramatic effects on individuals, with reports of aggression, violent behaviour and extreme mood disturbances, and this is reflected in extant literature. This paper aims to report on the narrative surrounding the use of trenbolone among AAS users. Method: As part of a larger qualitative study, a number of AAS users were interviewed regarding their usage practices. A narrative emerged regarding the physical and psychological harms which accompanied their AAS use of which trenbolone played a central role (N = 16). Results: Of all the AAS, trenbolone was viewed as having the most deleterious consequences for those who used it. Users reported an extreme shift in risk profile for psychosocial harms, particularly increased aggression and violent behaviour, as well as impulsivity regulation issues. AAS-using peers and family members of users reported the readily observable effect of trenbolone. Discussion and Conclusions: Users should be cognisant of the potential for significant harms and health-care providers working with this group may consider more focused screening strategies. Future policy decisions regarding AAS may wish to consider the pivotal role trenbolone plays in adverse outcomes for this unique group of substance users

Beyond the law: Exploring the impact of criminalising anabolic–androgenic steroid use on help-seeking and health outcomes in Australia

This study aimed to investigate how Anabolic–Androgenic Steroid (AAS) users and healthcare professionals perceive the criminalisation of AAS on users’ ability to seek help and, ultimately, what effect this has on the health outcomes for these consumers. This study triangulated the views (N = 24) of male (n = 8) and female (n = 7) AAS users (Mage = 35.4, SD = 9.1), as well as healthcare providers (n = 9), regarding how the criminalisation of AAS had an impact on consumers’ health behaviours and help-seeking. Data were analysed thematically. An overarching narrative was developed regarding the “politicogenic drug effects” which emerge from the illegality of AAS with three overarching themes. First, participants expressed challenges in seeking help and support due to the stigma and fear associated with the illegal nature of AAS use. This fear stemmed from the criminalisation of AAS and the potential legal consequences. Participants also highlighted the social challenges and the need for secrecy surrounding AAS use, which further hindered open discussions and engagement with healthcare providers. The cohort emphasised the close-knit social networks among AAS users, offering support and shared experiences but also entangled in the criminality associated with AAS use. Moreover, participants acknowledged the difficulties in promoting harm reduction initiatives due to the need for secrecy and the potential social and economic disadvantages. The escalation of AAS criminalisation that has impacted both consumers and healthcare professionals has exacerbated the challenges associated with their interaction, further impeding a relationship already fraught with obstacles. Consequently, users remain entrenched within the illicit market, with few options for harm reduction intervention. The study advocates for a rethinking of AAS policies, considering a potential reclassification aligned with the United Kingdom's Class C framework to destigmatise use and promote harm reduction. This shift would require comprehensive research to assess its impact on public health, user behaviour, and harm reduction outcomes

Beyond the law: Exploring the impact of criminalising anabolic–androgenic steroid use on help-seeking and health outcomes in Australia

This study aimed to investigate how Anabolic–Androgenic Steroid (AAS) users and healthcare professionals perceive the criminalisation of AAS on users’ ability to seek help and, ultimately, what effect this has on the health outcomes for these consumers. This study triangulated the views ( N = 24) of male ( n = 8) and female ( n = 7) AAS users ( Mage = 35.4, SD = 9.1), as well as healthcare providers ( n = 9), regarding how the criminalisation of AAS had an impact on consumers’ health behaviours and help-seeking. Data were analysed thematically. An overarching narrative was developed regarding the “politicogenic drug effects” which emerge from the illegality of AAS with three overarching themes. First, participants expressed challenges in seeking help and support due to the stigma and fear associated with the illegal nature of AAS use. This fear stemmed from the criminalisation of AAS and the potential legal consequences. Participants also highlighted the social challenges and the need for secrecy surrounding AAS use, which further hindered open discussions and engagement with healthcare providers. The cohort emphasised the close-knit social networks among AAS users, offering support and shared experiences but also entangled in the criminality associated with AAS use. Moreover, participants acknowledged the difficulties in promoting harm reduction initiatives due to the need for secrecy and the potential social and economic disadvantages. The escalation of AAS criminalisation that has impacted both consumers and healthcare professionals has exacerbated the challenges associated with their interaction, further impeding a relationship already fraught with obstacles. Consequently, users remain entrenched within the illicit market, with few options for harm reduction intervention. The study advocates for a rethinking of AAS policies, considering a potential reclassification aligned with the United Kingdom's Class C framework to destigmatise use and promote harm reduction. This shift would require comprehensive research to assess its impact on public health, user behaviour, and harm reduction outcomes