Friday, January 28, 2011

Internet “Pharmacies”: Dangers of Buying On-Line

Athletes are continually searching for an “edge” that will improve performance and lead to success in the arena. Unfortunately some turn to illegal strategies including the use of anabolic androgenic steroids (AAS). These compounds promote increase in muscle mass, strength and power. However, the side effects of these compounds can be serious and include testicular atrophy, liver disease, elevation of cardiovascular disease risk factors, and development of various cancers. Given this, it is not surprising that AAS are listed as Schedule III controlled substances under the US Controlled Substances Act, which makes the possession of such substances without a prescription a federal crime. Other countries have enacted similar laws. Despite this, illegal purchase of these drugs can be relatively easy. The black market is one source. A recent survey showed that more than 70% of AAS users purchased their products through the internet. Researchers in Italy found that internet marketing of illegal drugs is rampant with misleading information and deceptive practices that target athletes hoping to improve athletic performance. The study also emphasizes the critical need for coaches and health care providers to educate young athletes about the dangers of internet misinformation.

Researchers at the University of Unsurbria (Varese, Italy) surveyed 30 websites that were located worldwide with several in North America, Europe and Asia. All offered one or more AAS and most also offered a variety of dietary supplements. Information such as product name, manufacturer, cost, recommended dosages, therapeutic uses, recommended dosages, and adverse side effects were recorded. The team also recorded purchasing and shipping information and instructions as well as verification of a valid prescription.

The investigators reported several very troubling findings. First, nearly all of the websites presented a clear, fraudulent attitude towards the sale of their products. None of the websites required a valid prescription, most assured anonymous delivery and offered no warranty of delivery. Many offered delivery methods designed to avoid customs inspections and confiscation. Some sites also offered legal opinions about the consequences of illegal drug purchases. Included were what the consumer could expect and what steps he/she should take if confronted by authorities. In short, an attitude of “skirting the law” to the consumer was presented.

Second, the benefits of the advertised compounds were always described as recreational as opposed to therapeutic. Effects such as muscle mass and strength gains as well as fast results and popularity were regularity noted. Of more concern is that the adverse effects were rarely described and when they were, they were downplayed. For example, risks of major health complications were not mentioned but minor side effects such as the development of acne were. Different effects, positive or negative, on men and women were rarely described.

Third, many of the recommended dosages were often far larger than therapeutic. In some cases, the dosages and products recommended by the advertiser were approved for veterinary use only. For example, the therapeutic dose of nandrolone, one of the more widely sold products, is 25-100mg every 3-4 weeks and up to 50-200mg per week. Internet suppliers often recommended athletes take up to 600-800mg weekly, well above the indented therapeutic dose. Also, few sites provided instructions on the correct method of injection of drugs intended for intramuscular use.

Fourth, it is clear that some sites offer counterfeit compound to their buyers. Manufacturers of many drugs are listed but it is unlikely that these companies actually make the drugs being sold. One the listed manufactures posts on their website that they no longer manufacture the compound and have not done so for several years. The supposed manufacturer also states that Internet drug vendors are using their name without permission. The Internet vendors are providing false information about the makers of the drugs (counterfeit) or they are selling samples from outdated batches.

Finally, many Internet companies also use fake or similar names that resemble actual drugs. This was particularly true for products advertised as dietary supplements. For example cyclostanozol is advertised as a legal alternative to stanozolol (winstrol). Cyclostaozol is one of a class of compounds described as “prohormones” that are converted into full, active hormones (natural) within the body. However, the conversion rate of many prohormones is very small. Also, vast majority of research studies show they have no significant effects on muscle growth or muscular performance (they do, however raise the risk of negative side effects). Also, it is fairly evident that many companies are selling substances that have less than advertised amounts of the active drug. Price differences can differ considerably between vendors; in some cases by more than 3-fold. This suggests that cheaper drugs may be expired versions or may contain less of the active ingredient.

Based on their survey of 30 Internet sites that sell androgenic anabolic steroids, the investigators conclude that there is widespread occurrence of misleading and deceiving practices as well as a lack of transparency and accountability. The websites include misleading information about risks and benefits as well as recommended uses and dosages. Also, marketing of counterfeit and outdated products appears to be very common.

There is little doubt that email targeting and Internet advertisements of improved performance at the tip of a syringe or inside a pill bottle are widespread. The lure is strong – a quick and easy way to gain an advantage over the competition. However, there is no doubt that there are serious health risks and potential legal consequences associated with the use and purchase of androgenic anabolic steroids without medical supervision. There is also little doubt that following the information provided on these sites can lead to serious health problems. No credible health care provider or coach would recommend these compounds to any athlete much less a young soccer player.

This study also highlights the concerns over the use performance enhancing drugs by identifying potential risks of Internet marketing. It emphasizes the need to educate young athletes on the dangers of “buying into” the information provided by these sites. The ad campaigns are tempting and the information provided sounds scientific and is convincing. An unsuspecting athlete could easily conclude that the benefits of using AAS far out-weigh the risks. Unfortunately these advertisements and websites are grossly misleading at best and outright fabrications at worst. The true health and legal consequences of using many performance-enhancing drugs is simply not available.

Steroid use by soccer players in probably not as wide spread as in other sports that rely heavily on muscle mass, strength and power such as American football. However, some athletes (and parents) have asked about these compounds and how they might be used to improve soccer performance. Coaches and health care providers can play a pivotal role in preventing athletes from going down the steroid path. Educating players on the true risks of using these drugs can discourage use. Players should understand both the health and legal consequences of AAS use as well as the ethical issues. Coaches should also strive to promote an atmosphere that discourages in any interest in using these compounds. Place focus on training and diet rather than quick-fix solutions. Hopefully, in the end, players will choose to avoid use of AAS compounds.

Reference:

Cordaro FG, Lombardo S, Cosentino M (2011) Selling androgenic anabolic steroids by the pound: identification and analysis of popular websites on the internet. Scandinavian Journal of Medicine and Science in Sports, doi: 10.1111/j.1600-0838.2010.01263.x.

Adams JU (2010) An op-ed concerning steroids and the law: how the internet has changed illegal drug trade and its prosecution. Physiology and Behavior, 100:205-207.