Performance-enhancing Drugs and Body Image

Tuesday 21st February 2023 Westminster Hall

16:30

[Dr Luke Evans (Bosworth) (Con)]

I beg to move,

That this House has considered the matter of steroid and image and performance enhancing drug use.

It is a pleasure to serve under your chairmanship, Ms Fovargue.

We need to talk about steroids in the UK. I am talking about not just any steroids but anabolic steroids and image and performance-enhancing drugs—or IPEDs. There are an estimated 500,000 to 1 million users in the UK, but no one is talking about it. The closest we get is the “natty or not?” discussions on social media about naturally built men and women versus people who are enhanced. There is particular discussion about Hollywood actors.

[David Mundell in the Chair]

I will not cast any aspersions about who does or does not use steroids and performance-enhancing drugs, but it is fair to say that the debate is becoming bigger and louder, not only in this country but in America and throughout the western world. The Priory Group did some research about 10 years ago and estimated that around 50,000 people were using steroids; its estimate now is that 500,000 people are using them. It says that

“we are sleepwalking into a health crisis”.

I know from my time as a GP that when it comes to—[Interruption.]

[David Mundell (in the Chair)]

Order.

16:31

Sitting suspended for a Division in the House.

16:39

On resuming—

[David Mundell (in the Chair)]

The debate can continue to 5.38 pm.

[Dr Evans]

It is a pleasure to serve under your chairmanship, Mr Mundell.

Until we were rudely interrupted by that vote, I was saying that we need to talk about steroids in the UK because, as the Priory Group has said:

“we are sleepwalking into a…crisis.”

As a GP, I know that the obesity epidemic has been a real problem, but part of the nation is actually getting fitter while part of it is getting fatter. I will concentrate on the part that is getting fitter, because of those who go the gym—mainly men—we know that one in 10 suffer from bigorexia. What am I talking about? Bigorexia is body dysmorphia—the idea that someone’s muscles are not big enough, no matter how much they eat or train. It is important to understand that this is a growing epidemic in our country; even more importantly, it is quite prolific in the gay community. I will break the issue down into three sections. I will talk a little bit about how I came to this topic, the drivers behind it, and, most importantly, what needs to be done.

Growing up, I was a fairly normal kid. At the age of 14 or 15, I was playing sport and was reasonably academic, but I was an outlier, because for my 15th birthday I had saved up £500 to buy a multigym. In my head, I wanted to improve my rugby, get girls, fight off bullies and improve my body image. Surprisingly, I was the under-16s first-team captain, but the other three aims fell to one side. Looking back, I think, “How many other young men feel like this?” That was 25 years ago. I think the points I mentioned are the driving forces behind why men want to go to the gym and improve their body image. Society says to them, “We need to be perfect”, but what is that perfect image?

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Social media and reality TV have played a huge part in promoting unrealistic body ideals, which we often do not think about when it comes to men’s self-esteem. Does the hon. Member agree that there should be some greater controls around edited, unrealistic imagery?

[Dr Evans]

The hon. Member is spot on. The advent of social media over the last 20 years has really brought home that idea of body image. With the likes of Instagram, if a man is interested in using a gym, they are sent hundreds of images in 30, 40 or 50 seconds. Each individual image in itself is not the issue, but the cumulative effect of repeatedly being sent such images is a problem.

I would argue that the way to solve the problem is through the social media companies’ algorithms, to ensure that there is transparency about what people are being sent. Facebook talked about diet pills aimed at young girls being a real problem. If we do not deal with male body image and body dysmorphia, this will be the next iteration of that problem.

As a doctor, over the last 10 to 15 years I have started to see more and more young men coming into my clinics and asking to be prescribed protein powders or creatine, and asking, “How do I bulk up?” I also started to see more and more men in their 20s, 30s and 40s who were using steroids and having side effects, including bad acne, scarring acne, mood problems and depression. I have even seen some men who have had strokes, heart attacks, liver problems, kidney problems and erectile dysfunction, none of which are really talked about when it comes to steroids.

The problem with steroids is that they work, so people use them and see a drastic improvement. People who want to build muscle will see that improvement, take the cycle of whatever substance it happens to be and then plateau, which is very hard for them to deal with because they no longer see the gains they were initially getting under their regime. They say, “Oh, I’ll only use it once”, but once becomes twice, twice becomes thrice, and so on.

[Sir James Duddridge (Rochford and Southend East) (Con)]

My hon. Friend listed symptoms, but I do not think that he mentioned swelling of the brain. Matt Dear, a 17-year-old from Essex, tried to build himself up by taking bodybuilding pills, because he was committed to a career serving in the armed forces. He took pills that he had bought for £30, his brain swelled up and, tragically, he died. The memory of Matt has helped to educate children in the community. Is my hon. Friend concerned that even taking these things once can be terminal?

[Dr Evans]

My hon. Friend makes an incredibly important point—these are dangerous prescription drugs, if they are not used properly. There is a plethora of side effects that are not talked about, from the short-term acute stuff that could mean someone has swelling of the brain or a clot, or is having a heart attack, or the long-term effects, such as depression, scarring acne or erectile dysfunction, which, particularly for young men, can have a huge psychological effect when they are trying to find partners. My hon. Friend is spot on. My heart goes out to Matt’s family; I am pleased there is a memorial for him.

Our role as responsible elected Members is to think about what we can do. The obvious area I get directed to is sport. It is actually quite hard to dope in sport, especially for an elite athlete. It does happen, but the culture is quite strong not to do so. Many athletes who want to be elite have come to me, as their GP, and have refused to take prescriptions because they are not sure whether it will be an exemption or clean, or whether it might get them in trouble with UK Anti-Doping.

Sport is an interesting area. I have met UN Anti-Doping a couple of times, and it is seeing people using these drugs to improve their image, but then finding out that they are quite good at sport and then getting into trouble with the authorities. The classic example is the young Welsh rugby player, who wants to look big on the streets when he is out and about, and wants to look good in Ibiza—and he finds out that having that size and strength is good on the rugby field. He starts playing semi-professionally and then gets picked up by UK Anti-Doping.

At the other end of the spectrum, we see cyclists, particularly affluent middle-aged men, who have the money and wherewithal to train, dedicate their time, buy the equipment they need, and start to see progression through the ranks of cycling. Then they meet the edge and ask, “What’s next? Let’s lose weight. Let’s have a fat burner. Let’s think about steroids or something else, like EPO.” That sees people caught out.

Those are the people going into elite or semi-elite athlete status; we have not even touched on society and the health aspects. We have heard a lot over the past 10 years about women’s health and body image, but less so about men’s. “Love Island” is back on TV at the moment, and we often hear a debate about how the females look: “Is there diversity? What about their shapes?” Very rarely do we hear that about the men. Nine out of 10 of them will have a six-pack, large shoulders and big biceps, and we seem to think that is okay.

Spencer Matthews from “Made in Chelsea” talked about the pressure and the need to use steroids he felt, because of his concern about what he looked like. We only have to look at what is currently in cinemas—the Marvel comic films—to see the aspiration set for young men.

[Nick Fletcher (Don Valley) (Con)]

I congratulate my hon. Friend on securing this debate. Does he agree that boys and men are in a unique position in the 21st century? There are all kinds of pressures on boys and men that are often not seen, and which they often do not talk about. Does he agree that one way the Government could help is by putting in place a men’s health strategy? We could look at subjects such as this, and other issues that men are facing, as a whole to help men today.

[Dr Evans]

I am grateful to my hon. Friend for his intervention. I commend his work on the men’s health strategy, and on securing the men’s world health debate. He is right that these tend to be pertinent male issues. There is a difference: from my clinical approach, I see men’s health-seeking behaviours. It is apt to say that we should target some of these issues in these ways, particularly steroid abuse and performance-enhancing drugs used for imaging, because men tend to be most affected—not exclusively but mainly. My hon. Friend is absolutely right.

That leads to the fitness industry itself, which purports to put out images of the six-pack and shoulders bigger than a fridge. The problem is that those are stationary images of a point in time. Aspiring to live in that point in time is very difficult. Young people may not understand that many people in bodybuilding go through cycles of bulking up and then dropping weight to fit a certain image for their competitions. That is fine for a bodybuilder, but it is not good for a 19 or 20-year-old university student to aspire to that, because they are at a time of meeting other people and creating relationships.

There is a ratchet effect. We see images of very large, muscular men, which people aspire to, and there is a cheap and effective way to get there; that is a real concern. That leads to a wider issue currently faced by societies across the western world: what is masculinity?

We have heard a lot about toxic masculinity, which allows space for the likes of Andrew Tate to step in. Lots of people listen to what he has to say, in part because he is saying, “Be strong, stand up, look after yourself.” On the other hand, he has been found to be completely wanting and is now under investigation. Is that the kind of role model we want in front of our young men? Young men who do not understand what masculinity is because they are not told within society will look for other options—be they the Marvel comics or the likes of Andrew Tate—to tell them what is acceptable to be masculine. That is a dangerous place to settle in.

But we are waking up to the issue; the online culture is starting to move towards calling it out. The likes of James Smith and Ben Carpenter talk openly about the pros and cons of the fitness industry, and how it has been marketed. The Women and Equalities Committee did a report on body image, as did the Health and Social Care Committee. The Advertising Standards Authority produced an interim report that identified the key issue of depictions of muscularity in advertising, and it hopes to have further information about that in quarter four of 2023. Awareness is there and the culture is starting to think about it, but we are still at least 10 years off in comparison to the female idea of body image.

We are not doing enough, which comes out when we speak to the likes of UKAD. I thank Trevor Pearce and Jane Rumble from UKAD for providing me with information when I met them. In 2019, a UKAD survey found that 34% of gym goers are aware of IPEDs being used in their gym. That is certainly my experience as a gym goer. Wherever I have been in the country, I have been aware of such drugs being taken, because I have found syringes and packets in the changing rooms. That is quite a scary thought, from my own anecdotal experience—yet one in three men who use gyms is finding the same.

The Medichecks survey of people who go to the gym found that 61% of men want to be bigger, and that 80% of men are aware of some of the side effects of steroids, yet three out of four of those men would consider using steroids or IPEDs. As I mentioned, one in 10 gym goers has bigorexia—a number that is thought to be increasing. Thinking back to being that young boy with my multigym at the age of 15, if I had had the online ability to get hold of such substances, and an ever-growing social media pressure to conform and have muscles, maybe I would have been tempted? That is a scary thought for the generations coming through.

In 2020, The Times reported that users could easily buy steroids through Instagram, even though they are class C drugs. The law says that class C drugs are lawful for personal use with a prescription, but it is illegal to distribute or supply them. In 2021, Border Force seized 1.225 million doses of anabolic steroids, which was down on the number seized a few years before—that does not cover other drugs that are available, such as the fat-stripping drug Clenbuterol—yet there were only 37 convictions for possession or supply last year. The trend has been for between 30 and 40 people to be convicted each year, over the last five years.

The Government have produced an updated drug strategy, called “From harm to hope: A 10-year drugs plan to cut crime and save lives”. The House of Commons Library confirmed to me that there is no mention of the words “steroid” or “IPED” in that report. The start of the report says:

“Over 300,000 people are addicted to heroin and crack cocaine in England. This is the biggest section of the illegal drugs market”.

Is it? Given that we expect 500,000 to 1 million people to have taken steroids, we simply do not know. That is the point I am driving at. The report talks about the principle of

“putting evidence at the heart of this approach”.

When it comes to IPEDs and steroids, we need data and evidence.

That leads me to my asks of the Government. Given that a Health Minister is responding, I think it is fair to concentrate on simply the health aspect of the issue. I ask for three things. First, will he commission the research into steroids and IPEDs suggested in the Health and Social Care Committee report on body image? Secondly, will he pull together the different Departments that the issue crosses over? The issue is not a single departmental issue. It is not covered simply by the Department of Health and Social Care, the Department for Digital, Culture, Media and Sport, the Home Office or the Government Equalities Office; it is all of them—there is a crossover. We need to pull together in roundtables and a taskforce to think about how we deal with this.

My third ask is for education and awareness. We need to think about schools, outside agencies and the NHS—a bit like the Government have done with eating disorders. The number of people suffering eating disorders has skyrocketed, and the Government have responded well by getting the information and support out, and looking at ways to strategise. We are a long way off dealing with eating disorders, but this is the next big, similar crisis. I urge the Government to take that kind of strategy forward.

It would be remiss of me to come to the debate without offering wider solutions and there are some ideas that need to be talked about. They have pros and cons; I raise them because we need to have the conversation. We could look at compulsory mandatory education for personal trainers, who are the most likely people to come into contact with gym goers. We could change the IPED laws, and make sentencing more severe; or do the opposite, and take them out, and say, “No, this is a health issue that we need to deal with.” The debate needs to happen.

We can look at examples from across the world. Norway has licensing of gyms. If new drugs were being found in a nightclub—with new drugs being found and one in three people being aware of the situation—the authorities would be knocking on the door saying, “Should we be licensing? Should we revoke that licence? What should we do about it?” We are a long way off putting such a scheme in place, but it is not beyond our remit to have a discussion about whether that is something we should do to increase the responsibility of the gym owners. There are pros and cons. Fundamentally, we do not have the data and none of the details has been explored enough. That leads us full circle; we really need to start a conversation—we need to talk about steroids in the UK.

16:57

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

It is good to see you in the Chair, Mr Mundell. I start by thanking the hon. Member for Bosworth (Dr Evans) for securing the debate and for his excellent introduction. He spoke passionately and eloquently, from both his personal and professional experience. It would be difficult for me to add very much insight to what he has already provided, and there was very little I could quibble with in what he had to say. I am grateful to him for highlighting the issue’s significance as a public health issue, and as a growing public health problem at that, not just here but internationally. I fully confess that it is an issue of which I was not properly aware.

As the hon. Member pointed out, growing numbers of people are using IPEDs, including anabolic steroids. For various reasons, it is not clear precisely how many people are doing so, but it is clearly a very significant number. The hon. Member said that it is around 500,000, while others say it is more. A variety of sports have been implicated historically, including rugby union, rugby league, athletics and cycling, as we have heard. Other users are now engaging in this practice simply for reasons of image enhancement, including a growing number of gym users.

Studies suggest that young men in their early 20s are the most likely to start down this path, and increased use appears to be assisted by comparatively easy access, particularly through online sales and postal delivery from abroad. Border Force has previously reported annual seizures of millions of steroid doses.

As we have heard, this usage has significant consequences for people’s health. We have heard about problems with kidneys, liver problems, heart attacks and strokes. As the hon. Member for Rochford and Southend East (Sir James Duddridge) pointed out, there have been tragic cases where people have died from comparatively low amounts of steroid use. There are behavioural and mental health issues, including mood swings, aggression and eating disorders.

[Margaret Ferrier]

The hon. Member mentions aggression. A common side effect of steroids is roid rage, which means that it is not just those who choose to use steroids who are impacted, but everyone around them, too, and that can lead to serious life-ruining consequences all around. Does the hon. Member agree that greater understanding of side effects is an imperative part of tackling the abuse of these drugs?

[Stuart C. McDonald]

The hon. Member makes a valid point. One report I read suggested that when engaging with people who are already using steroids, sometimes the most persuasive factor in getting them to reconsider and move away from this conduct comes from speaking to them about the consequences for their mental health rather than the physical consequences. That appears to have more influence when it comes to behaviour. The hon. Member makes an interesting point.

Alone, most steroids are taken in pill form. If needle sharing is involved, there are other risks in terms of HIV and hep C. Use of counterfeits also further complicates risk. Of course, another consequence if they are used in sport is that unfairness is created and sporting integrity is undermined. As has been set out, the drugs are regulated under the Medicines Act 1968 and classified as class C under the Misuse of Drugs Act 1971.

The question rightly posed to us today is: what more can we do? I speak from a position of weakness, but I agree that first and foremost, we all need to improve our knowledge of the issue. Evidence has to be at the heart of the approach, as the hon. Member for Bosworth has said, so how better can we understand the scale, incidence and causation of the problems that have been highlighted and thereby better craft a response?

As the hon. Member highlighted, last August the Health and Social Care Committee reported on the impact of body image on mental and physical health and recommended a national review of the growing use of anabolic steroids as it relates to body image. That seems to me to be an essential first step. That research will then shape our response, which will have to use a public health approach and education to tackle demand and to try to close off access as best we can. That, of course, will involve a cross-departmental approach, which was another important point made by the hon. Member.

On education and campaigning, there are two sides to the coin. First, we need to look at the material and propaganda influencing and driving people to a place where they feel it is necessary or desirable to access IPEDs. That includes media and social media, as hon. Members have said, with the all-prevalent perfect body images in the press, on TV and increasingly on social media and in online advertising. If anyone shows a remote interest in trying to keep fit or even just losing a few pounds, they suddenly find themselves bombarded on Instagram or Facebook or whatever else with relentless images of what has been referred to in the past as the “Love Island” look, which to me seems pretty much unachievable for anyone who cannot spend every waking hour in the gym or unless they use IPEDs.

The Health and Social Care Committee dealt with that point in its report, calling on the Government to work with advertisers to feature a wider variety of body aesthetics and with industry and the Advertising Standards Authority to encourage advertisers and influencers not to doctor their images. The Committee said that

“the Government should introduce legislation that ensures commercial images are labelled with a logo where any part of the body, including its proportions and skin tone, are digitally altered.”

Those seem to be valuable suggestions that are certainly worth considering. The hon. Member for Bosworth pointed out that there has been some progress, but there is further to go.

As well as tackling the images and messages that promote the use of IPEDs, Government also need to raise awareness of the risks and how to minimise harm. Again, various Committee recommendations seem sensible, advocating for a campaign co-ordinated

“through existing steroid user support groups and targeted at areas of highest risk, such as gyms with a high proportion of body builders.”

We need to tackle head on the idea that these things are some sort of equivalent to supplements. They are in a different category altogether. The Committee also heard evidence stressing the importance of education about body image for young people, in terms of both critical thinking and appraising images, as well as self-worth. Again, the Government should strengthen those areas in education settings.

A report by the Scottish Drugs Forum noted the significance of close friends as a source of IPEDs. It suggested that peer education programmes could be an important way of overcoming that, with community members cascading positive health messages. And this is not just about education; mental health strategies need to be revisited as well, and we need to think about how we can support people struggling with self-esteem amid a bombardment of images.

Finally, we also need to consider appropriately targeted harm reduction advice and drugs services. There are many examples of good work out there. Yorkshire and the Humber has a regional steroid and IPED reference group and a workers forum of more than 30 people and with every district represented. In Glasgow, an image and performance enhancing drugs clinic provides testing, needle exchange services, consultation and advice on harm reduction and alternatives. Edinburgh, too, has a steroid clinic based in the harm reduction team of NHS Lothian. It provides advice services, equipment and testing, psychological services, and support to stop with mental and physical assistance. There is good work happening in the different parts of the United Kingdom. We should learn from that, and seek to ensure that more people around the various countries can benefit from it. Those are just a few ideas.

I will close by thanking the hon. Member for Bosworth again for bringing forward this debate. None of us have all the answers; I certainly do not—far from it. He had lots of ideas. He highlighted that there are pros and cons to some of them. Some of them are quite bold or controversial, but they are definitely worth discussing. His central point was that we need to have evidence to make the discussion as fully informed as possible. We should revisit this topic, and ensure that we continue to drive forward as we seek to address what is a growing public health issue.

17:05

[Sarah Jones (Croydon Central) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I congratulate the hon. Member for Bosworth (Dr Evans) on securing this debate. It is an important topic and he is doing some excellent campaigning. His description of bigorexia, the impact of social media and all the pressures on young men to get the perfect body image was powerful. It is true that we have been talking about these issues when it comes to women for a long time, but we have not been talking about men. I have twin boys who are 12 years old, and they tell me repeatedly that they want a six pack. They do not have one and they will not have one any time soon, but they are already thinking in that way.

The hon. Member for Bosworth mentioned Andrew Tate as a particularly powerful online influencer; they are putting great pressure on our young boys. I took a group of scouts around Parliament last week, and they were all telling me how poor Andrew Tate had been badly done by and locked up in prison for no reason. The hon. Member made the point that sometimes some of these men talk sense and sound like they are all about empowering men, but on the other hand they are being incredibly misogynistic and spreading awful mistruths. That is very true; I see it time and again.

This is an important conversation to have, and there is a wider conversation about the role that we can all play in developing what it means to be a man. I have done lots of debates about knife crime, and we talk endlessly about boys who feel they have to carry knives and be macho in order to be a man. There are boys now who go to the gym and are tempted to take steroids because they feel that is what it is to be a man. There is the growth of the horrific incel movement, with men who define themselves as not being attractive and not able to attract women. The Government need to think about all those important things in the round. It is a wider issue than this debate today.

We have covered a lot of the issues that the Government need to think about. The first thing is the law. As has been said, steroids are a class C drug, so they are illegal to own and sell. Possession is punishable by up to two years in prison or a fine, and people can get 14 years in prison for supply. Other drugs are illegal to ship or sell, but not to buy or possess. An example is the tanning drug melanotan, which I had not heard of until this debate, but it sounds like a strange thing to want to do. As with all classified substances, the Government are responsible for clamping down on the sale and use of those drugs. Although the Opposition said that the 10-year drugs plan did not go far enough, it did contain a lot of good policies. However, the fact that it did not include any of those steroids is amiss, and perhaps the Government should look at that again.

We have already talked about the physical side effects, which go way beyond what people read about when they decide that they want to get steroids. There are the potentially lethal impacts of strokes or heart attacks, as well as erectile dysfunction, sterility and loss of hair. We clearly need more information on all those things to tell people what they are likely to face if they take steroids. The other aspect is mental health. We know that use of these drugs is very high. It seems there is a debate online about the number being between 500,000 and 1 million. Perhaps 1 million is not quite right, but a large number of people in the UK use steroids; the hon. Member for Bosworth referred to the figures from UK Anti-Doping.

In a 2016 survey, 56% of steroid users said they were motivated by improving their body image, so getting stronger and fitter is not the driver here—it is body image. We all know the pressures to look good and conform to shockingly rigid beauty standards that are presented by the media. “Love Island” is back on television, as the hon. Member for Bosworth said, and there is really powerful pressure that very few of us are able to ignore. I certainly worry about my weight all the time, and why would men not do the same? We do not talk about that as much as we should.

Fads come and go, and new things will come on the market as soon as we tackle some of the older things. Recently I saw reports of a new procedure called buccal fat removal, which takes the fat out of one’s cheek. It is quite extraordinary, but apparently suddenly very popular. Surgeries and techniques and fitness tips change almost daily, but their impact on our mental health, especially that of young people, is relenting.

A study in 2021 found that 54% of men displayed signs of body dysmorphia and said that low body confidence had negative effects on aspects of their lives, while 49% of women admitted to often thinking about being lean and maintaining an extreme exercise programme and feeling anxiety at missing a workout. Over 80% of those aged 18 to 24 showed at least one sign of body dysmorphia. We have heard many more stats. The hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) talked about lots of the recommendations. The Women and Equalities Committee has heard that over 60% of women feel negatively about their bodies, but the equivalent figure for men does not come to the fore in the way that it should.

It is important to say that there is help out there for people who need it. The eating disorder charity Beat and the Campaign Against Living Miserably offer support to those affected by eating disorders, body dysmorphia and drugs. Help is out there for everyone, including men. Whatever toxic male influencers may say, there is no shame in seeking help for performance-enhancing drug use and body image issues. It is a sign of bravery and strength, not weakness. We should be clear that alongside proper enforcement of the law to tackle the crime, we should also tackle the causes of the crime. The next Labour Government will guarantee mental health treatment within a month for all who need it. That is a wider issue that the Government need to address.

The hon. Member for Bosworth very eloquently asked questions to the Minister. I know he is a Health Minister, so it is hard for him to talk about Home Office issues, but hopefully he can pass on the comments from this debate to his Home Office colleagues. There is a question about what is being done to stop the sale of these steroids. I was able to find a vast number of websites just by looking on Google. The websites ukroids247.com and hench-club.com will sell someone steroids. There is also onlinesteroidsuk.org. There were absolutely loads of them.

Although selling steroids is illegal and the Government say they are acting to stop such websites, there is little evidence that anything much is being done, so I ask the Minister: what will the Home Office do to tackle the sale of controlled IPEDs online? Will he look again at the 10-year drug strategy and perhaps expand it into this space? Will the Government commission a national review on steroid use, as has been mentioned, which the Health and Social Care Committee recommended?

The reasons that people use steroids and other image and performance-enhancing drugs are complex, but the drugs are illegal and cause serious harm to physical and mental health. This is an issue of public health as much as one of crime. It is clear from today that the Government must go further. We all need to catch up on the changing nature of the drugs that are available for people to buy. We need to move at the same speed as social media and do what we can to ease the pressure on young men in particular to build their body image by using these kinds of drugs. I am looking forward to hearing what the Minister has to say.

[David Mundell (in the Chair)]

I remind the Minister that he can go to 5.38 pm, while obviously leaving some time for Dr Evans to wind up.

17:14

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

It is a pleasure to serve under your chairmanship, Mr Mundell, and to listen to my hon. Friend the Member for Bosworth (Dr Evans). I knew as soon as he secured the debate that he would bring us something special, and he did not disappoint—it was a fascinating speech. Without wishing to spoil the impact of my response, there were so many good questions and important ideas in it that I will not be able to bottom all of them out this afternoon, but we should see this as the start of a conversation that I am keen to pursue with him. Likewise, there were many important and interesting observations from other hon. Members, including about the issue of roid rage, which was raised by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), and about the position of young men in society, which was raised by my hon. Friend the Member for Don Valley (Nick Fletcher). I was sorry to hear about the tragic case of Matt, which was raised by my hon. Friend the Member for Rochford and Southend East (Sir James Duddridge), and I am sure our hearts go out to his parents and family.

I will touch on the positive steps we took last week in the substance misuse and recovery strategy—the 10-year drugs strategy. My hon. Friend the Member for Bosworth mentioned that the strategy has a heavy focus on alcohol, heroin and crack, and the reasons for that are obvious. Indeed, as part of the launch, I met my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who will appreciate that there is a big focus on those drugs because they drive about half of all acquisitive crime. Alcohol is one of the big killers and addictions that causes so many problems. As part of that 10-year drugs strategy, we have created a ministerial working group across Departments of exactly the kind that my hon. Friend the Member for Bosworth talked about creating. There is every reason to look, through that group, at what we can collectively do, particularly on the illegal sale of some of these drugs.

To mention a bit about the strategy, this is a £421 million investment over the next two years to improve the number of recovery and treatment places. Perhaps I can cheekily use this opportunity to thank everyone working in the drug and alcohol treatment sector for all the fantastic work they are already doing, and there are many other things we want to extend out to, which my hon. Friend the Member for Bosworth has raised today.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw Members’ attention to my declaration in the Register of Members’ Financial Interests—I am a practising addiction psychiatrist. I thank the Minister for the focus he is bringing to bear on this area and for the fact that the Government have put in place a comprehensive strategy for the next 10 years that focuses on alcohol, crack cocaine and opiate use, which is absolutely the right focus. I also thank him for the fact that the strategy is backed up with substantial investment, which is very much needed and which I am sure will make a big difference over time.

However, we do not have good data collection for steroid misuse. A good way of collecting data about drug use in the general population is through the crime survey for England and Wales. I wonder whether the Minister might be able to take that away from the debate and collect some more robust data to ensure that steroid use is properly captured in that crime survey. Perhaps he might have conversations with colleagues in other Departments because that will give us a much stronger basis to work from, and an evidence base is important in drug and alcohol treatment.

[Neil O’Brien]

My hon. Friend brings huge expertise to the debate. He and my hon. Friend the Member for Bosworth are right that we need better data. Perhaps one route is through the CSEW, as he says. It may be that there are other routes for getting better data on prevalence. There are limits to how much people will report some of these crimes when it is something they are taking, rather than a case of stealing to fund that, but there may be different ways we can get the right data.

In terms of what we know, a small cohort of people—only 0.2% of people aged between 16 and 59—use steroids. However, these individuals, as my hon. Friend and other Members have pointed out, may not be fully aware of the health risks associated with the drug or the impact it can have on their mental or physical health. As Members present certainly know, anabolic steroids are prescription-only medicines that help patients gain weight and rebuild tissues that have become weak because of serious injury or illness—that is their clinical use. These drugs are sometimes taken without medical advice to try to improve muscle mass or athletic performance. Anabolic steroids are a class C drug under the Misuse of Drugs Act 1971. Although it is not illegal to possess them for personal use, possession, importation and exportation are illegal if deemed to be with the intent to supply others. So people who are involved in these issues need to be extremely careful.

Lots of work is under way across multiple Departments on this important issue, and I want to talk about just some of the actions the Government are taking, notwithstanding the need to do more on a range of fronts. The Government are committed to stopping the illegal trade in human medicines. The majority of IPEDs are sold online through illegal trading websites based overseas. The Medicines and Healthcare products Regulatory Agency works with private sector partners to try to reduce the presence of such websites and, with the Home Office Border Force, to intercept and seize medicines entering the UK.

We are also taking action in the Online Safety Bill to prevent criminal activity, including the illegal sale of steroids. The intention is that companies that fail to comply with the Bill when it has been enacted will face stiff financial penalties or, in the most serious cases, have their sites blocked by the independent regulator, Ofcom. I hope that that addresses some of the concerns about the frightening-sounding websites that the hon. Member for Croydon Central (Sarah Jones) mentioned.

Of course, we know that preventing the trade in steroids is not enough to tackle the problem. As my hon. Friend the Member for Bosworth rightly said, the wider issue lies with the increased prevalence of body dysmorphia and the societal preference for young men to look a particular way. The rise of social media has undoubtedly increased this pressure in recent years, as young people have greater access to platforms promoting often unrealistic and digitally altered body images.

Schools play a really important role in helping young people to make positive choices about their wellbeing through their compulsory relationships, sex and health education curriculum. The Office for Health Improvement and Disparities has worked with the Department for Education to create quality teaching resources for teachers in order to help prevent substance abuse and to address some of the issues with young people feeling that they should look a certain, completely unrealistic. To pick up on some of the horrifying stories that the hon. Member for Croydon Central shared about the young Scouts she met who were all fans of Andrew Tate, that is also something that we need to address in education in schools.

As well as informing students about the risks associated with harmful substances—this goes to the point that my hon. Friend the Member for Bosworth made about harm reduction as well as prevalence reduction—schools have an important duty to protect pupils from harm and to provide mental and physical health support. Through statutory health education, secondary school pupils are taught about the similarities and differences between the online world and the physical world, including how people may curate a particular image of their life online, how information is targeted at them, and how to be a discerning consumer of information online. I am always interested in how we can improve what is taught in schools, because the world facing young people is so different from the world that the generation of people represented here experienced when they were young.

I am proud to highlight that the Government have committed to offer all state schools and colleges a grant to train a senior mental health lead by 2025. That will enable schools to introduce effective, whole-school approaches to mental health and wellbeing. Backed by £10 million in 2022-23, over 8,000 schools and colleges have taken up the offer so far.

We are also taking significant steps to tackle body image issues. On 2 February, the Government responded to the Health and Social Care Committee’s important report on the impact of body image on mental and physical health. We welcomed the Committee’s report and recommendations, and we agree with the Committee that image and performance-enhancing drugs are a significant public health issue. However, we know that prevention is better than cure, and when it comes to harmful substances, it is crucial that we ensure the public have access to sufficient information to inform them of the harms associated with substances such as steroids. The Government-commissioned website Talk to FRANK provides detailed information on the mental and physical health risks of taking steroids, and it is updated on a regular basis.

Additionally, UK Anti-Doping already has an outreach and communication programme that is run in partnership with ukactive, which has been live since 2018. The partnership aims to improve education and awareness around image and performance-enhancing drugs in gyms and leisure centres because, as my hon. Friend the Member for Bosworth rightly pointed out, such places are a focus for these issues. They are the right places to target, and we need to work with sporting bodies, gyms and the like to try to tackle the problems where they are most concentrated.

I draw Members’ attention to the investment that we are making in mental health services. The Government will have invested £2.3 billion a year by 2024 in expanding the services available in England, including for people with body dysmorphic disorder. An additional £54 million is being invested in children and young people’s community eating disorder services in 2022-23. That investment is alongside the development of a major conditions strategy, which will address prevention and treatment for mental ill health, with an aim of producing an interim report in the summer.

I once again thank my hon. Friend for securing this debate on an important issue, and for his many, many ideas. He set out a whole suite of things that we need to be doing. It was a fascinating speech. I commend his work in this area, including his image campaign last year, which achieved national media coverage and will no doubt have had a beneficial impact.

The Government are taking significant steps to protect the mental health of the nation, and particularly young people, and we are ensuring that the right support is in place for those suffering or at risk of body dysmorphic issues. Although a review is not currently planned, the Department of Health and Social Care, the Department for Education and the Department for Digital, Culture, Media and Sport will continue to work closely on tackling the use of anabolic steroids, educating the public on the risks associated with them and ensuring that mental health support is available for all those who need it.

17:26

[Dr Evans]

Thank you for your chairmanship, Mr Mundell. Indeed, I thank both the Chairs we have had during this debate, as well as the Clerks for staying late and the officials for being here.

I thank the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) for talking about algorithms and body image. My hon. Friend the Member for Rochford and Southend East (Sir James Duddridge), who is no longer in his place, raised the sad case of Matt. The constant campaigning of my hon. Friend the Member for Don Valley (Nick Fletcher) for men’s health has been fantastic. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) hit the nail on the head: this issue is about how we record data.

I am grateful to the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) for his point about bold ideas. The whole point of this discussion is that no stone should be left unturned. The bold ideas might not be right, but they need to be explored, because that is the key thing to do when trying to deal with this issue.

I am glad to hear about the twins of the hon. Member for Croydon Central (Sarah Jones). These are exactly the conversations that people should be having up and down the country. Mothers, fathers, grandfathers and grandmothers should be asking questions about what young people are aware of and what they are seeing.

It is lovely to come into a debate after three years and hear that there is unanimous support across the House on this issue and a desire to fill the void, because there is a worry that the likes of Andrew Tate will step into it. I would love to take the Minister up on his “keen pursuit”—to quote him—of this issue. We are at the start of a road, and this is all about having a conversation about steroids in the UK.

Question put and agreed to.

Resolved,

That this House has considered the matter of steroid and image and performance enhancing drug use.

17:27

Sitting adjourned.