Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study

Background: The UK continues to experience a rise in the number of anabolic steroid-using clients attending harm reduction services such as needle and syringe programmes. Methods: The present study uses interviews conducted with harm reduction service providers as well as illicit users of anabolic steroids from different areas of England and Wales to explore harm reduction for this group of drug users, focussing on needle distribution policies and harm reduction interventions developed specifically for this population of drug users. Results: The article addresses the complexity of harm reduction service delivery, highlighting different models of needle distribution, such as peer-led distribution networks, as well as interventions available in steroid clinics, including liver function testing of anabolic steroid users. Aside from providing insights into the function of interventions available to steroid users, along with principles adopted by service providers, the study found significant tensions and dilemmas in policy implementation due to differing perspectives between service providers and service users relating to practices, risks and effective interventions. Conclusion: The overarching finding of the study was the tremendous variability across harm reduction delivery sites in terms of available measures and mode of operation. Further research into the effectiveness of different policies directed towards people who use anabolic steroids is critical to the development of harm reduction. Keywords: Harm reduction, Needle and syringe programmes, Anabolic steroid

Anabolic steroids in the UK: an increasing issue for public health

Aims: The aim of the paper was to identify changes in the extent and patterns of anabolic steroid use in the United Kingdom to better understand the public health implications within the context of the current health-related evidence base. Methods: Using the two time points of 1995 (prior to legislation changes in the United Kingdom) and 2015, a review of the evidence related to health harms was conducted, in conjunction with needle and syringe programme (NSP) data in Cheshire & Merseyside (UK) relating to anabolic steroid users. Findings: Dramatic increases in the numbers of anabolic steroid users accessing NSPs, 553 in 1995 to 2446 in 2015, now accounting for 54.9% of clients. With the inclusion of pharmacy NSPs, this rose to 5336 individual anabolic steroid users. Conclusions: Key changes in our knowledge during the 20 years, in particular in relation to HIV prevalence, changes in the market and patterns of use make anabolic steroid use a public health concern. In the context of increasing numbers of injectors, there is a need for comprehensive interventions

Trends in drop out, drug free discharge and rates of re-presentation: a retrospective cohort study of drug treatment clients in the North West of England

Background: Governments aim to increase treatment participation by problematic drug users. In the UK this has been achieved by fiscal investment, an expanded workforce, reduced waiting times and coercive measures (usually criminal justice (CJ) led). No assessment of these measures on treatment outcomes has been made. Using established monitoring systems we assessed trends in 'dropped out' and 'discharged drug free' (DDF), since the launch of the national drug strategy, and rates of treatment re-presentation for these cohorts. Methods: A longitudinal dataset of drug users (1997 to 2004/05, n = 26,415) was used to identify people who dropped out of, and were DDF from, services for years 1998 to 2001/02, and representations of these people in years to 2004/05. Trends in drop out and DDF, baseline comparisons of those DDF and those who dropped out and outcome comparisons for those referred from the CJ system versus other routes of referral were examined using chi square. Logistic regression analyses identified variables predicting drop out versus DDF and subsequent representation versus no re-presentation. Results: The proportion of individuals dropping out has increased from 7.2% in 1998 to 9.6% in 2001/02 (P < 0.001). The proportion DDF has fallen from 5.8% to 3.5% (P < 0.001). Drop out was more likely in later years, by those of younger age and by CJ referrals. The proportion re-presenting to treatment in the following year increased from 27.8% in 1998 to 44.5% in 2001/02 (P < 0.001) for those DDF, and from 22.9% to 48.6% (P < 0.001) for those who dropped out. Older age and prior treatment experience predicted re-presentation. Outcome (drop out or DDF) did not predict re-presentation. Conclusion: Increasing numbers in treatment is associated with an increased proportion dropping out and an ever-smaller proportion DDF. Rates of drop out are significantly higher for those coerced into treatment via the CJ system. Rates of re-presentation are similar for those dropping out and those DDF. Encouragingly, those who need to re-engage with treatment, particularly those who drop out, are doing so more quickly. The impact of coercion on treatment outcomes and the appropriateness of aftercare provision require further consideration

HIV among people using anabolic steroids in the United Kingdom: an overview

Since the mid-1980s, preventing HIV transmission among people who inject drugs (PWIDs) has been one of the cornerstones of the UK’s response to HIV. The early comprehensive implementation of harm reduction, particularly needle and syringe programmes, has been widely acknowledged as key to a low prevalence of HIV among PWIDs in the UK. However, this harm-reduction strategy was developed to avert an HIV epidemic among people injecting heroin and while the prevalence in this population remains low, it is clear that there are now emerging populations of PWIDs with different patterns of drug use and risks

Access to needle and syringe programs by people who inject image and performance enhancing drugs

We appreciate van Beek and Chronister's concerns regarding the funding of harm reduction interventions in an environment of diminishing resources (van Beek & Chronister, 2015), however we disagree with their conclusion and support the international guidelines for equitable and non-discriminatory NSP provision for all people who inject drugs. van Beek and Chronister outline the response of the Kirketon Road Centre (KRC), an established primary health care facility in Sydney, New South Wales (NSW), to a potential “public policy dilemma” resulting from an increase in the injection of drugs with the primary purpose of enhancing image and/or performance in Australia (van Beek & Chronister, 2015). Using data from surveys of 102 men injecting image and performance enhancing drugs (IPEDs) attending the KRC Needle and Syringe Program (NSP), they assessed the risk of blood-borne viral (BBV) infections in this group to be lower than among people who inject drugs primarily for their psychoactive effects. The KRC subsequently implemented a policy decision to limit the availability of injecting equipment from their NSP to people who inject IPEDs. The authors also encouraged other NSP services to undertake local assessment

Factors influencing the culture of special school physical education : A Gramscian critique

© The Author(s) 2020. Physical education (PE) research has largely been preoccupied with mainstream (regular) schools. This article reports on part of a larger research project that centralises special school PE. In particular, Gramsci’s conceptualisations of hegemony, power and ideology are utilised to help shed light on the key factors that shape the culture of special school PE. A number of key themes were constructed from twelve interviews with special school senior leaders and PE teachers including, ‘economic climate: budgetary constraints’, ‘access to appropriate facilities and learning spaces’ and ‘pressures from Office for Standards in Education, Children’s Services and Skills (Ofsted) and senior management team’. These findings demonstrate how particular historical and contemporary factors contribute to the positioning of PE in special schools. The status and value of PE in these settings is sometimes considered less favourably than other areas of the curriculum or indeed mainstream PE. In spite of this, staff tasked with delivering special school PE had the desire and creativity to offer engaging experiences. In concluding we note that issues concerning economic constraints, limited space to deliver PE and pressures associated with Ofsted can be found in many mainstream schools too. However, honing in on the particular circumstances within special schools broadens insight about PE in contemporary schools

Stereotype Behaviour in Sows and Gilts Housed in Stalls, Tethers, and Groups

Observations of sows and gilts in tethers, stalls, and groups showed two distinct types of behaviour: pre-feed behaviour when pigs were anticipating food, and after-feed behaviour. Sows and gilts tethered for the first time do not show pre-feed excitement, but this develops in 42 days which suggests that pre-feed behaviour is not stereotype, as suggested by the literature, but is a conditioned reflex. The question of the importance of after-feeding behaviours which are often called stereotypies is examined. The total time occupied by these behaviours over 24 hours by tethered sows is 14.5 to 29.0%, by tethered gilts 1.4 to 5.6%, by stalled sows 10 to 14%, and 4.2 to 6.3% in stalled gilts. Grouped animals do not show the same behaviours as the stalled and tethered ones. Several examples of true stereotypies are described, but not all tethered or stalled pigs exhibit chronic bar biting. Changes in the environment of two of these sows did not alter the fixed stereotype behaviour. Each individual seems to have an optimum level of environmental stimulation which may account for the great differences in individual behaviours

Stereotype Behaviour in Sows and Gilts Housed in Stalls, Tethers, and Groups

Observations of sows and gilts in tethers, stalls, and groups showed two distinct types of behaviour: pre-feed behaviour when pigs were anticipating food, and after-feed behaviour. Sows and gilts tethered for the first time do not show pre-feed excitement, but this develops in 42 days which suggests that pre-feed behaviour is not stereotype, as suggested by the literature, but is a conditioned reflex. The question of the importance of after-feeding behaviours which are often called stereotypies is examined. The total time occupied by these behaviours over 24 hours by tethered sows is 14.5 to 29.0%, by tethered gilts 1.4 to 5.6%, by stalled sows 10 to 14%, and 4.2 to 6.3% in stalled gilts. Grouped animals do not show the same behaviours as the stalled and tethered ones. Several examples of true stereotypies are described, but not all tethered or stalled pigs exhibit chronic bar biting. Changes in the environment of two of these sows did not alter the fixed stereotype behaviour. Each individual seems to have an optimum level of environmental stimulation which may account for the great differences in individual behaviours

Model of unidirectional block formation leading to reentrant ventricular tachycardia in the infarct border zone of postinfarction canine hearts

AbstractBackgroundWhen the infarct border zone is stimulated prematurely, a unidirectional block line (UBL) can form and lead to double-loop (figure-of-eight) reentrant ventricular tachycardia (VT) with a central isthmus. The isthmus is composed of an entrance, center, and exit. It was hypothesized that for certain stimulus site locations and coupling intervals, the UBL would coincide with the isthmus entrance boundary, where infarct border zone thickness changes from thin-to-thick in the travel direction of the premature stimulus wavefront.MethodA quantitative model was developed to describe how thin-to-thick changes in the border zone result in critically convex wavefront curvature leading to conduction block, which is dependent upon coupling interval. The model was tested in 12 retrospectively analyzed postinfarction canine experiments. Electrical activation was mapped for premature stimulation and for the first reentrant VT cycle. The relationship of functional conduction block forming during premature stimulation to functional block during reentrant VT was quantified.ResultsFor an appropriately placed stimulus, in accord with model predictions: 1. The UBL and reentrant VT isthmus lateral boundaries overlapped (error: 4.8±5.7mm). 2. The UBL leading edge coincided with the distal isthmus where the center-entrance boundary would be expected to occur. 3. The mean coupling interval was 164.6±11.0ms during premature stimulation and 190.7±20.4ms during the first reentrant VT cycle, in accord with model calculations, which resulted in critically convex wavefront curvature and functional conduction block, respectively, at the location of the isthmus entrance boundary and at the lateral isthmus edges.DiscussionReentrant VT onset following premature stimulation can be explained by the presence of critically convex wavefront curvature and unidirectional block at the isthmus entrance boundary when the premature stimulation interval is sufficiently short. The double-loop reentrant circuit pattern is a consequence of wavefront bifurcation around this UBL followed by coalescence, and then impulse propagation through the isthmus. The wavefront is blocked from propagating laterally away from the isthmus by sharp increases in border zone thickness, which results in critically convex wavefront curvature at VT cycle lengths