April 23, 2018

Performance and image enhancing drugs (PIEDs)


Performance and image enhancing drugs (PIEDs) are substances taken by people who would like to change their physical appearance, enhance their sporting performance, or both. There are several types of PIEDs, including anabolic steroids, peptides, and hormones.

So, what are they and why are they becoming a public health concern?

Different types of PIEDs

There are several different types of performance and image enhancing drugs, however the most commonly used in Australia are anabolic-androgenic steroids. These are synthetic hormones that imitate male sex hormones, namely testosterone, and they can either be injected or taken as a tablet.1

Peptides stimulate the release of human growth hormone, which has an important role in muscle and bone growth. Peptides have become increasingly popular as they are more difficult to detect due to how quickly they are absorbed by the body2.

Hormones are chemicals naturally released by the body, and there are numerous artificial hormones and hormone stimulating drugs available in the PIEDs market2.

PIED use in Australia

PIEDs have been increasingly popularised in Australia among fitness and bodybuilding enthusiasts leading to a shift away from them being predominantly used among professional bodybuilders and athletes.3, 4

Approximately 0.6% of Australians have used steroids in their lifetime for non-medical purposes, a figure that has doubled from 0.3% in 2004.5

There is some research to suggest that people who inject PIEDs are likely to source their injecting equipment from needle and syringe programs or pharmacies, and that needle sharing is very low.6,7 However, we also know that people who use PIEDs would prefer to remain anonymous, which can affect their help-seeking behaviour when it comes to harm reduction practice.6

Risks associated with PIED use

As with any drug, there is no safe level of use when it comes to PIEDs. All drugs carry some level of risk.

And while there is a wide variety of PIEDs, similarly there is a wide variety and differing levels of harm associated with them. There are very few shared harms for all PIEDs.

Common side-effects of PIED use will vary between individuals, but the negative impacts may affect physical, psychological and/or behavioural wellbeing. The harmful effects will depend on the particular PIEDs taken, how much and how often the drug is taken, and the physiological characteristics of the person.

Injected PIEDs have additional risks due to the harms associated with the use of needles. These include infection, transmission of disease through needle sharing, and problems associated with incorrect injecting technique.8

Public health concerns

Although the research is limited in this space, there are a few emerging public health issues associated with PIED use among the broader fitness community. These include the increasing number of people using these drugs, which means there is an increased number of people exposed to the risks; and the lack of harm reduction focus from our healthcare system to protect people who use PIEDs specifically.4,7,8

Unless someone has a medical reason to be taking steroids or other PIEDs, they will most likely source the drugs on the black market. This means there is very little control over the quality and purity of these drugs.9

PIEDs and the law

It is illegal to manufacture, import, possess, use or supply steroids without a prescription or medical practitioner’s licence in all states and territories in Australia.10

Steroid use is banned in competitive sport, and when an athlete tests positive for these substances, they can be fined, suspended or permanently banned.10

Stigma – an inevitable harm

The unrealistic and idealised culture of body sculpting within the fitness industry creates an expectation that is often difficult for people to achieve via purely natural means, resulting in use of PIEDs. This environment leads to the normalisation of the use of PIEDs, and research demonstrates that people who use them do not perceive their practice as substance use.4 Instead, seeing themselves as people who are working hard towards their desired physique, and that PIEDs are only a small part of the bigger process.

This mentality among people who use PIEDs and the wider fitness community means that people may be less likely to seek professional help with respect to common side effects that have short- and long-term harms.

Though there is a contradiction within this environment, the pressures that are created within the subculture of bodybuilding and fitness mean that people who use PIEDs may feel that they can’t be open about their use for fear of losing credibility. This can have unfortunate negative impacts on their health, as they may rely on sources of information regarding drugs that are not informed by the medical profession.6

More information

Performance and Image Enhancing Drugs

  1. Larance, B., Louisa, D., Paul, D., & Copeland, J. (2005). Use of performance and image enhancing drugs among men: a review. Sydney: National Drug and Alcohol Research Centre.
  2. Australian Crime Commission. (2013). Organised crime and drugs in sport. Canberra: Australian Crime Commission.
  3. Seear, K., Fraser, S., Moore, D., & Murphy, D. (2015). Understanding and responding to anabolic steroid injecting and hepatitis C risk in Australia: A research agenda. Drugs: Education, Prevention and Policy, 22(5), 449-455.
  4. Underwood, M. (2017). Exploring the social lives of image and performance enhancing drugs: An online ethnography of the Zyzz fandom of recreational bodybuilders. International Journal of Drug Policy, 39, 78-85.
  5. Australian Institute of Health and Welfare. (2016). Illicit Use of Drugs. Retrieved April 12, 2018, from Australian Institute of Health and Welfare.
  6. Larance, B., Degengardt, L., Copeland, J., & Dillon, P. (2008). Injecting risk behaviour and related harm among men who use performance and image enhancing drugs. Drug and Alcohol Review, 27, 679-686.
  7. Dunn, M., Henshaw, R., & McKay, F. H. (2016). Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug and Alcohol Review, 35, 377-382.
  8. Larance, B., Degenhardt, L., Dillon, P., & Copeland, J. (2005). Rapid assessment of performance and image enhancing drugs (PIEDs) in New South Wales: Feasibility Study. Sydney: National Drug and Alcohol Research Centre.
  9. Coomber, R., Pavlidis, A., Santos, G. H., & Wilde, M. (2014). The supply of steroids and other performance and image enhancing drugs (PIEDs) in one English city: Fakes, counterfeits, supplier trust, common beliefs and access. Performance Enhancement & Health, 3, 135-144.
  10. Australian Medical Association. (2018, April 2). Drugs in Sport 2018. Retrieved from Australian Medical Association

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