Performance-enhancing Drugs and Body Image

Stuart C McDonald Excerpts

Tuesday 21st February 2023 Westminster Hall

[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.