Exploring the role of community pharmacies as a harm reduction environment for anabolic-androgenic steroid consumers: triangulating the perspectives of consumers and pharmacists.
Anabolic–androgenic steroids
Harm reduction
Injections
Pharmacies
Risk environment
Journal
Harm reduction journal
ISSN: 1477-7517
Titre abrégé: Harm Reduct J
Pays: England
ID NLM: 101153624
Informations de publication
Date de publication:
13 Mar 2024
13 Mar 2024
Historique:
received:
31
07
2023
accepted:
22
02
2024
medline:
14
3
2024
pubmed:
14
3
2024
entrez:
14
3
2024
Statut:
epublish
Résumé
While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic-androgenic steroid (AAS) consumers. This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist's regarding AAS harm reduction. Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis. While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively. Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers.
Sections du résumé
BACKGROUND
BACKGROUND
While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic-androgenic steroid (AAS) consumers.
OBJECTIVE
OBJECTIVE
This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist's regarding AAS harm reduction.
METHODS
METHODS
Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis.
RESULTS
RESULTS
While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively.
CONCLUSIONS
CONCLUSIONS
Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers.
Identifiants
pubmed: 38481218
doi: 10.1186/s12954-024-00972-5
pii: 10.1186/s12954-024-00972-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
59Informations de copyright
© 2024. The Author(s).
Références
Steckowych K, Smith M, Spiggle S, et al. Building the case: changing consumer perceptions of the value of expanded community pharmacist services. J Pharm Pract. 2019;32:637–47.
pubmed: 29756535
doi: 10.1177/0897190018771521
Steckowych K, Smith M. Primary care workflow process mapping of medication-related activities performed by non-provider staff: a pilot project’s approach. Res Social Adm Pharm. 2019;15:1107–17.
pubmed: 30344092
doi: 10.1016/j.sapharm.2018.09.014
Kiles TM, Peroulas D, Borja-Hart N. Defining the role of pharmacists in addressing the social determinants of health. Res Social Adm Pharm. 2022;18:3699–703.
pubmed: 35086772
doi: 10.1016/j.sapharm.2022.01.005
Watson T, Hughes C. Pharmacists and harm reduction: a review of current practices and attitudes. Can Pharm J/Revue des Pharm du Can. 2012;145(124–127):e122.
McMillan SS, Chan H, Hattingh LH. Australian community pharmacy harm-minimisation services: scope for service expansion to improve healthcare access. Pharmacy. 2021;9:95.
pubmed: 33926030
pmcid: 8167599
doi: 10.3390/pharmacy9020095
Jones L, Pickering L, Sumnall H, et al. Optimal provision of needle and syringe programmes for injecting drug users: a systematic review. Int J Drug Policy. 2010;21:335–42.
pubmed: 20189375
doi: 10.1016/j.drugpo.2010.02.001
Nacopoulos AG, Lewtas AJ, Ousterhout MM. Syringe exchange programs: impact on injection drug users and the role of the pharmacist from a US perspective. J Am Pharm Assoc. 2010;50:148–57.
doi: 10.1331/JAPhA.2010.09178
Sawangjit R, Khan TM, Chaiyakunapruk N. Effectiveness of pharmacy-based needle/syringe exchange programme for people who inject drugs: a systematic review and meta-analysis. Addiction. 2017;112:236–47.
pubmed: 27566970
doi: 10.1111/add.13593
Wu L-T, John WS, Mannelli P, et al. Patient perspectives on community pharmacy administered and dispensing of methadone treatment for opioid use disorder: a qualitative study in the US. Addict Sci Clin Pract. 2023;18:45.
pubmed: 37533071
pmcid: 10398989
doi: 10.1186/s13722-023-00399-6
Radley A, Melville K, Easton P, et al. ‘Standing Outside the Junkie Door’—service users’ experiences of using community pharmacies to access treatment for opioid dependency. J Public Health. 2017;39:846–55.
doi: 10.1093/pubmed/fdw138
Neale J, Tompkins C, Sheard L. Barriers to accessing generic health and social care services: a qualitative study of injecting drug users. Health Soc Care Community. 2008;16:147–54.
pubmed: 18290980
doi: 10.1111/j.1365-2524.2007.00739.x
McVeigh J, Hearne E, Bates G, et al. Community pharmacist experiences of providing needle and syringe programmes in Ireland. Res Social Adm Pharm. 2017;13:767–77.
pubmed: 27568822
doi: 10.1016/j.sapharm.2016.07.006
Gibbs N, Piatkowski T. The Liver King Lie: Misrepresentation, justification, and public health implications. Int J Drug Policy. 2023;114:103979. https://doi.org/10.1016/j.drugpo.2023.103979
doi: 10.1016/j.drugpo.2023.103979
pubmed: 36841216
McVeigh J, Hearne E, Boardley I, et al. Generating evidence on the use of Image and performance enhancing drugs in the UK: results from a scoping review and expert consultation by the Anabolic Steroid UK network. Harm Reduct J. 2021;18:1–12.
doi: 10.1186/s12954-021-00550-z
Piatkowski TM, White KM, Hides LM, et al. Australia’s Adonis: Understanding what motivates young men’s lifestyle choices for enhancing their appearance. Aust Psychol. 2020;55:156–68. https://doi.org/10.1111/ap.12451
doi: 10.1111/ap.12451
Piatkowski TM, Obst PL, White KM, et al. The relationship between psychosocial variables and drive for muscularity among male bodybuilding supplement users. Aust Psychol. 2022;57:148–59. https://doi.org/10.1080/00050067.2021.2020074
doi: 10.1080/00050067.2021.2020074
Van de Ven K, Maher L, Wand H, et al. Health risk and health seeking behaviours among people who inject performance and image enhancing drugs who access needle syringe programs in Australia. Drug Alcohol Rev. 2018;37:837–46.
pubmed: 29968372
doi: 10.1111/dar.12831
Dunn M, Piatkowski T. Investigating the impact of COVID-19 on performance and image enhancing drug use. Harm Reduct J. 2021;18:1–8. https://doi.org/10.1186/s12954-021-00571-8
doi: 10.1186/s12954-021-00571-8
Pope HG, Khalsa JH, Bhasin S. Body image disorders and abuse of anabolic-androgenic steroids among men. JAMA. 2017;317:23–4.
pubmed: 27930760
doi: 10.1001/jama.2016.17441
Grant B, Kean J, Vali N, et al. The use of post-cycle therapy is associated with reduced withdrawal symptoms from anabolic-androgenic steroid use: a survey of 470 men. Subst Abus Treat Prev Policy. 2023;18:66.
doi: 10.1186/s13011-023-00573-8
Atkinson A, Van De Ven K, Cunningham M, et al. Performance and image enhancing drug interventions aimed at increasing knowledge among healthcare professionals (HCP): reflections on the implementation of the Dopinglinkki e-module in Europe and Australia in the HCP workforce. Int J Drug Policy. 2021;95:103141.
pubmed: 33549466
doi: 10.1016/j.drugpo.2021.103141
Piatkowski T, Neumann D, Keane C, et al. “More drugs means more stress on my body”: exploring enhancement and health among elite strength athletes who use performance and image enhancing drugs. Addict Res Theory. 2023. https://doi.org/10.1080/16066359.2023.2271839 .
doi: 10.1080/16066359.2023.2271839
Piatkowski TM, Hides LM, White KM, et al. Understanding harm reduction perspectives of performance and image enhancing drug consumers and health care providers. Perform Enhanc Health. 2022;10:100223. https://doi.org/10.1016/j.peh.2022.100223
doi: 10.1016/j.peh.2022.100223
Jacka B, Larance B, Copeland J, et al. Health care engagement behaviors of men who use performance-and image-enhancing drugs in Australia. Subst Abus. 2020;41:139–45.
pubmed: 31545138
doi: 10.1080/08897077.2019.1635954
Dunn M, Piatkowski T, Whiteside B, et al. Exploring the experiences of general practitioners working with patients who use performance and image enhancing drugs. Perform Enhanc Health. 2023;11:100247. https://doi.org/10.1016/j.peh.2023.100247
doi: 10.1016/j.peh.2023.100247
Rhodes T. Risk environments and drug harms: a social science for harm reduction approach. Amsterdam: Elsevier; 2009. p. 193–201.
Santos GH, Coomber R. The risk environment of anabolic–androgenic steroid users in the UK: examining motivations, practices and accounts of use. Int J Drug Policy. 2017;40:35–43.
doi: 10.1016/j.drugpo.2016.11.005
Gibbs N, Cox L, Turnock L. Anabolics coaching: Emic harm reduction or a public health concern? Perform Enhanc Health. 2022;10:100227.
doi: 10.1016/j.peh.2022.100227
Tighe B, Dunn M, McKay FH, et al. Information sought, information shared: exploring performance and image enhancing drug user-facilitated harm reduction information in online forums. Harm Reduct J. 2017;14:48. https://doi.org/10.1186/s12954-017-0176-8
doi: 10.1186/s12954-017-0176-8
pubmed: 28732534
pmcid: 5521146
Piatkowski TM, Dunn M, White KM, et al. Exploring the harms arising from polysubstance use among performance and image enhancing drug users among young Australian men. Perform Enhanc Health. 2021;9:100197. https://doi.org/10.1016/j.peh.2021.100197
doi: 10.1016/j.peh.2021.100197
Harvey O, Parrish M, van Teijlingen E, et al. Support for non-prescribed anabolic androgenic steroids users: a qualitative exploration of their needs. Drugs Educ Prev Policy. 2020;27:377–86.
doi: 10.1080/09687637.2019.1705763
Harvey O, Keen S, Parrish M, et al. Support for people who use anabolic androgenic steroids: a systematic scoping review into what they want and what they access. BMC Public Health. 2019;19:1–13.
doi: 10.1186/s12889-019-7288-x
Duff C. Networks, resources and agencies: on the character and production of enabling places. Health Place. 2011;17:149–56.
pubmed: 20926330
doi: 10.1016/j.healthplace.2010.09.012
Duff C. Enabling places and enabling resources: new directions for harm reduction research and practice. Drug Alcohol Rev. 2010;29:337–44.
pubmed: 20565528
doi: 10.1111/j.1465-3362.2010.00187.x
Duff C. Accounting for context: exploring the role of objects and spaces in the consumption of alcohol and other drugs. Soc Cult Geogr. 2012;13:145–59.
doi: 10.1080/14649365.2012.655765
Antoniou T, Pritlove C, Shearer D, et al. A qualitative study of a publicly funded pharmacy-dispensed naloxone program. Int J Drug Policy. 2021;92:103146.
pubmed: 33568317
doi: 10.1016/j.drugpo.2021.103146
Taylor S, Cairns A, Glass B. Consumer perspectives of expanded practice in rural community pharmacy. Res Social Adm Pharm. 2021;17:362–7.
pubmed: 32280050
doi: 10.1016/j.sapharm.2020.03.022
Taylor S, Cairns A, Glass B. Expanded practice in rural community pharmacy: a macro-, meso and micro-level perspective. Rural Remote Health. 2021;21:1–11.
Rhodes T. The ‘risk environment’: a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002;13:85–94.
doi: 10.1016/S0955-3959(02)00007-5
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57.
pubmed: 17872937
doi: 10.1093/intqhc/mzm042
Piatkowski T, Robertson J, Lamon S, et al. Gendered perspectives on women’s anabolic–androgenic steroid (AAS) usage practices. Harm Reduct J. 2023;20:1–11. https://doi.org/10.1186/s12954-023-00786-x
doi: 10.1186/s12954-023-00786-x
River J, Bellingham B, Isobel S, et al. Raising the bar: a qualitative study of a co-produced model for promoting research partnerships in mental health. Int J Qual Methods. 2023;22:16094069231213268.
doi: 10.1177/16094069231213268
Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11:589–97.
doi: 10.1080/2159676X.2019.1628806
Braun V, Clarke V. Toward good practice in thematic analysis: avoiding common problems and be (com) ing a knowing researcher. Int J Transgender Health. 2023;24:1–6.
doi: 10.1080/26895269.2022.2129597
Wacquant LJ. Pugs at work: bodily capital and bodily labour among professional boxers. Body Soc. 1995;1:65–93.
doi: 10.1177/1357034X95001001005
Zampini GF, Buck-Matthews E, Killick A, et al. We, ourselves and us: Tensions of identity, intersubjectivity and positionality stemming from the people and dancefloors project. Int J Drug Policy. 2021;98:103096.
pubmed: 33446396
doi: 10.1016/j.drugpo.2020.103096
Ross LE. An account from the inside: examining the emotional impact of qualitative research through the lens of “insider” research. Qual Psychol. 2017;4:326.
pubmed: 29230428
pmcid: 5722257
doi: 10.1037/qup0000064
Dwyer SC, Buckle JL. The space between: on being an insider-outsider in qualitative research. Int J Qual Methods. 2009;8:54–63.
doi: 10.1177/160940690900800105
Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol. 2021;18:328–52.
doi: 10.1080/14780887.2020.1769238
Azungah T. Qualitative research: deductive and inductive approaches to data analysis. Qual Res J. 2018;18:383–400.
doi: 10.1108/QRJ-D-18-00035
Guest G, Namey E, Chen M. A simple method to assess and report thematic saturation in qualitative research. PLoS ONE. 2020;15:e0232076.
pubmed: 32369511
pmcid: 7200005
doi: 10.1371/journal.pone.0232076
Lam W, Mey A, King MA, et al. The nature of conflict in community pharmacy–A pilot study of pharmacists’ experiences during the COVID-19 pandemic. Res Social Adm Pharm. 2022;18:3164–73.
pubmed: 34521587
doi: 10.1016/j.sapharm.2021.09.002
Piatkowski T, Puljevic C, Ferris J, et al. They sent it away for testing and it was all bunk”: exploring perspectives on drug checking among steroid consumers in Queensland. Aust Int J Drug Policy. 2023. https://doi.org/10.1016/j.drugpo.2023.104139 .
doi: 10.1016/j.drugpo.2023.104139
Turnock LA, Mulrooney KJ. Exploring the impacts of rurality on service access and harm among image and performance enhancing drug (IPED) users in a remote english region. Contemp Drug Probl. 2023;50:232–53.
doi: 10.1177/00914509231155487
Hattingh HL, Emmerton L, Ng Cheong Tin P, et al. Utilization of community pharmacy space to enhance privacy: a qualitative study. Health Expect. 2016;19:1098–110.
pubmed: 26332335
doi: 10.1111/hex.12401
Piatkowski T, Gibbs N, Dunn M. Beyond the law: exploring the impact of criminalising anabolic-androgenic steroid use on help-seeking and health outcomes in Australia. J Criminol. 2023. https://doi.org/10.1177/26338076231209044 .
doi: 10.1177/26338076231209044
Pope HG, Kanayama G, Ionescu-Pioggia M, et al. Anabolic steroid users’ attitudes towards physicians. Addiction. 2004;99:1189–94.
pubmed: 15317640
doi: 10.1111/j.1360-0443.2004.00781.x
Hatzenbuehler ML. Structural stigma: research evidence and implications for psychological science. Am Psychol. 2016;71:742.
pubmed: 27977256
pmcid: 5172391
doi: 10.1037/amp0000068
Hattingh HL, Hallett J, Tait RJ. ‘Making the invisible visible’through alcohol screening and brief intervention in community pharmacies: an Australian feasibility study. BMC Public Health. 2016;16:1–12.
doi: 10.1186/s12889-016-3805-3
Tsui J, Gojic A, Pierce K, et al. Pilot study of a community pharmacist led program to treat hepatitis C virus among people who inject drugs. Drug Alcohol Depend Rep. 2024;10:100213.
pubmed: 38261893
doi: 10.1016/j.dadr.2023.100213
Matheson C, Thiruvothiyur M, Robertson H, et al. Community pharmacy services for people with drug problems over two decades in Scotland: implications for future development. Int J Drug Policy. 2016;27:105–12.
pubmed: 26723885
doi: 10.1016/j.drugpo.2015.11.006
Rubin SE, Schulman RM, Roszak AR, et al. Leveraging partnerships among community pharmacists, pharmacies, and health departments to improve pandemic influenza response. Biosecur Bioterror. 2014;12:76–84.
pubmed: 24697207
doi: 10.1089/bsp.2013.0082
Richardson A, Antonopoulos GA. Anabolic-androgenic steroids (AAS) users on AAS use: negative effects, ‘code of silence’, and implications for forensic and medical professionals. J Forensic Leg Med. 2019;68:101871.
pubmed: 31557629
doi: 10.1016/j.jflm.2019.101871
Ainsworth N, Thrower NS, Petróczi A. Fragile femininity, embodiment, and self-managing harm: an interpretative phenomenological study exploring the lived experience of females who use anabolic-androgenic steroids. Qual Res Sport Exerc Health. 2022;14:363–81.
doi: 10.1080/2159676X.2021.1941210
Ainsworth NP, Thrower SN, Petroczi A. Two sides of the same coin: A qualitative exploration of experiential and perceptual factors which influence the clinical interaction between physicians and anabolic-androgenic steroid using patients in the UK. Emerging Trends Drugs Addict Health. 2022;2:100033.
doi: 10.1016/j.etdah.2022.100033
van de Ven K, Boardley I, Chandler M. Identifying best-practice amongst health professionals who work with people using image and performance enhancing drugs (IPEDs) through participatory action research. Qual Res Sport, Exercise Health. 2022;14:199–215.
doi: 10.1080/2159676X.2021.1898457
Bates G, McVeigh J, Leavey C. Looking beyond the provision of injecting equipment to people who use anabolic androgenic steroids: harm reduction and behavior change goals for UK policy. Contemp Drug Probl. 2021;48:135–50.
doi: 10.1177/0091450921998701
Bates G, Shepherd S, McVeigh J. Harm reduction strategies for androgen users: providing appropriate support and improving engagement with healthcare. Curr Opin Endocrinol Diabetes Obes. 2021;28:630–5.
pubmed: 34534148
doi: 10.1097/MED.0000000000000676
Hope Ø, Ness O, Friesinger JG, et al. ‘Living needs a landscape’: A qualitative study about the role of enabling landscapes for people with mental health and substance abuse problems. Health Place. 2023;84:103144.
pubmed: 37976916
doi: 10.1016/j.healthplace.2023.103144
Bank M, Roessler KK. Therapeutic environments in drug treatment: from stigmatising spaces to enabling places. a theory-based qualitative analysis. Int J Environ Res Public Health. 2022;19:5005.
pubmed: 35564411
pmcid: 9102114
doi: 10.3390/ijerph19095005
Gibbs N. # Sponseredathlete: the marketing of image and performance enhancing drugs on Facebook and Instagram. Trends in Organized Crime 2023: 1–40.
Turnock L and Gibbs N, Click, click, buy: The market for novel synthetic peptide hormones on mainstream e-commerce platforms in the UK. Performance Enhancement & Health 2023: 100251.
Turnock L, Gibbs N, Cox L, et al. Big business: The private sector market for image and performance enhancing drug harm reduction in the UK. Int J Drug Policy. 2023;122:104254. https://doi.org/10.1016/j.drugpo.2023.104254
doi: 10.1016/j.drugpo.2023.104254
pubmed: 37950942
Paoli L, Cox LTJ. Across the spectrum of legality: the market activities of influencers specialized in steroids and other performance and image enhancing drugs. Int J Drug Policy. 2024;123:104246.
pubmed: 37979285
doi: 10.1016/j.drugpo.2023.104246
Cox L, Gibbs N and Turnock LA. Emerging anabolic androgenic steroid markets; the prominence of social media. Drugs: Education, Prevention and Policy 2023: 1–14.
Cox LTJ and Paoli L. Social media influencers, YouTube & performance and image enhancing drugs: A narrative-typology. Performance Enhancement & Health 2023: 100266.
Jacka B, Peacock A, Degenhardt L, et al. Trends in PIEDs use among male clients of needle–syringe programs in Queensland, Australia; 2007–2015. Int J Drug Policy. 2017;46:74–8.
pubmed: 28651113
doi: 10.1016/j.drugpo.2017.05.048
Skauen JE, Pallesen S, Bjørnebekk A, et al. Prevalence and correlates of androgen dependence: a meta-analysis, meta-regression analysis and qualitative synthesis. Curr Opin Endocrinol Diabetes Obes. 2023;30:309–23.
pubmed: 37410490
doi: 10.1097/MED.0000000000000822
McVeigh J, Begley E. Anabolic steroids in the UK: an increasing issue for public health. Drugs Educ Prev Policy. 2017;24:278–85.
doi: 10.1080/09687637.2016.1245713
Piatkowski T, Robertson J, Dunn M. Polysubstance use practices among women using anabolic-androgenic steroids (AAS). Perform Enhanc Health. 2023;11:100248. https://doi.org/10.1016/j.peh.2023.100248
doi: 10.1016/j.peh.2023.100248
Piatkowski TM, Neumann DL, Dunn M. ‘My mind pretty much went to mush’: A qualitative exploration of trenbolone in the performance and image enhancing drug community. Drug Alcohol Rev. 2023. https://doi.org/10.1111/DAR.13656
doi: 10.1111/DAR.13656
pubmed: 36992616
Hattingh HL, Knox K, Fejzic J, et al. Privacy and confidentiality: perspectives of mental health consumers and carers in pharmacy settings. Int J Pharm Pract. 2015;23:52–60.
pubmed: 24761999
doi: 10.1111/ijpp.12114
Mey A, Knox K, Kelly F, et al. Trust and safe spaces: mental health consumers’ and carers’ relationships with community pharmacy staff. The Patient-Patient-Cent Outcomes Res. 2013;6:281–9.
doi: 10.1007/s40271-013-0032-1