Adding life to years and years to life Delivering Effective Needle and Syringe Programmes Working...

Adding life to years and years to life

Delivering Effective Needle and Syringe Programmes

Working With and Providing Services for Performance

and Image Enhancing Drug Users (PIEDs)

Mark Harrison. Ralph Heron. County Durham Drug and Alcohol Action Team


DISCUS

DRUGS IN SPORT CLINIC and USERS SUPPORT

DRUGS IN SPORT CLINIC and USERS SUPPORT

“The use of images in this presentation does not imply an individuals’ use of performance and image enhancing drugs, rather that they are used to depict the attainment of a desired physique and appearance of the individuals.”


Why DISCUS• Need identified locally in 1993• 50% of needle exchanges were for PIED users• April-Sept 07 43% all new registrations• Prevention of blood borne viruses• PIED users reluctant to approach existing “drugs” services• Experience within gyms• Gateway service focussing on harm reduction• Some users collecting for up to 250 users


The DISCUS Team

DISCUS Service User

Clinic Co-ordinator

R.M.O.

15 years old this yearNurse

Sports DietitianSports Massage

Onward Referral


Services Available 1• 2 Hours per week • Over 1000 individuals registered • Informal and confidential• Full range of needle exchange services• Safer injecting advice• Responsible Medical Officer• Nursing assessment


Services Available 2• Specialist Dietician• Hepatitis A and B vaccination• Regular blood investigations• ECG• Body fat analysis• BBV testing• Referral on to other services if / when necessary


Services Available 3Regular blood investigations• FBC• LFT’s• Cholesterol• HDL/LDL• Testosterone levels• Thyroid Stimulating Hormone (TSH)• Hepatitis Titre


DISCUS Activity 2008-2009• Number of attendances 750• Number of Individuals 198• New Registrations 53• Needle Exchanges 225• Bloods Taken 154

Durham Harm Minimisation Services (April-September 07)• 43% of all new registrations to all Harm Minimisation services

were for PIEDs users.


DISCUS Gender Ratio

Male97%

Female3%

Male

Female

DISCUS Gender Split

Female 3%

Male 97%


Harm Minimisation• Start with lowest dose/stack possible

• Optimise diet and training regimes

• Use low androgenic initially

• Regular investigations

• Shortest cycle possible with max. time clean

• Use your own, sterile injecting equipment

• Correct injecting technique

• Know your source of gear


Creatine Monohydrate• Acts as muscle’s capacitor

• Effective in 70% of users

• 5-7lb of lean muscle

• Each dose = 2lb steak

• Take in warm drink with 100g of carbohydrate

• Loading phase = 10g for 5/7 then 5g for 5/7

• Maintenance phase = 2g daily


Style of PIED Use• Style of usage – stacking

style of cycle duration of cycle

time off cycle

• Oral or I.M. ? 17 Alpha-Alkylation


Indications of Public Health in the English Regions

Indicator England North East

North West

Yorkshire & Humber

East midlands

West Midlands

East England

London South East

South West

Rate per 1000 population who have used anabolic steroids

(2007-2008)

5.36 11.97 5.21 7.37 7.34 3.78 1.83 3.05 6.94 3.78

Better than average Consistent with average

Worse than average

Rates of Performance and Image Enhancing Drugs

Association of Public Health Observatories (2009) (from British Crime Survey)


Our Role (1)• Drug misusers have the same entitlement as other patients to the

services provided by the NHS.

• The General Medical Council has stated: “The investigations or treatment you provide or arrange must be based on the

assessment you and the patient make of their needs and priorities, and on your clinical judgement about the likely effectiveness of the treatment options.”

You must not refuse or delay treatment because you believe that a patient’s actions have contributed to their condition.

Drug Misuse and Dependence: UK Guidelines on Clinical Management (2007)


Our Role (2)

The General Medical Council has stated:• You must treat your patients with respect whatever their life choices

and beliefs.

• You must not unfairly discriminate against them by allowing your personal views (including your views about a patient’s lifestyle) to adversely affect your professional relationship with them or the treatment you provide or arrange.”

Where do PIED users fit into this guidance????


Recognition• British Medical Association identified DISCUS as an

“example of good practice”. (Pressure to Perform BMA 2001)• October 2008 DISCUS presented to Advisory Council

on the Misuse of Drugs (ACMD) and contributing to national review of PIEDs.

• Previous presentations at national injecting and PIED conferences.


Contact Details

Mark Harrison

Joint Commissioning Manager

Office: 0191 3837800

Mobile: 07747475402

[email protected]

Ralph Heron

Development Manager

Office: 0191 3837800

Mobile: 07884436320

[email protected]

Adding life to years and years to life Delivering Effective Needle and Syringe Programmes Working...

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