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International Journal of Drug Policy 119 (2023) 104139
0955-3959/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
Research Paper
“They sent it away for testing and it was all bunk”: Exploring perspectives
on drug checking among steroid consumers in Queensland, Australia
Timothy Piatkowski
a
,
c
,
*
, Cheneal Puljevic
b
,
c
, Cameron Francis
c
, Jason Ferris
c
,
d
,
Matthew Dunn
c
,
e
a
School of Applied Psychology, Grifth University, Gold Coast, QLD, Australia
b
School of Public Health, The University of Queensland, Brisbane, QLD, Australia
c
The Loop Australia, Australia
d
Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
e
School of Health and Social Development/Institute for Health Transformation, Deakin University, Geelong, Australia
ARTICLE INFO
Keywords:
Anabolic-androgenic steroids
Drug checking
Drug policy
Harm reduction
Risk environments
ABSTRACT
Introduction: Research supports the feasibility and acceptance of drug checking among nightlife and festival
attendees. Interest in expanding drug checking to other groups of people who use drugs, including those who
inject drugs, has grown. However, understanding the acceptability and feasibility of drug checking among
specic cohorts, like anabolic-androgenic steroids (AAS) consumers, remains a research gap. This study explores
AAS consumers’ perspectives on drug checking and service preferences, aiding the preparation for drug checking
delivery in Queensland, Australia. Methods: A purposive sampling technique was used to recruit 15 AAS con-
sumers (9 males, 6 females; Mage =36.80 years, SD =6.12) from Australia. One-on-one semi-structured
qualitative interviews were conducted with questions exploring participants’ views on drug checking/testing and
their preferences for AAS analysis. Thematic analysis was conducted with nal themes established through
iterative consensus. Results: Consumers expressed frustration with the prevailing stereotypes, social stigma, and
the perception of criminality associated with the use of AAS. There was a strong dependence on personal con-
nections and trusted suppliers, with coaches exerting signicant inuence. Participants expressed concerns about
the widespread availability of counterfeit products and underground operations. The act of using unknown AAS
was likened to a game of Russian roulette, underscoring the importance of obtaining accurate information and
access to reliable drug checking services. Consumers expressed a preference for a web-based platform that en-
ables individuals to access their own test results while contributing to a comprehensive database of brand-
specic testing outcomes. Discussion: AAS consumers recognise the signicance of monitoring their AAS use
and seek a service that can not only assist them in making informed decisions regarding AAS usage but also
potentially contribute to the knowledge of the wider AAS-consuming community. These ndings underscore the
importance of tailored education, drug checking services, and harm reduction measures to address the diverse
needs of AAS consumers.
Introduction
One of the consequences of drug prohibition is the lack of knowledge
regarding the composition and purity of illicit substances (Miron, 2003;
Taylor et al., 2016). This information gap poses signicant risks to in-
dividuals who consume drugs, as they lack knowledge of the contents
which can lead to physical harm (Darke & Farrell, 2014; Unick et al.,
2014). In the context of harm reduction, drug checking has emerged as a
strategy to address this issue. Drug checking programs aim to provide
consumers with accurate and timely information about the content and
potential harms associated with the substances they intend to consume
(Maghsoudi et al., 2022). Drug checking was traditionally designed to
provide harm reduction services and information about illicit substances
in party scenes, however, the remit of drug checking has expanded
signicantly (see Barratt & Measham, 2022). Drug checking programs
can be traced back to the late 1960s in the United States (Barratt et al.,
2018). According to a recent systematic review, these programs have
expanded globally and are now implemented in many countries
* Corresponding author at: School of Applied Psychology, Gold Coast Campus, Grifth University, QLD 4222, Australia.
E-mail address: t.piatkowski@grifth.edu.au (T. Piatkowski).
Contents lists available at ScienceDirect
International Journal of Drug Policy
journal homepage: www.elsevier.com/locate/drugpo
https://doi.org/10.1016/j.drugpo.2023.104139
International Journal of Drug Policy 119 (2023) 104139
2
including the United States, United Kingdom, Netherlands, Switzerland,
Spain, Portugal, Belgium, France, Australia, and Canada (Colledge--
Frisby et al., 2023).
Drug checking initiatives seek to empower individuals to make
informed decisions about their drug use (Weicker et al., 2020). These
programs typically involve analysing drug samples using various
methods, such as spectrometry or reagent testing, to identify the pres-
ence of specic substances and potential adulterants as well as dosage or
strength (Barratt & Measham, 2022). The provision of drug testing re-
sults to consumers provides some information about the potential risks
associated with their drug use (Barratt & Measham, 2022), although it is
important to note that these results may not encompass all possible risks
due to limitations in testing methodologies and the multifaceted nature
of drug-related harms (Masterton et al., 2022). Risks associated with
drug use can be inuenced by various factors, including the environ-
ment and co-substance consumption, which may signicantly impact
the overall risk prole beyond the specic drug content or purity
(Masterton et al., 2022). However, the implementation of drug checking
programs has shown positive outcomes and increased safety among drug
consumers in jurisdictions where it has been applied (Bardwell & Kerr,
2018; Measham, 2019). Feasibility studies indicate acceptance and
willingness among consumer populations to engage with these services
(Kennedy et al., 2018; Krieger et al., 2018; Palamar et al., 2019; Sher-
man et al., 2019). The positive reception among consumer populations
to engage with these services align with the call for widely accessible
harm reduction measures.
The Global Commission on Drug Policy recently advised govern-
ments to make harm reduction measures, including drug checking ser-
vices, widely accessible (Bewley-Taylor & Tinasti, 2020; Buxton et al.,
2020). Although there have been calls for drug checking in Australia for
some time (Ritter, 2020), initially there were only two Australian trials
of drug checking, both performed in a festival context (Byrne et al.,
2018; Olsen et al., 2019). This comprised a xed site trial service
launched in Canberra in 2022, which has been extended and is expected
to become a permanent service (Olsen et al., 2022). In February 2023,
the government of Queensland (the second largest and third most
populous state in Australia) announced support for the introduction of
drug checking services (Australian Broadcasting Corporation, 2023).
The recent recommendation to make drug checking services widely
accessible aligns with the harm reduction approach, which recognises
the social context and inuences surrounding substance use (Bewley--
Taylor & Tinasti, 2020; Buxton et al., 2020). The support for introducing
drug checking services by the government of Queensland reects a step
towards implementing population-level interventions aimed at reducing
drug-related harms and addressing health inequalities. While previous
studies surrounding these services have focused on populations such as
the nightlife/festival attendees, particularly ecstasy consumers, there is
still a gap in research regarding the perspectives and experiences of
those involved in the consumption of performance and image enhancing
drugs (PIEDs) such as anabolic-androgenic steroids (AAS). Therefore, in
the context of the Queensland government’s commitment to supporting
such services, this study specically aimed to explore AAS consumers
attitudes, perceptions, and needs regarding drug checking. Doing so
aligns service provision with broader goal of enhancing health outcomes
for this population given the high representation of AAS consumption in
Queensland, accounted for by the overrepresentation of AAS-related
arrests compared to other states and territories (Australian Criminal
Intelligence Commission, 2021).
The present study
There has been a consistently growing global trade in PIEDs (Mag-
nolini et al., 2022; Paoli & Donati, 2014) with AAS being a prominently
used group of these substances (Dunn et al., 2021; Dunn & Piatkowski,
2021; Hope et al., 2021). Despite a growing AAS market, these sub-
stances have been often reported to be variable in their quality
(Magnolini et al., 2022). Research suggests that illicit AAS generally lack
the specied active ingredient entirely or contain a different amount or
type of active ingredient than indicated on the labelling, highlighting
issues of misrepresentation and inconsistency in product composition
(Coimbra et al., 2021; da Justa Neves and Caldas, 2017). For example, a
global study of 5,413 samples suggested that the average estimated
prevalence of counterfeit AAS within the illicit market was 36%, while
an additional 37% were classied as substandard in terms of quality
(Magnolini et al., 2022). Coomber et al. (2015) found that the percep-
tion of risk for AAS consumers regarding substance analysis cannot be
solely determined based on forensic ndings. This is because users
genuinely believe that they are buying legitimate and effective AAS, and
they employ various subjective methods to ensure the authenticity of the
products (Coomber et al., 2015). Therefore, for AAS consumers, drug
checking can offer crucial information on the presence and purity of a
substance. This is particularly signicant given the high prevalence of
counterfeit AAS products in circulation (Coomber et al., 2015; Turnock
& Gibbs, 2023; van de Ven et al., 2020), where unintended use of
harsher varieties of AAS, such as Trenbolone (19-Nor AAS), can have
severe psychosocial consequences compared to testosterone or
DHT-derivatives of testosterone (Piatkowski et al., 2023b). Further-
more, the unpredictable combination of unknown substances or
dangerously high or low doses in counterfeit AAS products (Magnolini
et al., 2022) adds another layer of risk, increasing the potential for un-
foreseen and unpredictable health consequences among consumers.
Creating a bridge between public health and drug policy in the
context of AAS would be a signicant step towards providing adequate
healthcare to this, often overlooked, group of substance consumers
(Dunn et al., 2023; Piatkowski et al., 2022, 2023a). The risk environ-
ments framework provides a theoretical foundation for doing so (Rho-
des, 2002), emphasising the importance of enabling contexts and
resources in advancing harm reduction (Duff, 2009, 2011). Substance
use, including AAS, is inuenced by various interacting factors within a
social context. Hanley Santos and Coomber (2017) indicate that patterns
of AAS use among consumers varied based on their motivations, prior
knowledge, and experiences. Many users had limited knowledge about
AAS before starting their use, relying on information from peers or
suppliers, which was sometimes inaccurate or incomplete (Hanley
Santos & Coomber, 2017). As Hanley Santos and Coomber (2017) sug-
gest, when developing interventions targeting AAS use, it is crucial to
consider the broader context (e.g., motivations and experiences).
Therefore, we extend this study by investigating how individuals’ social
contexts and cultural interpretations of risk practices shape their
engagement with and perceptions of drug checking services, aiming to
enhance our understanding of the complexities surrounding risk be-
haviours and informing drug policy and practice in the context of drug
checking. While there is some integration of AAS consumers in harm
reduction, predominantly through needle service provision (Kimergard
& McVeigh, 2014; Piatkowski, Hides et al., 2022), ensuring the delivery
of sterile injecting equipment should be regarded as a minimal
requirement (Bates et al., 2021), Scholars have suggested harm reduc-
tion frameworks should expand to encompass a comprehensive range of
harm reduction interventions that address the needs of individuals using
AAS throughout their entire usage cycle, including those who opt for
temporary or permanent cessation of use (Bates et al., 2021; Bates &
Vinther, 2021). Therefore, further establishing the position of AAS
within harm reduction frameworks can facilitate an alliance between
public health policy and AAS consumers. This research is the rst study
internationally which attempts to investigate AAS consumers’ perspec-
tives on drug checking services, lling a research gap in the existing
literature. Drawing on a small group of consumers, this study explored
AAS consumers’ perspectives on drug checking services and investigated
strategies to meet their needs, aiding the preparation for drug checking
delivery in Queensland, Australia.
T. Piatkowski et al.
International Journal of Drug Policy 119 (2023) 104139
3
Methods
Sampling and recruitment
A sample of 15 AAS consumers (>18 years of age) were recruited
through purposive sampling techniques, leveraging the personal and
professional networks of the research team. These networks include The
Loop Australia and Queensland Injectors Voice for Advocacy and Action
(QuIVAA). Those interested and eligible completed informed consent
procedures. Participants were reimbursed for their time with a gift card.
Ethical approval was granted from the Grifth University Human
Research Ethics Committee (Approval: 2023/257).
Materials and data collection
Participants were invited to take part in one-on-one semi-structured
qualitative interviews. Questions included: Why do you believe testing
AAS is important/not important? What do you think about testing/
checking AAS? If there was a drug checking/testing service which could
analyse AAS, what information would you like to receive? Participants
were also asked for demographic information, such as age and their
gender. These interviews took place on the MS Teams platform, where
audio recordings were transcribed automatically. These transcripts were
checked for errors and imported into NVivo (QSR) for further analysis.
The mean length of interviews was 39 minutes and 32 seconds (Range =
14-118 minutes).
Data analysis
Data collection and preliminary analysis were conducted concur-
rently by the rst author, allowing for reexivity and adaptation of the
semi-structured interview guide questions with emerging insights
(Braun & Clarke, 2023). For instance, participants were specically
prompted to share their previous experiences related to AAS testing, as
several individuals in the sample had undergone such testing. Moreover,
additional prompts were introduced to encourage participants to pro-
vide more detailed responses to specic inquiries, such as "What po-
tential health effects can arise from the use of untested steroids?" The
data was analysed through a lens of social constructivism (Adams,
2006). This ontological position was recognised as suitable given that
knowledge is co-constructed through the interaction between the
researcher and participants, as the research aims and theoretical
framework shape the analysis of data and the resulting ndings
(Poucher et al., 2020). Further, given that the research aimed to explore
the perspective of this unique group of substance consumers and facil-
itate a collaborative research process, this was deemed a suitable
framework (Noorbergen et al., 2021). Once all interviews were
completed and transcribed, data were imported into NVivo for thematic
analysis. Thematic analysis followed Braun and Clarke’s six-step guide
(Braun & Clarke, 2019) involving data familiarisation, initial code
generation, identication of potential themes, review of themes, de-
ning/naming themes, and writing up ndings. Inductive analysis was
used to identify codes which were synthesised into themes to summarise
the key ndings from the interviews (Azungah, 2018). The coding
process continued until achieving inductive thematic saturation, a point
where the collected data ceased to yield signicant novel insights that
were pertinent to the research aims (Guest et al., 2020; Saunders et al.,
2018). This state of saturation was marked by the absence of newly
identied codes, themes, or sub-themes in the incoming data, which
could not be accounted for by the existing knowledge and literature in
the eld (Guest et al., 2020; Lam et al., 2022; Saunders et al., 2018).
Specically, no additional meaningful information or patterns emerged
from the data, indicating that the data analysis reached a point of
saturation, where the research aims were sufciently addressed, and
further data collection was unlikely to contribute substantially to the
research outcomes. The research team then met to discuss and review
this categorisation to arrive at nal themes and subthemes and names
thereof by an iterative consensus decision-making process (Braun &
Clarke, 2021). Participants were assigned with pseudonyms to preserve
their anonymity.
The researchers involved in this study brought together diverse
expertise from the elds of behavioural science, public health, and social
work. The rst author acknowledges his lived experience in the strength
sport and tness community. This rsthand involvement provided a
comprehensive understanding of the subcultures that emerge among
AAS users, and the author’s lived experience served as an asset during
interviews, facilitating in-depth exploration and enriching the depth of
inquiry (Zampini et al., 2021). The other authors contributed different
perspectives and interpretations to the ndings, generating novel
themes that contributed to the construction of the ndings in accordance
with established best practice (Braun & Clarke, 2023).
Findings
The participant pool consisted of male (n =9) and female (n =6)
participants whose mean age was 36.80 (SD =6.12); see Table 1 for full
participant characteristics. All participants in the study were either
originally from Queensland or had lived in Queensland for a portion of
their lives. However, two participants resided outside of Queensland at
the time of data collection. Seven participants had previously or were
currently testing their AAS through a private operator. We identied
four overarching themes that developed from the data.
Theme 1: Russian roulette: perceptions of unknown substances and
interactions with the criminal system
The metaphor of playing ‘Russian roulette’ emerged repeatedly in
participant narratives when describing the process of using untested
AAS, underscoring the uncertainty and potential harm associated with
using unknown substances. Stories of individuals injecting substances
that were revealed to be cooking oil or other unintended compounds
highlight the risks that consumers face when using product purchased in
a marketplace where there is no formal quality control due to its illegal
nature. One participant conveyed the potential consequences of unin-
formed decisions in the context of AAS use:
Albert [37, Male]: It’s like playing Russian roulette isn’t it. You’re
putting something into body thinking that it’s something… injecting
and having it smell like either like rosemary oil or sesame seed oil
and ending up with massive sort of welts and acne. It’s infected sort
of injection sites because like – “I think it’s, I think it’s testosterone.
I’ll use it”.
Many participants considered AAS to be overlooked and receive little
attention within the harm reduction space. Participants expressed frus-
tration with the prevailing stereotype that associates AAS use
Table 1
Participant details.
P Pseudonym Gender Age Interview Length (M:S)
1 Bryce M 33 31:04
2 Paul M 41 34:55
3 Albert M 37 33:32
4 Phoebe F 21 30:20
5 Henry M 35 31:15
6 Cuthbert M 35 13:31
7 Jayden M 38 117:47
8 Paris F 43 34:16
9 Alexis F 32 25:21
10 Willy M 41 52:12
11 Victor M 39 25:33
12 Samantha F 42 44:23
13 Danielle F 30 16:06
14 Winslow M 40 38:57
15 Rose F 45 48:10
T. Piatkowski et al.
International Journal of Drug Policy 119 (2023) 104139
4
exclusively with ‘massive bodybuilders.’
Jayden [38, Male]: Steroids is something which is sort of often
overlooked in terms of, you know, seeing it as a drug because, you
know, people just think oh, you know, it’s these massive body-
builders that are taking it.
In turn, this frustration appeared to drive consumers into increas-
ingly insular communities. Given the legalities surrounding illicit sub-
stance consumption in Australia, there were also criminality factors
which heightened participants penchant for close-knit groups.
Henry [35, Male]: Yeah, like I said, man, like a lot of people, they’re
really shady, but they don’t talk about it [AAS]. And for obvious
reasons, they might not want people to know that they’re doing what
they’re doing.
For instance, several participants shared experiences that under-
scored the criminal nature of AAS use. These occurrences ranged from
interactions with police, as well as instances of being caught with un-
derground AAS and subsequent legal consequences. These experiences
were not uncommon among participants.
Jayden [38, Male]: There’s been a couple times, you know, outside of
our gym where? You know, a few of us have sort of been randomly
pulled over by police ofcers, you know, after walking out with bags
from the gym.
Cuthbert [35, Male]: I’ve been caught a couple of times. I got raided and
the cops found my stuff and I’ve been in court a few times.
Interestingly, in occasions when police seized and tested these
compounds, they were reported to be counterfeit.
Albert [37, Male]: I’m all for it [drug checking] because there was
there was an incident where I got caught with underground steroids.
And they sent it away for testing [forensic analysis] and it was all
bunk [fake].
Ultimately, participants believed that the ability to test AAS in a safe
manner and receive feedback would reduce the likelihood of encoun-
tering counterfeit or harmful substances.
Samantha [42, Female]: I think people being able to test stuff and
realise how crap it is, and how much they’re just throwing their
money away on shit is more likely to prevent steroid use than harsh
laws.
Theme 2: social networks and personal relationships: “it’s all word of
mouth”
Social relationships held signicant importance in the acquisition of,
by the consumer’s standard, reliable AAS. Participants described their
preferred strategies for nding reliable sources of AAS. They stressed the
importance of personal connections and social validation, relying on
suppliers who have established relationships with high-level athletes.
Trust was placed in individuals who demonstrated passion and expertise
in manufacturing AAS. This social validation helped legitimise the
sources and provided consumers with a sense of condence in the sub-
stances they obtained.
Rose [45, Female]: I physically like, I know the person that I’m
buying gear [AAS] off, as in have a social relationship with them.
This sounds really odd but also to know how passionate they are
about what they do in regards to manufacturing performance
enhancing drugs. I also know that they supply to a lot of really high-
level athletes.
Several participants noted that coaches played a pivotal role in
shaping the market by endorsing specic suppliers and vouching for the
quality and legitimacy of the products. Participants mentioned instances
where coaches themselves used the same substances and assured their
athletes about their safety and effectiveness. This dynamic creates a
bidirectional effect, as athletes place trust in their coaches’ judgment
and follow their recommendations. Coaches, as inuential gures
within the AAS community, contribute to the establishment of reliable
sources and inuence the choices made by consumers.
Phoebe [21, Female]: They’re oftentimes buying it off their coach
who like their coach is endorsing this particular supplier and prob-
ably getting a cut as well and like. The coach is assuring them that the
quality is amazing, all the quality’s legit. Like, I take this stuff, blah
blah, blah, like, and these are like young girls that they’re doing this
to.
The participant narratives underscored that trust is built through
ongoing interactions and a sense of familiarity. They express satisfaction
in knowing the person they are buying from, believing that this
connection ensures greater accountability and decreases the likelihood
of being deceived or sold counterfeit substances. This interpersonal
dimension of the market fosters a sense of reliability and reduces the
perceived risk associated with purchasing and using AAS.
Victor [39, Male]: I have, you know, a good relationship with the person
who supplies me.
Danielle [30, Female]: So, the person that I get it off is also in the
powerlifting world. So he has used all of those things. I trust him in
terms of providing legit stuff.
Social networks were important in obtaining reliable AAS and
shaping the market. Participants expressed trust in their personal re-
lationships with suppliers, who were considered to be well-connected
within the AAS manufacturing community. They relied on word-of-
mouth information and anecdotal evidence, verging on myth, from
other consumers to assess the quality and safety of the substances they
purchase.
Cuthbert [35, Male]: It’s hard because batches do change so often.
The truth is, yeah, you can go on the bodybuilding forums, and you
can do as much as you possibly can to research and stuff like that, but
it’s all word of mouth.
Theme 3: navigating product legitimacy and quality: “there’s no receipt”
Despite the importance of social networks, reliability and trustwor-
thiness of AAS sources were frequently questioned, given the prevalence
of counterfeit and substandard products. Notwithstanding the methods
outlined previously that participants used to try and ensure they were
using good quality product, they still expressed concerns over the lack of
transparency and the potential for unscrupulous actors to manipulate
the contents of the purchased products.
Rose [45, Female]: I’ve known suppliers to tell me that they have
supplied gear to people they didn’t like, and they just lled the
containers up with oil… people they see in the gym every day.
Counterfeit and substandard substances were prevalent, leading to
scepticism about the transparency and integrity of suppliers. The illegal
nature of the market limited consumers’ recourse in addressing these
issues, as there was no ofcial avenue to report or address counterfeit
products. Participants expressed frustration over the lack of account-
ability, recognising the inherent challenges of illicit trade. As one
participant noted, attempts to manipulate labelling systems and
distribute inferior products not only undermined the branding efforts of
legitimate suppliers but also left consumers powerless to seek recourse.
The absence of regulatory oversight and the illegal nature of the trade
contributed to a sense of helplessness and the inability to voice concerns
or seek redress.
Albert [37, Male]: Someone tried to knock off their [brand name]
labelling system and there was a heap around of it [product]… stuff
that was sort of bunk shit which sort of wrecked their branding and
T. Piatkowski et al.
International Journal of Drug Policy 119 (2023) 104139
5
there’s nothing that you can do about it because it’s illegal. Who are
we going to fucking tell?
Winslow [40, Male]: There’s no receipt. So, you’d legitimise the trade
process if people were able to test it.
The comparison between pharmaceutical-grade AAS and those pro-
duced in underground operations also emerged as a noteworthy
distinction. Participants recognised that obtaining AAS directly from
testosterone-replacement therapy clinics offered a higher level of con-
dence in terms of product quality and legitimacy. Pharmaceutical-
grade AAS were often considered more potent and reliable, leading to
a perception of increased control and effectiveness. However, the illicit
nature of the AAS market and the associated risks of legal repercussions
made accessing pharmaceutical-grade products difcult for many
consumers.
Victor [39, Male]: I know a lot of guys who have gone from under-
ground to pharma [pharmaceutical testosterone] and then go wow.
They feel the difference in a smaller dose of pharma because it’s
stronger and it’s more legit and controlled. To know what you’re
getting, it’s a roll of the dice, because who knows how those guys are
making it, right.
To mitigate the risks associated with product legitimacy, participants
had various strategies for checking the quality and authenticity of the
AAS they obtained. These strategies ranged from visual inspections to
more advanced techniques, such as testing. Participants emphasised the
importance of testing the substances they purchase to verify their po-
tency and purity.
Paris [43, Female]: So there has been two different brands that I’ve
used and stuck with. I tested and they both came back as great
quality. So I was like okay, done. I’m onto a good thing, not gonna
change it.
Forums also played a signicant role in disseminating information
and experiences related to product legitimacy and brand reputation.
These sites were used so that consumers could share their testing results
and discuss trusted and untrusted brands. These forums provided con-
sumers an opportunity to navigate the complex landscape of the AAS
market and make informed decisions about their purchases.
Alexis [32, Female]: I know there’s a private group there where you
can pay per month and then you get access to those results. But
getting access to those results, you’d at least know which branch you
should denitely stick away from.
Despite the awareness of the prevalence of counterfeit and sub-
standard AAS and the inherent risks associated with them, consumers
continued to rely on these products to discern authenticity. These pro-
cesses underscore an urgency for enhanced measures, such as drug
checking services, to address the persistent issues precluding consumers
from ensuring reliable AAS for informed decision-making among
consumers.
Theme 4: emphasis on testing, transparency, and support: “there’s a level of
trust that needs to be built”
There was strong inclination to possess comprehensive knowledge
about the composition, potency, and absence of contaminants in AAS.
The signicance of ensuring accurate labelling of AAS was emphasised,
indicating the commitment of consumers to procure and use AAS that
are not only effective but also considered ‘safe’. This nding underscores
the importance placed by consumers on obtaining reliable and trust-
worthy AAS products.
Bryce [33, Male]: We’re gonna want to know the label’s right. The
compound. The purity. If there’s anything that shouldn’t be in there.
The idea of drug checking was met with acceptance by participants.
They saw no issues with sending their samples to a testing facility and
receiving results through an email or an online portal. The convenience
and anonymity offered by this approach aligned with the participants’
desire for harm reduction in a public space. They emphasised that AAS
use is a niche community with unique complexities, and the availability
of reliable drug checking services would contribute to harm reduction
efforts.
Victor [39, Male]: It is a little bit more serious for us [AAS con-
sumers]. You’re making sure something that you’re putting intra-
muscularly into your system is what it is. You see some horror stories
where guys put in random stuff and get an infection and have to get it
cut out.
Consumers discussed the potential benets of real-time monitoring
and anonymous dissemination of testing results. They envisioned that
their individual test results could contribute to a larger database of
brand-specic testing outcomes. This approach would allow consumers
to track the quality and consistency of different brands over time,
leading to informed decisions about their purchases.
Alexis [32, Female]: Then you can database it. If you’ve got an account
you can log into, you can see what things were and what they are.
The participants recognised the potential benets of a service that
provided information and support for harm reduction in the context of
AAS use. They believed that if such a service existed, individuals would
be less likely to use variable dosed or contaminated substances.
Phoebe [21, Female]: I think with regards to harm reduction, say
they had that service accessible where they could test their gear. I
think if they found out what they were taking currently or had plans
to take was fake or underdosed, overdosed, or contaminated etc. they
may be less inclined to take that. They may just do something else
like I think it would be so helpful just if it was accessible.
Trust and rapport emerged as signicant factors in the participants’
discussions about accessing support services. These views were closely
linked to participants’ experiences of persistent stigma associated with
AAS use, describing it as a "hush, hush" and taboo subject. Engaging in
discussions about AAS use was perceived as socially unacceptable,
leading to secrecy and silence among consumers. The prevailing stigma
created an environment of fear and apprehension, contributing to a
culture of secrecy surrounding AAS consumption.
Bryce [33, Male]: Yeah, it’s still like very, you know, hush, hush. I
know a lot of people that use or have used, but it’s still a very taboo
subject.
As a result, participants stressed the importance of building trust
with the service providers which already had strong rapport in the
community – needle service providers (NSPs). The close and trusted
association with NSPs and AAS consumers has been demonstrated to
facilitate access to essential resources, support, and information related
to safe injection practices, harm reduction, and other health-related
services.
Henry [35, Male]: I walk in the front door [of the NSP] and walk out.
You take those brown bags out; everyone knows what it is and I don’t
care. I think that it [the NSP] helps in a big way. Down on the [place
name] in [place name] there’s one needle exchange and that’s the
one I used to go to. They’re good.
Phoebe [21, Female]: So, I guess if the service was attached to like a
needle exchange that would be helpful.
Building on this, participants recognised that trust is vital to estab-
lishing a safe and supportive environment where individuals can seek
advice and share their experiences openly. The presence of qualied
experts or individuals with rsthand experience was highly valued, as
they could offer reliable and informed guidance.
T. Piatkowski et al.
International Journal of Drug Policy 119 (2023) 104139
6
Henry [35, Male]: If there’s a physical location, keeping it like the needle
exchanges is good. They’re always kind of tucked around the back, not
visible inside.
Alexis [32, Female]: You know, there’s I think there’s a level of trust
that needs to be built for the service and the site [drug checking xed
site] and those people who work within it.
The participants further highlighted the role of peers in the AAS
community. They discussed the need for peer-led support, where in-
dividuals with extensive knowledge and experience could provide
mentorship and guidance to those seeking information. Participants
acknowledged that not all sources of advice are reliable, and the inu-
ence of peers could be signicant in shaping individuals’ decisions and
practices. They expressed the desire for expert opinions and in-
terventions to ensure the safe and effective use of AAS.
Samantha [42, Female]: You know, even something like some
mentorship or like maybe someone with far more lived experience.
For example, having a look at someone’s cycle because people do run
stuff which makes no sense, could be harmful for them.
There is a strong linkage between Theme 2 and Theme 4 which
highlights the interplay between social relationships and the emphasis
on trust in the context of AAS consumption. Social relationships and
trust are integral factors inuencing AAS consumer behaviour and mo-
tivations. There was signicance placed on personal connections in
obtaining reliable AAS, relying on individuals with established re-
lationships with high-level athletes and coaches who vouched for the
quality and legitimacy of the products. This social network played a
pivotal role in shaping the market and inuencing consumers’ choices.
Building trust with service providers was also emphasised, as they
served as trusted sources of support, information, and harm reduction
resources within the community. The participants’ discussions under-
lined the importance of trust, rapport, and ongoing interactions in
establishing a safe and supportive environment, where individuals could
seek advice and share experiences openly. Peer-led support, mentorship,
and guidance were also recognised as valuable resources. These ndings
underscore the intricate relationship between social relationships and
trust, as well as their collective impact on the experiences and behav-
iours of AAS consumers.
Discussion
Enhancing awareness and facilitating access to reliable drug check-
ing services emerged as critical needs within a sample of people from the
AAS community in Queensland, Australia. The signicance of recog-
nising potential risks of underground AAS and educating consumers
about physical harms through public health initiatives as well as the
provision of drug checking services, were underscored by consumers.
Notably, the initiatives emphasised by consumers echo extant work in
this area, including specic types of information to effectively manage
risks associated with AAS use, medical and emotional assistance, and the
need for addressing societal biases and promoting understanding (Har-
vey et al., 2020; Underwood et al., 2021). Consumers drew parallels
between the uncertainty and potential harm associated with consuming
unknown substances and the risky nature of ‘playing Russian roulette’.
They expressed a specic desire for detailed knowledge regarding the
composition, purity, and absence of contaminants in the AAS they use.
Their vision encompassed a web-based platform that enables individuals
to anonymously access their own test results while contributing to a
comprehensive database of publicly available brand-specic testing
outcomes. Transparency and real-time monitoring via web platform
were identied as potential mechanisms to incentivise suppliers to
improve product quality. Accessible harm reduction support was desired
by this group, both at a point-of-care xed site and via digital platforms.
There was importance placed on condentiality and trust as key ele-
ments in facilitating effective interventions. While these ndings align
with the existing literature on the broader group of illicit substance
consumers who welcome drug checking services (Kennedy et al., 2018;
Krieger et al., 2018; Palamar et al., 2019; Sherman et al., 2019, Valente
et al., 2019), it is important to acknowledge that this study contributes
to the establishment of specic support and needs within the AAS
community. This aspect positions these ndings as a potential reference
point for policy makers, demonstrating the unique requirements and
advocating for the implementation of targeted interventions and support
services for AAS consumers.
Shaping the steroid market: enabling contexts to reduce harm
Drug harms are shaped by social situations and environments,
expanding the responsibility for harm reduction beyond individuals to
include social and political institutions (Rhodes, 2009). Contemporary
discourse in the eld of public health, drawing upon diverse research
traditions, underscores the signicance of social determinants in
shaping health disparities and asserts that effective mitigation of these
disparities necessitates the implementation of population-level in-
terventions (Gehring et al., 2022). However, scholars have asserted that
relying solely on ‘persuasion’ and ‘command and control’ strategies for
intervention is insufcient (Bacon & Seddon, 2020; Ritter, 2010).
Notably, market-driven regulation has been suggested to have the po-
tential to mitigate the harms associated with drug use for some time
(Ritter, 2010), further evidenced by proactive support from consumer
groups (Measham & Turnbull, 2021). Implementation of market stra-
tegies such as drug checking can effectively alter consumer preferences
and incentivise changes in the behaviour of sellers operating within the
drug market (Ritter, 2010; Seddon, 2020). For AAS, the surging unreg-
ulated supply from online sources is accompanied by misleading infor-
mation regarding the benets and risks associated with their use (Gibbs,
2023; Turnock & Gibbs, 2023), posing signicant concerns. The present
study builds on previous work, outlining AAS consumers overreliance on
information from suppliers (Hanley Santos & Coomber, 2017). There-
fore, public drug checking services, with provision for AAS, could have
potential to shape the market for AAS consumers, representing an
enabling place and resource (Duff, 2010, 2011). Due to the reported
structure of AAS markets (Coomber et al., 2015) this ‘shaping’ may have
large-scale impact.
Social environments signicantly inuence AAS consumers’ de-
cisions and experiences (Hanley Santos & Coomber, 2017; Kimergard &
McVeigh, 2014). AAS consumers trusted their long-term drug dealers
due to established relationships, consistent supply, and effective
communication, which shares parallels with other illicit substance
consuming cohorts (Bardwell et al., 2019). Participants in this study
relied on word-of-mouth information and trusted suppliers who had
established relationships. Further, tting with previous work, coaches
(Gibbs et al., 2022; Gibbs & Piatkowski, 2023; Piatkowski et al., 2023b,
2023c) and peers (Piatkowski, Hides et al., 2022) inuenced consumers’
choices by endorsing specic suppliers, reecting their important
structural position within AAS communities. Trust in personal connec-
tions may create a perception of reliability and reduce perceived risks
associated with AAS procurement and use. However, it is important to
recognise that this trust may be misplaced, as the trusted individuals
may not have direct control over the quality of the substances they sell,
and their own suppliers may play a signicant role in determining
product quality. Perhaps, as a result, participants did discuss concerns
about counterfeit and substandard products in the AAS market, indica-
tive of current trends (Frude et al., 2020; van de Ven et al., 2020). Un-
derground operations were recognised as variable in product quality,
while pharmaceutical-grade AAS were seen as more potent and reliable,
albeit difcult to access, reective of existing work (Dunn et al., 2021;
Underwood et al., 2021). Online forums have been proposed to provide
a platform for sharing harm reduction information (Tighe et al., 2017),
which the current ndings build on, demonstrating a component of
reducing harm is employed through consumer-driven measures to
T. Piatkowski et al.
International Journal of Drug Policy 119 (2023) 104139
7
increase brand transparency. Strategies for checking quality and
authenticity ranged from visual inspections to advanced techniques like
QR codes and private testing services. Although consumers indicated
some utility of private testing services, they specied public drug
checking services would be welcomed and preferrable. Ultimately, the
discussion on drug checking services which catered to AAS consumers
underscored the signicance of providing this group with feedback on
testing results, enabling them to modify their usage practices, thus,
empowering them to make informed decisions and incentivise suppliers
to improve the quality and legitimacy of their products. The practice of
making informed choices on substance consumption has demonstrated
its benecial impact on consumers’ health, particularly in the context of
engaging with other illicit substances (Bardwell et al., 2019; Barratt
et al., 2018).
Conclusions
The present study investigated the specic needs of a sample of AAS
consumers from Queensland, Australia regarding drug checking services
and their perceptions of the most effective strategies for meeting those
needs. Although the study sample was modest, this work represents the
world’s rst research to explore AAS consumers drug checking needs.
These ndings contribute to establishing specic support and needs
within the AAS community, serving as a potential reference point for
policy makers to advocate for targeted interventions for AAS consumers.
The study underscores the importance of tailored education and drug
checking services to address the diverse needs of AAS consumers.
Further research may assess the utility of building strategies for pro-
ducing and disseminating education to AAS consumers alongside drug
checking services. These measures could further mitigate the risks
associated with AAS use and enhance harm reduction efforts.
CRediT authorship contribution statement
Timothy Piatkowski: Writing – review & editing, Writing – original
draft, Resources, Project administration, Methodology, Investigation,
Formal analysis, Data curation, Conceptualization. Cheneal Puljevic:
Writing – review & editing, Formal analysis. Cameron Francis: Writing
– review & editing, Formal analysis, Conceptualization. Jason Ferris:
Writing – review & editing, Formal analysis. Matthew Dunn: .
Declaration of Competing Interest
Dr’s Piatkowski, Dunn, Puljevic, and Prof Ferris, are volunteer
members of The Loop Australia, which is a national organisation for
drug checking and drug checking research. Cameron Francis is the CEO
of The Loop Australia.
Funding
Dr Cheneal Puljevi´
c is supported by Discovery Early Career
Researcher Award from the Australian Research Council
(DE230101131).
Ethics
The Authors declare all procedures were performed in compliance
with relevant institutional guidelines and that the appropriate institu-
tional committee(s) have approved them. We also include a statement in
the manuscript regarding appropriate ethical safeguards and ethical
approvals which were obtained.
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