The supply of steroids and other performance and image
enhancing drugs (PIEDs) in one English city: Fakes,
counterfeits, supplier trust, common beliefs and access
Author
Coomber, R, Pavlidis, A, Santos, GH, Wilde, M, Schmidt, W, Redshaw, C
Published
2014
Journal Title
Performance Enhancement & Health
Version
Accepted Manuscript (AM)
DOI
https://doi.org/10.1016/j.peh.2015.10.004
Copyright Statement
© 2014 Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-
NoDerivatives 4.0 International (http://creativecommons.org/licenses/by-nc-nd/4.0/) which
permits unrestricted, non-commercial use, distribution and reproduction in any medium,
providing that the work is properly cited.
Downloaded from
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1
Ross Coomber
1
, Adele Pavlidis
1
, Gisella Hanley Santos
2
, Michael
Wilde
2,
Wiebke Schmidt
2,3,
and Clare Redshaw ,
2,3
1
Griffith University;
2
Plymouth University;
3
Exeter University;
The supply of steroids and other performance and image enhancing drugs
(PIEDs) in one English city: Fakes, counterfeits, supplier trust, common beliefs
and access
Abstract
As with other illicit drugs, such as heroin or cocaine, illicit steroids and other
performance and image enhancing drugs (PIED) have for some time been
assumed to involve an inherent degree of danger and risk. This is due to the
unknown and potentially dangerous substances present in them; fakes and
counterfeits are of particular concern. Many of these ‘risks’ are unknown and
unproven. In addition, a tendency to abstract these risks by reference to
forensic data tends to negate the specific risks related to local PIED markets,
and this in turn has led to much being missed regarding the broader nature of
those markets and how buyers and suppliers interact and are situated within
them. This article reports on research that sought to explore each of these
issues in one mid-sized city in South West England. A snapshot image is
provided of what the steroids and other image or performance enhancing drugs
market ‘looked like’ in this particular city in 2013: how it operated; how
different users sought out and purchased their PIED; the beliefs they held
about the PIED they sourced; and the methods they employed to feel confident
in the authenticity of their purchases. A forensic analysis was undertaken of a
sample of user-sourced PIED as a complementary approach. The results
showed almost all of these drugs to be poor-quality fakes and/or counterfeits.
The level of risk cannot be ‘read off’ from forensic findings, and poor-quality
fakes/counterfeits cannot simply be considered an attempt to defraud. Users
believed they had received genuine PIED that were efficacious, and employed
a range of basic approaches to try to ensure genuine purchases. Many, if not
2
most, transactions at the ‘street’ level were akin to ‘social supply’ rather than
commercial in nature.
Keywords: doping; social supply; dealing; GC-MS; black market; counterfeit; fake;
performance enhancing drugs.
3
1. Introduction
1.1 Background
As long ago as 1991, Strauss and Yesalis [15] claimed the non-prescription steroid
and other PIED market to be increasingly besmirched by fakes and counterfeits and
moreover, because these PIED were often being injected, these represented a real
danger to those using them. Some years later Lenehan [15] suggested that the
‘majority’ of PIED purchased by users were likely to be fakes and carried meaningful
public health consequences. These concerns, about the public health risks of ‘fake’ or
counterfeit PIED, are similar to concerns historically voiced about the ‘dangers’
contained in most illicit street drugs, particularly injectables, regarding dangerous
cutting agents or substitutes/fakes. The equation of fake/counterfeit = danger/risk
however should not be taken as a simple given.
In Coomber [1, 2, 3, 4, 5, 6] and later in Cole et al [7], it was established that nearly
all that is believed about the ‘cutting’ of illicit drugs such as heroin, cocaine, ecstasy
and other street drugs is mythical and/or misunderstood. Such substances are not ‘cut’
or ‘stepped on’ (adulterated/diluted) by drug dealers with dangerous substances such
as rat-poison, brick-dust, ground-glass, talcum powder or scouring powder, and street
drugs such as heroin and crack are not ‘cut’ down through the chain of distribution as
is commonly supposed. Nor are they routinely cut at any stage. Adulteration does
occur, but this is almost always purposive, mostly happens prior to importation and is
usually done with either comparatively benign substances (compared with the main
drug) or with substances that mimic or enhance the drug being supplied. So-called
‘fakes’ or substitutes are supplied to unsuspecting customers on occasion, but this is
often either a direct attempt to simply defraud – for example, individual wraps sold by
street dealers to transient buyers rather than buyers known to them [cf. 8] who might
seek recompense – or, in the case of ‘pills’ (e.g. PMA in place of MDMA), it is either
unknown to the seller (most likely) or, if known, is an attempt to supply something
close to the desired product during a time of scarcity of the desired drug. For illicit
street drugs, trust is a key criterion for users when they are choosing their source, and
an attempt to protect against ‘rip-offs’ and ensure (to some extent at least) quality or
reasonable potency [9, 10, 11]. The health risks assumed to be inherent in non-
4
genuine street drugs, while clearly not an unimportant concern, are non-the-less often
unreasonably exaggerated on the basis of assumption rather than evidence, as is the
case with so many drug market-related fears [12].
As with other street drugs, it is the controlled or prohibited nature of PIED use that
produces a black market. In black markets, supply to users takes place in clandestine
contexts, which means that products usually have little or no formal quality control to
protect consumers and ensure that what is sold/purchased is authentic. Essentially,
‘the rise of the “black market” sources brings with it a host of risks, from poor quality
doping products to a general “hardening” of the market’ [16: 239]. To date, however,
despite the solid body of evidence developing on the black market of illicit drugs,
there has been little focus on either the nature of the black market for PIED or supply-
side dynamics [18, 16]. This is especially true for the market intersection with those
non-elite athletes mainly engaged with PIED for body and image enhancing purposes.
1.2 Sourcing PIED internationally
A report by the UK Advisory Council on the Misuse of Drugs (ACMD) in 2010 [19]
reviewed data suggesting that the illicit market for PIED has three basic sources:
(1) products manufactured ‘legitimately’ in middle-income countries (for example,
China and India) where regulatory oversight is weak; (2) products
manufactured/packaged in ‘underground’ laboratories where quality and safety is not
demonstrable (or guaranteed); and (3) legitimate products manufactured in high-
income countries and bought either legally or illegally. The contribution of each
source to the overall market is unknown.
The picture is further complicated in the sense that, although PIED are strongly
controlled substances in many jurisdictions, they are nonetheless legal in some. Also,
the addition of new products – and therefore new laws – complicates the legal
standing of some substances [20]. This means that the production and distribution of
PIED worldwide is in fact a ‘semi-legal’ market [21].
Where non-prescribed use and non-licensed distribution of PIED are illegal, however
– as in the non-sporting world – common assumptions are made about the drug
market that tend to an over-homogenisation of what it looks like [cf. 22]. In general,