editorial
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Deputy Editor Aysha Mendes da Mata [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Commercial Manager Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Lindsey Butlin Publisher Anthony Kerr Chief Executive Officer Ben Allen UK Personal subscription rates
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£42 £164 £173 £294 £415
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com © MA Healthcare Ltd, 2014. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2014, Vol 23, No 12
Performance-enhancing drugs and public health
T
he incidence of HIV among those people who inject performance-enhancing drugs (for example, anabolic steroids) has increased. The risk of HIV, hepatitis B and hepatitis C infection is greater than had been previously considered (Public Health England (PHE) et al, 2013). The rate of HIV among this group of people is on a par with those who inject psychoactive drugs, such as heroin and crack-cocaine. Among those people who inject psychoactive drugs, infection remains a common feature. Approximately half of this group have been infected with hepatitis C. It is estimated too that one in every 100 has HIV, with almost one-third reporting having a recent symptom of an injecting site bacterial infection (PHE et al, 2013). Nurses work with a number of people in a variety of settings. They have a clear remit to enhance the public health of the people they serve (Nursing and Midwifery Council (NMC), 2008) and as such they are well-placed to offer people advice concerning a number of healthcare issues, including the risks associated with the injection of performanceenhancing drugs. While the ratio of those who had been infected with hepatitis B is less than in those who inject psychoactive drugs, recent survey findings (Hope et al, 2013) suggest the degree of infection has increased over time. In order to minimise the damage that can result from injecting drug use and the changes in the patterns of use that increase the risk of infection, the detection of risk and making a prompt and appropriate response is paramount. The continued public-health monitoring of injecting drug use is key but this has to be in tandem with the provision of services that aim to avoid infections among those people who inject drugs, regardless of whether these are psychoactive or image/performance-enhancing drugs. These services must be maintained despite the current savings that are being called for in health and social care. The number of those who inject performanceenhancing drugs and who are using needle and syringe programmes has increased considerably—in some areas this group of injectors is now the largest group of programme users (Advisory Council on the Misuse of Drugs, 2010). This change in the use of these services is significant. The most frequently injected performanceenhancing drugs reported in a survey of men by Hope et al (2013) were anabolic steroids (86%) and growth hormone (32%). However, a variety of other drugs including melanotan (8.6%) and insulin
(5.6%) have also been reported as being injected. The frequency of HIV among those who inject performance-enhancing drugs and an increase in the proportion of this group who are infected with hepatitis B are a source of concern. There is a need for targeted needle and syringe programmes that will address and be responsive to the needs of those who choose to inject performance-enhancing drugs. Understanding the patterns of drug use and injection are important. Nurses need to be alert to the use and injection of performance-enhancing drugs along with their consequences if they are to provide advice to people with the intention of reducing risk and enhancing health and wellbeing. Detecting changes in injecting drug use means that intervention strategies can be introduced promptly in order to minimise harm. Those who are responsible for commissioning communitybased services to reduce harm related with injecting drugs should give appropriate priority to preventing the spread of infections among people who use performance-enhancing drugs. Services (including primary care services, sexual health services and drug treatment services) should ensure that people have easy access to evidence-based information and advice on safer injecting practices, safer sex activities, avoiding injecting site infections, preventing blood-borne virus transmission and the safe disposal of any used equipment. The provision of hepatitis B and tetanus vaccination, diagnostic testing for HIV and hepatitis C, health checks and treatment for injection site infections should be made available. Interventions aimed at decreasing or stopping injecting should include those who inject performance-enhancing drugs. The provision of these services should reflect the full range of drugs BJN that are being injected.
Ian Peate
Editor in Chief British Journal of Nursing
Advisory Council on the Misuse of Drugs (2010) Consideration of the Anabolic Steroids http://tinyurl.com/ lgj745a (accessed 17 June 2014) Hope VD, McVeigh J, Maronglu A et al (2013) Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study. BMJ Open. 3:e003207 doi:10.1136/ bmjopen-2013-003207 Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC. London Public Health England, Health Protection Scotland, Public Health Wales, and Public Health Agency Northern Ireland (2013) Shooting Up: Infections Among People who Inject Drugs in the United Kingdom 2012. Public Health England, London
633
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Deputy Editor Aysha Mendes da Mata [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Commercial Manager Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Lindsey Butlin Publisher Anthony Kerr Chief Executive Officer Ben Allen UK Personal subscription rates
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£42 £164 £173 £294 £415
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com © MA Healthcare Ltd, 2014. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2014, Vol 23, No 12
Performance-enhancing drugs and public health
T
he incidence of HIV among those people who inject performance-enhancing drugs (for example, anabolic steroids) has increased. The risk of HIV, hepatitis B and hepatitis C infection is greater than had been previously considered (Public Health England (PHE) et al, 2013). The rate of HIV among this group of people is on a par with those who inject psychoactive drugs, such as heroin and crack-cocaine. Among those people who inject psychoactive drugs, infection remains a common feature. Approximately half of this group have been infected with hepatitis C. It is estimated too that one in every 100 has HIV, with almost one-third reporting having a recent symptom of an injecting site bacterial infection (PHE et al, 2013). Nurses work with a number of people in a variety of settings. They have a clear remit to enhance the public health of the people they serve (Nursing and Midwifery Council (NMC), 2008) and as such they are well-placed to offer people advice concerning a number of healthcare issues, including the risks associated with the injection of performanceenhancing drugs. While the ratio of those who had been infected with hepatitis B is less than in those who inject psychoactive drugs, recent survey findings (Hope et al, 2013) suggest the degree of infection has increased over time. In order to minimise the damage that can result from injecting drug use and the changes in the patterns of use that increase the risk of infection, the detection of risk and making a prompt and appropriate response is paramount. The continued public-health monitoring of injecting drug use is key but this has to be in tandem with the provision of services that aim to avoid infections among those people who inject drugs, regardless of whether these are psychoactive or image/performance-enhancing drugs. These services must be maintained despite the current savings that are being called for in health and social care. The number of those who inject performanceenhancing drugs and who are using needle and syringe programmes has increased considerably—in some areas this group of injectors is now the largest group of programme users (Advisory Council on the Misuse of Drugs, 2010). This change in the use of these services is significant. The most frequently injected performanceenhancing drugs reported in a survey of men by Hope et al (2013) were anabolic steroids (86%) and growth hormone (32%). However, a variety of other drugs including melanotan (8.6%) and insulin
(5.6%) have also been reported as being injected. The frequency of HIV among those who inject performance-enhancing drugs and an increase in the proportion of this group who are infected with hepatitis B are a source of concern. There is a need for targeted needle and syringe programmes that will address and be responsive to the needs of those who choose to inject performance-enhancing drugs. Understanding the patterns of drug use and injection are important. Nurses need to be alert to the use and injection of performance-enhancing drugs along with their consequences if they are to provide advice to people with the intention of reducing risk and enhancing health and wellbeing. Detecting changes in injecting drug use means that intervention strategies can be introduced promptly in order to minimise harm. Those who are responsible for commissioning communitybased services to reduce harm related with injecting drugs should give appropriate priority to preventing the spread of infections among people who use performance-enhancing drugs. Services (including primary care services, sexual health services and drug treatment services) should ensure that people have easy access to evidence-based information and advice on safer injecting practices, safer sex activities, avoiding injecting site infections, preventing blood-borne virus transmission and the safe disposal of any used equipment. The provision of hepatitis B and tetanus vaccination, diagnostic testing for HIV and hepatitis C, health checks and treatment for injection site infections should be made available. Interventions aimed at decreasing or stopping injecting should include those who inject performance-enhancing drugs. The provision of these services should reflect the full range of drugs BJN that are being injected.
Ian Peate
Editor in Chief British Journal of Nursing
Advisory Council on the Misuse of Drugs (2010) Consideration of the Anabolic Steroids http://tinyurl.com/ lgj745a (accessed 17 June 2014) Hope VD, McVeigh J, Maronglu A et al (2013) Prevalence of, and risk factors for, HIV, hepatitis B and C infections among men who inject image and performance enhancing drugs: a cross-sectional study. BMJ Open. 3:e003207 doi:10.1136/ bmjopen-2013-003207 Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. NMC. London Public Health England, Health Protection Scotland, Public Health Wales, and Public Health Agency Northern Ireland (2013) Shooting Up: Infections Among People who Inject Drugs in the United Kingdom 2012. Public Health England, London
633
British Journal of Nursing. Downloaded from magonlinelibrary.com by 193.061.135.112 on November 21, 2015. For personal use only. No other uses without permission. . All rights reserved.
