Body image disorders and misuse of anabolic-androgenic steroids (AAS) and other performance and image enhancing drugs (PIEDs) among men have increased, particularly among the non-athlete population (Pope, Khalsa, & Bhasin, 2017). Use of PIEDs has been linked to an elevated drive for muscularity (Parent & Moradi, 2011), and the supra-physiological doses used to accelerate increases in muscle size and strength can negatively impact physical and psychological health (Kanayama, Hudson, & Pope, 2008). Additionally, there is conflicting evidence surrounding the prevalence of polydrug use among people who use PIEDs and there is growing evidence of AAS dependence (Iversen, Currie, Maher, & on behalf of the Collaboration of Australian Needle and Syringe Programs, 2013; Kanayama, Brower, Wood, Hudson, & Pope, 2009).
Despite intensive median and public interest, little is known about population level use of PIEDs in Australia and available data relies on accessing a highly marginalised population (Larance, Degenhardt, Copeland, & Dillon, 2008; Seear, Fraser, Moore, & Murphy, 2015). Descriptions of men who use PIEDs show lifetime and recent use of non-AAS substances, (e.g. human growth hormone, other prohormones, beta agonists, anti-oestrogenic agents and diuretics) in the context of numerous motivators such as increased muscle mass and strength, and enhanced physical appearance (Cohen, Collins, Darkes, & Gwartney, 2007; Larance et al., 2008; Rowe, Berger, & Copeland, 2016). Recently, the diffusion of PIEDs on the Internet has greatly influenced uptake, with evidence of the Internet playing a central role in both the supply and distribution of AAS and the initiation of use (Dresen, Kläber, & Dietz, 2014; Kraska, Bussard, & Brent, 2010). Misleading and deceiving practices implemented by websites selling PIEDs are of particular concern given the potential risks associated with non-medical use of both AAS and other PIEDs substances (Cordaro, Lombardo, & Cosentino, 2011).
People who inject PIEDs are increasingly utilising needle and syringe programs (NSP) in Australia (Iversen, Topp, Wand, & Maher, 2013; van Beek & Chronister, 2015). Many people who use PIEDs are recent initiates to injecting (Iversen, Topp et al., 2013, Rowe et al., 2016), and require greater guidance and support from NSP service providers. The aim of this study is to investigate trends in PIEDs use among clients at NSPs in Queensland between 2007 and 2015, with a specific focus on any information and education interventions provided at the time of service occasion.