Over-the-Counter Steroids?This study evaluated the degree to which anabolic-androgenic steroids are proffered for sale over the Internet and how they are characterized on popular websites. Searches for specific steroid product labels e. The websites frequently presented misinformation about steroids and minimized their dangers. Implications for education, prevention, treatment over the counter anabolic steroids policy are discussed. Anabolic-androgenic steroids AAS are synthetic forms of the primary male sex hormone, testosterone. Anabolic refers to the tissue-building properties of these drugs whereas androgenic refers to their over the counter anabolic steroids of masculine characteristics, such as anabolci hair. To date, hundreds of AAS have been developed and many of these are available by prescription within the United States.
Nonprescription Steroids on the Internet
This study evaluated the degree to which anabolic-androgenic steroids are proffered for sale over the Internet and how they are characterized on popular websites. Searches for specific steroid product labels e. The websites frequently presented misinformation about steroids and minimized their dangers. Implications for education, prevention, treatment and policy are discussed. Anabolic-androgenic steroids AAS are synthetic forms of the primary male sex hormone, testosterone.
Anabolic refers to the tissue-building properties of these drugs whereas androgenic refers to their promotion of masculine characteristics, such as facial hair.
To date, hundreds of AAS have been developed and many of these are available by prescription within the United States. Schedule III drugs are those that have a medically indicated use but also have a moderate liability for misuse and may precipitate physical or psychological dependence 21 U. Like many commonly misused drugs, AAS have a variety of legitimate medical indications.
They are used to promote weight gain for patients with HIV-related weight loss Stawford et al. Available evidence indicates that AAS can significantly enhance mood Pope et al. Unfortunately, substantial health risks have been associated with the use of AAS, even when taken in accordance with prescription standards and at a fraction of the dosage typically ingested by those misusing AAS for increased strength and muscular enhancement. These adverse effects may include peliosis hepatitis blood-filled cysts on the liver or spleen Nakao et al.
The psychological effects are unpredictable and can range from simple mood swings to unprovoked rage Daly, Of particular concern is the severe withdrawal syndrome that can follow cessation of AAS after sustained high doses, which may include depression, lethargy, decreased libido and muscular atrophy Brower, , ; Sinha-Hakim et al.
Some of the physical side effects of AAS especially those related to hepatic functioning can be bypassed by using injectable preparations in lieu of pills. However, a variety of injection-specific risks can arise that mirror those of other drugs delivered by syringe Evans, Moreover, because AAS are delivered primarily via deep muscle injections as opposed to intravenously, there is a risk of nerve damage if the syringe is not properly positioned Evans, The goal of cycling is to promote recuperation of the hypothalamic-pituitary-testicular-axis HPTA , restore endogenous testosterone production and reverse AAS induced hypogonadism.
Additionally, off-cycles are used to avoid detection during competition in drug-free athletic events. During on-cycles, a pyramid-dosing or titration regimen might be followed, in which the user gradually works up to the highest dosage and then back down to a low dose prior to the conclusion of the cycle National Institute on Drug Abuse [NIDA], ; Peters et al.
Anecdotal evidence suggests that tapering off of high levels of AAS, as with many other medications, can reduce withdrawal symptoms or rebound effects; however, this has not been established scientifically NIDA, Finally, some people misusing steroids may adhere to intricate multi-drug regimens using a combination of oral, intramuscular and transdermal preparations NIDA, ; Peters et al. There is, however, limited scientific evidence that stacking accomplishes these goals.
Non-AR mediated anabolism, such as increases in endogenous growth hormone production, has been proposed but is poorly understood and may be more dependent on the particular AAS employed rather than the use of supraphysiologic dosages.
Despite popular beliefs, the addition of excessive dosages and multiple types of AAS have not been shown to elicit a summative effect NIDA, Maycock and Howat describe the self-reported barriers as well as how AAS users overcome these barriers before initiating steroid use.
According to users, barriers to AAS use include: Wichstrom discusses predictors of AAS use and notes that those who are offered AAS are at a higher risk of initiating use. Prior to the advent of the Internet, AAS were commonly smuggled into the United States from Mexico and European countries DEA, and sold in clandestine ways at gyms and through direct, person-to-person sales. Now, purchasers can place orders from their homes to online pharmacies, many of which ignore legal prescription regulations or operate out of countries like Mexico and Thailand in which AAS are available without a prescription GAO, All of those shipments contained actual AAS and were delivered from foreign countries.
Although many legitimate online pharmacies do follow these guidelines, others purport to offer an online consultation in the form of a medical questionnaire see Appendix A1 for a sample online medical questionnaire , perhaps followed by a phone call. In light of the findings of Maycock and Howat , the information sought out by youth online may aid in the breakdown of barriers to AAS use. The social stigma of AAS use is one of the barriers Maycock and Howat discuss and could be a contributing factor to the feeling that these drugs are hard to talk about.
Searching for information and purchasing drugs online could be a convenient avenue for users to overcome the barrier of social stigma. According to Wichstrom , even when searching the Internet for informational purposes only, the large number of offers to sell the drug may increase the likelihood that AAS use will be initiated.
The present study was undertaken to quantify the degree to which AAS are being proffered for sale over the Internet, how these drugs are being characterized on popular websites, and the accuracy of the information being presented.
There are literally hundreds of AAS substance-related terms, including both generic and brand labels. It was thus necessary to reduce this exhaustive list to a manageable set of search terms that are most likely to be used by individuals seeking to obtain AAS without a valid prescription. The first search examined the top 20 links to determine whether the most popular websites were advocating use of these drugs, discouraging their use, or providing objective information about their use.
The second search examined the top links to determine what proportion of the websites offered to sell AAS without a valid prescription or linked to other websites purporting to do so i. This search was extended to links because individuals seeking to purchase drugs illegally would be more likely to delve farther in pursuit of their objectives.
Two highly trained research technicians independently coded the websites according to a priori scoring criteria described below. Including duplicate sites best represented what online users would be likely to encounter during a routine search. Although duplicate sites were encountered from time to time, they were not common and did not appear to unduly influence the tallies. Although sponsored links are apt to be viewed by online users, their prominence can fluctuate considerably depending upon the length of sponsorship.
For this reason, they were not included in the tabulations for this study. All of these methods were purposely taken to produce a conservative estimate best case scenario of the issues examined. The first 20 non-sponsored links returned for each search term were categorized according to the following criteria:.
The first links were coded according to whether the websites offered to sell AAS without a valid prescription or linked to other websites offering to do so. Payment options were recorded for retail non-prescription websites, as was the country of registration using domain registration look-up services including godaddy.
The websites were categorized as:. Table 2 presents the average percentages of the top 20 websites that were classified as Pro-use, Anti-misuse, Neutral or Other during the four-month study. In contrast, drug-specific terms elicited a greater percentage of websites advocating for use of the drugs. Most of the product labels elicited roughly one-half or more websites that were classified as Pro-use and almost no site that was classified as Anti-misuse.
This is likely attributable to the fact that Oxandrolone is used more readily for legitimate medical indications such as severe tissue wasting due to injury, illness, infection, or trauma e.
A standardized content analysis was beyond the scope of this research study. It is noteworthy, however, that the large majority of pro-use websites were geared towards people seeking strength, physical attractiveness and popularity. Among adolescents, AAS are often used to enhance performance, however, the most prominent reason for use is to improve appearance Bahrke et al. The pro-use websites often provided testimonials from satisfied customers that would impress most adolescents e.
In total, 32 distinct Retail websites offering to sell AAS without a valid prescription were identified during the course of this 4-month study.
Many of these websites also offered to sell human growth hormone, harm-reduction products, syringes, and cycling and stacking regimens. March through June Again, there was relatively little variability between specific AAS drugs, with most searches eliciting roughly one-quarter to one-third Portal sites. In total, distinct Portal websites were identified.
As previously stated, a standardized content analysis was beyond the scope of this study. It was noted, however, that the Portal sites generally fell into one of three categories.
For example, bodybuilding websites often contained message boards that were used by patrons to post links to retail sites selling AAS and related paraphernalia. For example, certain online texts and encyclopedias permit entries to be posted by patrons. The AAS-related entries in many of these online texts included pro-use statements or links to retail sites posted by visitors. Information regarding acceptable payment methods was collected for all Retail websites.
Finally, data were collected on the country of registration for each Retail and Portal website. To establish a website, it is necessary to purchase a website name from one of various domain registration services such as register. Unfortunately, there appears to be little in the way of a check on the veracity of the information provided; however, these are the best data currently available on the country of registration for websites.
The results of this study suggest that the Internet may be serving as a substantial repository of illegal advertising and misinformation about AAS; as well as a resource for acquiring these drugs without a valid prescription and for non-medically indicated uses. This may be of particular concern for parents of minors and young adults, because many of the sites are directing their messages towards those seeking rapid improvements in strength, physical attractiveness and popularity.
The large proportion of online offers for AAS may increase the risk of AAS use by individuals who initially search the Internet just for information and come in contact with these websites Wichstrom, An online search using any of the common AAS product labels, slang references, or generics yield many results. Given such statistics, it would be ill advised for parents or teachers to encourage children, especially adolescents, to learn about AAS using the Internet — or for example in an un-monitored library research project.
Misinformation an adolescent might encounter on these websites will promote positive, incorrect views and could play a significant role in AAS initiation.
In the absence of effective governmental regulation of Internet websites, parents and educators need to educate their children about the inherent dangers of the Internet and assure they are exposed to objective websites that offer accurate health information. The largely misleading information presented on the Internet regarding AAS could lead one to believe that the misuse of these drugs is both safe and beneficial. Because objective websites appear to be outnumbered on the order of ten- to twenty-fold, youths might be unlikely to encounter them unless properly guided by an informed, trusted adult.
In light of the findings of this research, the positive messages and misinformation on the Internet regarding AAS could lead to a false belief of the safety of these drugs and therefore may impair reasoned judgment of a person considering AAS use.
In contrast, the names of specific AAS drugs e. This suggests that anti-misuse websites need to do a better job of including relevant search terms in the text of their websites to ensure they are accessed during a broader range of online searches.
These websites also need to insert themselves as sponsored links into the most popular search engines to ensure they are accessed during a broader array of AAS-related search terms. Due to the fact that Internet-based drug dealers have become proficient at ensuring that Internet users repeatedly encounter their messages, educators, scientists and treatment providers need to become equally proficient at spreading their own messages.
Sources of legitimate information, such as NIDA, also need to be cautious to put forward scientific and objective information that has been checked for validity as the presentation of false or misleading information could result in a lack of trust in people seeking reliable drug information. The Internet appears to be a very active marketplace for AAS and thus represents a significant public health threat based on the serious side effects known to be associated with these drugs.
Advertising for AAS occurs on a daily basis through the media reporting on high profile athletes who are known or suspected to use them and whose performance has been enhanced. An obvious limitation of this study is that we did not order the drugs to determine whether they would, in fact, be delivered. It is possible that some of the purported Retail sites are actually scams and do not ship AAS or other illicit drugs.
It is likely that a significant proportion of the retail sites identified in the current study do ship these drugs without a valid prescription and in violation of U. Individuals who are intent on making illicit drug purchases are likely to refine their search strategies quickly to obtain a purer and longer list of Retail and Portal sites. Finally, it should be noted that websites with different URL addresses and distinct homepages and content, may still be owned by the same party or parties.
Some online sellers may create multiple websites in hopes of attracting a larger number of customers. Moreover, websites may be continuously erected and taken down on an ongoing basis to elude law enforcement officials.