Jim McVeigh PhD was appointed as the Director of Public Health Institute in November 2015. Jim has worked within health/public health for nearly 30 years, with an academic career starting in the University of Liverpool before moving to Liverpool John Moores University as a Research Assistant in 1999. Subsequently he has held various positions within Public Health including Senior Lecturer, Reader, Deputy Director and most recently, Acting Director. He has gained significant management skills and leadership experience, while developing extensive links with external organisations and stakeholders at local, national and international level. Jim has an international reputation within his academic specialism relating to the uses and public health implications of anabolic androgenic steroids and other human enhancement drugs. He has co-authored more than 200 academic outputs, including 70 peer reviewed papers and been invited to deliver keynote presentations and plenary papers at some of the most influential national and international conferences.
Background Anabolic–androgenic steroids (AAS) mimic the effects of testosterone and may include t... more Background Anabolic–androgenic steroids (AAS) mimic the effects of testosterone and may include testosterone itself; they are used for body enhancement within the general population. AAS use has been linked with increased mortality, cardiovascular disease, mental health disorders, and infertility. AAS-induced hypogonadism can persist for an uncertain time period despite cessation, during which men may report physical and neuropsychiatric symptoms. In an attempt to mitigate these symptoms and expedite testicular recovery, many men self-administer post-cycle-therapy (PCT), typically involving human chorionic gonadotrophin (hCG) and selective oestrogen receptor modulators (SERMs), which are known to potently stimulate testicular function. However, this practice has no objective evidence of effectiveness to lessen the severity or duration of hypogonadal symptoms. Methods An anonymous survey of four-hundred-and-seventy men using AAS explored the symptoms they experienced when ceasing AAS...
Background: Effective harm reduction work is needed to prevent and respond to the harms associate... more Background: Effective harm reduction work is needed to prevent and respond to the harms associated with image and performance enhancing drug (IPED) use and the diverse needs of IPED communities. Methods based around understanding and mapping complex systems have previously been applied to advance thinking on a range of complex health issues. We applied a systems perspective to explore factors that contribute to IPED-related harms in the UK and to identify harm reduction priorities. Methods: An illustrative systems map was developed based on methods for mapping complex systems with expert stakeholders. Participants in two online workshops debated the important factors contributing to harm amongst people who use IPEDs and helped to refine and clarify the map. Discussions using the map reflected on where in the system intervention is needed and the policy implications. Results: Stakeholders (n = 18) identified 51 distinct factors as being important determinants of IPEDs-related harms, and the connections between them. These were grouped under nine domains that formed this system: identity, cognitive processes, beliefs about risk and harm, health and wellbeing, social environment, beliefs about healthcare, healthcare providers, interventions, and IPED markets. Four harm reduction priorities identified through reflexive discussion included providing a wider range of interventions, improving engagement between the IPED communities and healthcare professionals, new approaches to disseminating information in the community, and early intervention. Conclusion: Systems mapping methods are a useful approach to engage stakeholders to discuss drug use issues. A comprehensive policy response is required to this complex issue that recognises diversity in IPEDs communities, their decision-making, and their intervention and service needs, as current approaches are failing to adequately address important areas of harm. Engaging with a wide range of stakeholders is critical to generate new insights that can help respond effectively to reduce the risk of health harms.
Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typical... more Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typically used to increase muscle mass. Many users develop a dependence on these substances, contributing to worsened physical and mental health outcomes. Aspects of personality and executive dysfunction may represent underlying vulnerabilities for developing dependence. Objective: To identify levels of AAS dependence within substance use disorder (SUD) treatment patients and assess the relationship between dependence severity and personality traits and executive function (EF). Methods: Data were collected from patients at 38 SUD treatment facilities in Norway. Questionnaires were completed for measures of personality and EF. Measures of symptoms of AAS dependence were used in latent class analysis to identify subgroups of patients, which were evaluated for association with EF and personality traits, and compared with a group of non-AAS using SUD patients. Results: Three classes were identified; largely reflecting low, moderate, and high symptoms of dependence. Multinomial regression analyses indicated that moderate and high symptoms were associated with several measures of EF and personality traits, particularly self-monitoring, antagonism, disinhibition, and rigid perfectionism while users with low symptoms exhibited higher capacities for emotional control and shift, and lower negative affectivity, relative to non-AAS using SUD patients. Backward stepwise regressions indicated antagonism, and decreased self-monitoring as key personality and cognitive characteristics of SUD patients with severe AAS dependence. Conclusion: Our findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.
In the past, research, policy and media have reported the use of anabolic androgenic steroids (AA... more In the past, research, policy and media have reported the use of anabolic androgenic steroids (AAS) primarily among younger males. However, recent studies have indicated the presence of an older cohort of men who use AAS in comparison to previous years. We carried out a scoping review of the extant literature to map and describe what is known about the use of AAS by older men (>40 years). A systematic search collected and analysed empirical research and grey literature relevant to the research question. Following application of inclusion and exclusion criteria, 44 studies were included which were subsequently charted and thematically analysed. The records included originated from the UK,
Harms associated with anabolic androgenic steroids (AAS) use are well-established and a public he... more Harms associated with anabolic androgenic steroids (AAS) use are well-established and a public health concern. Robust estimates of the numbers using AAS are needed to inform responses, however, in the UK these are lacking. Due to the comparative rarity and associated stigma, general population surveys are problematic and data availability limits the use of indirect approaches. To address this, the Delphi method was used to refine the key parameters needed for indirect estimation from attendances at needle and syringe programmes (NSP) for AAS use. An expert panel (n ¼ 63) was surveyed three times (n ¼ 40, 39, and 37) to refine the parameters needed to generate a likely range from data on NSP attendances. A broad agreement was reached on: regional variations in use; the proportion of men using AAS who only use them orally; the proportion of men who inject AAS using NSP; and the proportion of the AAS population who are women. We conclude that previous general population surveybased estimates of recent AAS use appear implausible, with the likely range indicated by NSP data being up to 10-times higher. AAS use in the UK is more common than previously indicated, but further work is needed to refine population size estimation and characteristics.
Understanding of the choices and motivations of people who use anabolic androgenic steroids (AAS)... more Understanding of the choices and motivations of people who use anabolic androgenic steroids (AAS) for muscular enhancement has increased greatly in the past thirty years, along with understanding of a wide range of health harms associated with this form of drug use in the community. During this period the predominant public health intervention for this population in the UK has consistently remained the provision of injecting equipment to prevent blood borne virus (BBV) transmission. The study explored the health professionals’ and other stakeholders’ perceptions on: whether the current UK public health response is sufficient to address the needs of people who use AAS, and if not, what other needs they might have. This included an exploration of whether there were gaps in harm reduction strategies or other behavioral outcomes and interventions that were needed. Interviews with 27 stakeholders who provide support to people who use AAS in a variety of roles established consensus on the...
Background The use of anabolic androgenic steroids (AAS) and associated image and performance enh... more Background The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs. Methods A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK aca...
Self-injection of a range of oils and fillers for body enhancement dates back to 1899, but due to... more Self-injection of a range of oils and fillers for body enhancement dates back to 1899, but due to significant associated harms and fatalities this practice has been largely linked to distinct cultural groups in recent times. This scoping review gathers what is currently known on the self injection of body fillers for aesthetic purposes, using Arksey and O’Malley’s (2005) five stage iterative process scoping review methodology. Thematic manual coding then organised the data into themes through identified patterns: indicative profiling of individuals who self inject body fillers; motivation for use across types of oil injection; sourcing routes and documented harms. It was found that the majority of people who inject body fillers are male and do so to grossly increase muscle size. Injection of oils and other materials in the male genitalia was also described, in addition to female self-injection in the breast, hand and leg areas for augmentation. A range of health consequences were re...
INTRODUCTION AND AIMS Historically, people who inject image and performance enhancing drugs (IPED... more INTRODUCTION AND AIMS Historically, people who inject image and performance enhancing drugs (IPED) were not perceived as being at high risk of HIV or hepatitis C virus (HCV) infection. However, recent studies indicate HCV and HIV prevalences are elevated, with many HCV infections undiagnosed. DESIGN AND METHODS Men who inject IPEDs recruited from community settings and specialist services, including needle-syringe programs, across UK during 2016 self-completed a questionnaire. Multivariate analyses examined factors associated with HCV/HIV testing. RESULTS The participants' (n=562; 24% service recruited) median age was 31 years, 4% identified as gay or bisexual, 18% had ever been imprisoned and 6% had ever injected a psychoactive drug. Those community recruited more often reported sharing drugs vials (16% vs. 8%, P=0.021) and, among those with 2+ sexual partners, poor condom use (50% vs. 36%, P=0.063), than those service recruited. Overall, one-third had ever been tested for HCV (31%) and/or HIV (34%). Testing uptake was associated with other risk factors for HCV/HIV, being recruited through services and having received metabolic tests. Participants' motivations for using IPEDs were associated with recruitment setting and HIV/HCV testing uptake. DISCUSSION AND CONCLUSIONS The majority were untested for HCV/HIV. HCV/HIV testing and risks were associated with recruitment through services. Previous needle and syringe program-based studies have potentially overestimated testing uptake and underestimated risk. Targeted interventions are needed, particularly for those not accessing services. The association between HCV/HIV testing uptake and receipt of metabolic tests suggests that developing a combined offer of these tests as part of health monitoring could improve uptake.
Background: Anabolic androgenic steroid (AAS) use is associated with serious mental and physical ... more Background: Anabolic androgenic steroid (AAS) use is associated with serious mental and physical health problems. Evidence indicates that AAS use among people who use psychoactive substances is higher than in the general population. This study aims to estimate lifetime AAS use among patients in substance use disorder (SUD) treatment, compare characteristics of AAS and non-AAS users and identify whether AAS use was addressed during treatment. Methods: This cross-sectional survey included 563 (142 women, 24.2%) patients in 38 SUD treatment facilities in Norway. Respondents reported on AAS and substance use, and treatment experiences. Results: Lifetime AAS use was reported by 156 (28.3%) SUD patients, thereof 35.6% of the men and 8.0% of the women. Lifetime AAS use was highest among men with stimulants (55.8%) as preferred substance, and lowest among men who preferred alcohol (14.6%). Initiation of AAS use due to getting thinner following substance use was reported by 44.5% of the AAS ...
Background Anabolic–androgenic steroids (AAS) mimic the effects of testosterone and may include t... more Background Anabolic–androgenic steroids (AAS) mimic the effects of testosterone and may include testosterone itself; they are used for body enhancement within the general population. AAS use has been linked with increased mortality, cardiovascular disease, mental health disorders, and infertility. AAS-induced hypogonadism can persist for an uncertain time period despite cessation, during which men may report physical and neuropsychiatric symptoms. In an attempt to mitigate these symptoms and expedite testicular recovery, many men self-administer post-cycle-therapy (PCT), typically involving human chorionic gonadotrophin (hCG) and selective oestrogen receptor modulators (SERMs), which are known to potently stimulate testicular function. However, this practice has no objective evidence of effectiveness to lessen the severity or duration of hypogonadal symptoms. Methods An anonymous survey of four-hundred-and-seventy men using AAS explored the symptoms they experienced when ceasing AAS...
Background: Effective harm reduction work is needed to prevent and respond to the harms associate... more Background: Effective harm reduction work is needed to prevent and respond to the harms associated with image and performance enhancing drug (IPED) use and the diverse needs of IPED communities. Methods based around understanding and mapping complex systems have previously been applied to advance thinking on a range of complex health issues. We applied a systems perspective to explore factors that contribute to IPED-related harms in the UK and to identify harm reduction priorities. Methods: An illustrative systems map was developed based on methods for mapping complex systems with expert stakeholders. Participants in two online workshops debated the important factors contributing to harm amongst people who use IPEDs and helped to refine and clarify the map. Discussions using the map reflected on where in the system intervention is needed and the policy implications. Results: Stakeholders (n = 18) identified 51 distinct factors as being important determinants of IPEDs-related harms, and the connections between them. These were grouped under nine domains that formed this system: identity, cognitive processes, beliefs about risk and harm, health and wellbeing, social environment, beliefs about healthcare, healthcare providers, interventions, and IPED markets. Four harm reduction priorities identified through reflexive discussion included providing a wider range of interventions, improving engagement between the IPED communities and healthcare professionals, new approaches to disseminating information in the community, and early intervention. Conclusion: Systems mapping methods are a useful approach to engage stakeholders to discuss drug use issues. A comprehensive policy response is required to this complex issue that recognises diversity in IPEDs communities, their decision-making, and their intervention and service needs, as current approaches are failing to adequately address important areas of harm. Engaging with a wide range of stakeholders is critical to generate new insights that can help respond effectively to reduce the risk of health harms.
Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typical... more Anabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typically used to increase muscle mass. Many users develop a dependence on these substances, contributing to worsened physical and mental health outcomes. Aspects of personality and executive dysfunction may represent underlying vulnerabilities for developing dependence. Objective: To identify levels of AAS dependence within substance use disorder (SUD) treatment patients and assess the relationship between dependence severity and personality traits and executive function (EF). Methods: Data were collected from patients at 38 SUD treatment facilities in Norway. Questionnaires were completed for measures of personality and EF. Measures of symptoms of AAS dependence were used in latent class analysis to identify subgroups of patients, which were evaluated for association with EF and personality traits, and compared with a group of non-AAS using SUD patients. Results: Three classes were identified; largely reflecting low, moderate, and high symptoms of dependence. Multinomial regression analyses indicated that moderate and high symptoms were associated with several measures of EF and personality traits, particularly self-monitoring, antagonism, disinhibition, and rigid perfectionism while users with low symptoms exhibited higher capacities for emotional control and shift, and lower negative affectivity, relative to non-AAS using SUD patients. Backward stepwise regressions indicated antagonism, and decreased self-monitoring as key personality and cognitive characteristics of SUD patients with severe AAS dependence. Conclusion: Our findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.
In the past, research, policy and media have reported the use of anabolic androgenic steroids (AA... more In the past, research, policy and media have reported the use of anabolic androgenic steroids (AAS) primarily among younger males. However, recent studies have indicated the presence of an older cohort of men who use AAS in comparison to previous years. We carried out a scoping review of the extant literature to map and describe what is known about the use of AAS by older men (>40 years). A systematic search collected and analysed empirical research and grey literature relevant to the research question. Following application of inclusion and exclusion criteria, 44 studies were included which were subsequently charted and thematically analysed. The records included originated from the UK,
Harms associated with anabolic androgenic steroids (AAS) use are well-established and a public he... more Harms associated with anabolic androgenic steroids (AAS) use are well-established and a public health concern. Robust estimates of the numbers using AAS are needed to inform responses, however, in the UK these are lacking. Due to the comparative rarity and associated stigma, general population surveys are problematic and data availability limits the use of indirect approaches. To address this, the Delphi method was used to refine the key parameters needed for indirect estimation from attendances at needle and syringe programmes (NSP) for AAS use. An expert panel (n ¼ 63) was surveyed three times (n ¼ 40, 39, and 37) to refine the parameters needed to generate a likely range from data on NSP attendances. A broad agreement was reached on: regional variations in use; the proportion of men using AAS who only use them orally; the proportion of men who inject AAS using NSP; and the proportion of the AAS population who are women. We conclude that previous general population surveybased estimates of recent AAS use appear implausible, with the likely range indicated by NSP data being up to 10-times higher. AAS use in the UK is more common than previously indicated, but further work is needed to refine population size estimation and characteristics.
Understanding of the choices and motivations of people who use anabolic androgenic steroids (AAS)... more Understanding of the choices and motivations of people who use anabolic androgenic steroids (AAS) for muscular enhancement has increased greatly in the past thirty years, along with understanding of a wide range of health harms associated with this form of drug use in the community. During this period the predominant public health intervention for this population in the UK has consistently remained the provision of injecting equipment to prevent blood borne virus (BBV) transmission. The study explored the health professionals’ and other stakeholders’ perceptions on: whether the current UK public health response is sufficient to address the needs of people who use AAS, and if not, what other needs they might have. This included an exploration of whether there were gaps in harm reduction strategies or other behavioral outcomes and interventions that were needed. Interviews with 27 stakeholders who provide support to people who use AAS in a variety of roles established consensus on the...
Background The use of anabolic androgenic steroids (AAS) and associated image and performance enh... more Background The use of anabolic androgenic steroids (AAS) and associated image and performance enhancing drugs (IPEDs) is now a global phenomenon. There is a need to develop evidence to support the development of interventions to prevent the commencement of use, to minimise the potential harms or to support those in their cessation of use. While the United Kingdom (UK) is no exception to this issue, its public health and legislative response to the phenomenon differs to other countries and requires the examination of research specific to the UK. Therefore, a scoping review has been conducted to examine the recent relevant literature to help inform the development and evaluation of effective interventions to reduce the harmful use of IPEDs. Methods A comprehensive search strategy was developed for multiple bibliographic databases, supported by and iterative citation searching process and complimented by expert input from the Anabolic Steroid UK Network. Research conducted by or UK aca...
Self-injection of a range of oils and fillers for body enhancement dates back to 1899, but due to... more Self-injection of a range of oils and fillers for body enhancement dates back to 1899, but due to significant associated harms and fatalities this practice has been largely linked to distinct cultural groups in recent times. This scoping review gathers what is currently known on the self injection of body fillers for aesthetic purposes, using Arksey and O’Malley’s (2005) five stage iterative process scoping review methodology. Thematic manual coding then organised the data into themes through identified patterns: indicative profiling of individuals who self inject body fillers; motivation for use across types of oil injection; sourcing routes and documented harms. It was found that the majority of people who inject body fillers are male and do so to grossly increase muscle size. Injection of oils and other materials in the male genitalia was also described, in addition to female self-injection in the breast, hand and leg areas for augmentation. A range of health consequences were re...
INTRODUCTION AND AIMS Historically, people who inject image and performance enhancing drugs (IPED... more INTRODUCTION AND AIMS Historically, people who inject image and performance enhancing drugs (IPED) were not perceived as being at high risk of HIV or hepatitis C virus (HCV) infection. However, recent studies indicate HCV and HIV prevalences are elevated, with many HCV infections undiagnosed. DESIGN AND METHODS Men who inject IPEDs recruited from community settings and specialist services, including needle-syringe programs, across UK during 2016 self-completed a questionnaire. Multivariate analyses examined factors associated with HCV/HIV testing. RESULTS The participants' (n=562; 24% service recruited) median age was 31 years, 4% identified as gay or bisexual, 18% had ever been imprisoned and 6% had ever injected a psychoactive drug. Those community recruited more often reported sharing drugs vials (16% vs. 8%, P=0.021) and, among those with 2+ sexual partners, poor condom use (50% vs. 36%, P=0.063), than those service recruited. Overall, one-third had ever been tested for HCV (31%) and/or HIV (34%). Testing uptake was associated with other risk factors for HCV/HIV, being recruited through services and having received metabolic tests. Participants' motivations for using IPEDs were associated with recruitment setting and HIV/HCV testing uptake. DISCUSSION AND CONCLUSIONS The majority were untested for HCV/HIV. HCV/HIV testing and risks were associated with recruitment through services. Previous needle and syringe program-based studies have potentially overestimated testing uptake and underestimated risk. Targeted interventions are needed, particularly for those not accessing services. The association between HCV/HIV testing uptake and receipt of metabolic tests suggests that developing a combined offer of these tests as part of health monitoring could improve uptake.
Background: Anabolic androgenic steroid (AAS) use is associated with serious mental and physical ... more Background: Anabolic androgenic steroid (AAS) use is associated with serious mental and physical health problems. Evidence indicates that AAS use among people who use psychoactive substances is higher than in the general population. This study aims to estimate lifetime AAS use among patients in substance use disorder (SUD) treatment, compare characteristics of AAS and non-AAS users and identify whether AAS use was addressed during treatment. Methods: This cross-sectional survey included 563 (142 women, 24.2%) patients in 38 SUD treatment facilities in Norway. Respondents reported on AAS and substance use, and treatment experiences. Results: Lifetime AAS use was reported by 156 (28.3%) SUD patients, thereof 35.6% of the men and 8.0% of the women. Lifetime AAS use was highest among men with stimulants (55.8%) as preferred substance, and lowest among men who preferred alcohol (14.6%). Initiation of AAS use due to getting thinner following substance use was reported by 44.5% of the AAS ...
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