Traditionally policymakers have paid little attention to the consumption of steroids and other performance and image enhancing drugs (PIEDs) in Australia. Yet, in recent times PIEDs have come to occupy an increasing amount of discursive space and, indeed, regulatory action. This newfound interest may be attributed to several broader developments, not least the perception of the involvement of organized crime in distributing PIEDs to the professional sports world and other sectors of this illicit market. This paper seeks to explore the empirical reality of the claim that the production and supply of PIEDs in Australia is the prerogative of organized crime groups. A retrospective content analysis of Australian PIED provider cases was conducted between 2010 and 2016. To widen our search, both media articles describing court cases, obtained from the Factiva database, and public online court records, using the Australasian Legal Information Institute (AustLII) database, were searched. Search terms included “steroid*”, “doping” and “testosterone” in combination with the terms “traffic*”, “production”, “supply*” and “import*”. In total, 477 PIED provider cases were identified yet most cases were duplicates, irrelevant or lacked sufficient detail, resulting in a final dataset of 144 cases. A coding schedule was developed based on existing PIED supply literature. Our data shows that most PIED provider cases took place in Queensland (41.7%), followed by New South Wales (25%) and Victoria (13.2%). Regarding the type of providers, the largest group consisted of people active in the gym industry (22%), followed by the healthcare sector (17%), the ‘other’ category (12%) and the security sphere (8%). Of the 144 steroid-provider cases, only 12% of the cases indicated the potential involvement of organized crime groups, with half of those being linked to outlaw motorcycle gangs. In contrast to the claims of authorities, our data suggests that organized crime groups currently play a proportionally small role in the illicit production and supply of steroids and other performance and image enhancing drugs in Australia. Indeed, various actors are involved of which only a small fraction are part of or involved with organized crime groups. Many suppliers are particularly active in the gym industry and healthcare sector. The relative presence of such suppliers has important policy implications, not least with regard to the role of criminal law in addressing the provision of PIEDs.

This commentary invites discussion about implicit and explicit factors that impede research about substance use from a nuanced perspective that recognises potential benefits and advantages. It is argued that explicit efforts to engage in scholarship beyond those informed by theoretical and philosophical assumptions that substance use is inherently risky and problematic can enhance genuine inquisition about substance use and transform which discourses and interpretations are legitimised. Prioritisation of scholarly funding and publication has largely been predicated on the notion that illicit substances pose an inherent risk for individual and social harm. This has implicitly and explicitly influenced what type of research has been conducted and how substance use is constructed. Researchers who engage in scholarship that suspends assumptions of risk and problems associated with substance use may become subject to judgement about their credibility, ethics, and expertise. Moving forward, we suggest that conscientiously attending to broad, nuanced experiences associated with substance use will contribute to a stronger evidence base. Equal opportunity should be given to examine the complexity of lived experiences. It may also be timely to consider what brings value to scholarly pursuit, recognising that health is but one valued social outcome. Perhaps other outcomes, such as human rights, compassion, and justice are equally commendable. To advance substance use scholarship, it is essential that decision-makers (e.g., funding bodies, editors) embrace research that does not conform to assumptions of risk or inherent problems as exclusively legitimate, advocate for scholarship that resists conforming to dominant discourses, and create spaces for critical perspectives and interpretations.

Background: Testosterone is used therapeutically in medical settings. Non-prescribed testosterone use is typically illegal, described as 'enhancement’ or 'doping’, and considered a problem. However, research has found that some non-prescribed testosterone use may be therapeutic (i.e. self-medication). Little is known about testosterone self-medication. It has been noted among individuals who use image and performance enhancing drugs (IPEDs), but never systematically explored.
Approach: This paper describes the findings of a 4-year ethnographic study in online forums and social media groups frequented by people who use IPEDs. It focusses on 31 men who used enhancement doses of testosterone, but who described some of their testosterone use as 'testosterone replacement therapy’ (TRT). In particular, it focuses on the 26 (84%) of these individuals who self-medicated TRT. Data was analysed thematically (using NVivo) in order to answer the question: 'how and why is testosterone self-medicated?’. Using Bacchi's (2016) problematization approach to policy analysis, this paper also asks, 'what happens to the 'problem’ of non-prescribed testosterone use if such use is therapeutic?’.
Findings: Self-medicated TRT was found to be very similar to TRT as practised in medical contexts. Self-medication was often practised because of an inability to access testosterone through health practitioners (who were either reluctant or unable to prescribe). However, some individuals were found to prefer self-medication because of price, ease of access, reliability of supply, and because health practitioners were perceived as lacking expertise regarding testosterone use.
Conclusion: By documenting the therapeutic use of testosterone outside of medical settings, this paper calls into question previous conceptualisations of all illicit testosterone use as 'abuse’, and the utility of the repair/enhancement dichotomy as a foundation for discussions of drug use. It suggests that in some cases the problem may not be non-prescribed testosterone use per se, but policies that prevent access to medical treatment.

We are currently witnessing a seismic shift within the global drug policy landscape. Some of these shifts have resulted from changes in global drug supply and demand. For example, new drugs have entered the market as a result of changes in the availability and purity of traditional, established drugs (European Monitoring Centre for Drugs & Drug Addiction, 2016); there are new ways of purchasing drugs, with the emergence of virtual currencies (Barratt & Aldridge, 2016); and the way we access drugs has evolved, thus that online drug markets have become established alongside traditional street-based markets (Cunliffe, Martin, Decary-Hetu, & Aldridge, 2017; van de Ven & Koenraadt, 2017). Some of these shifts have occurred because we now have good evidence to suggest that old ways of addressing the global 'drug problem' have failed; indeed, we are recognising that drugs are perhaps only a problem because we have framed them as such. The unending and political motivation of the 'war on drugs' means that we now must be prepared to acknowledge that we cannot arrest ourselves out of the problem that our policies have created.

In February 2020 the Human Enhancement Drugs Network (HEDN; www.HumanEnhancmentDrugs.com) organised a symposium entitled "Human Enhancement Drugs and New Research Directions". Human enhancement drugs (HEDs) includes "substances that are used as functional aids - their predominant purpose is not primarily immediate gratification or pleasure (in contrast to psychoactive drugs) but are rather often utilized in the pursuit of excellence, the attempt to surpass one’s natural potential, and/or the attempt to retain, regain or recover a quality, skill or standard. In short, this may be expressed as "better than well"" (van de Ven, Mulrooney, & McVeigh, 2019, p. 3). The aim of the symposium was to bring together a broad spectrum of scholarly insights and research expertise from various disciplines to examine key (inter)national issues in the field of enhancement drugs. Its purpose was to facilitate debates on our understanding of the cultural and societal contexts of HED use and supply, as well as the critical analysis of (the consequences of) policy implementation. Approximately 30 people attended the symposium (in person and via Zoom) including academics, anti-doping officials, drugs/health/implementation science researchers, chemists, a retired athlete, a lawyer, and needle and syringe program (NSP) staff. At the end of the symposium, attendees were asked to submit what they believed to be the three most important issues in this field; i.e. what are some of the key problems they would like to see addressed and where would like more research to be focused? In this editorial, we (the organisers of the event and board members of HEDN) will reflect on the priorities that have been raised during this symposium. We have purposely added the question mark behind the word "new" in our title, because as we will show some of the raised priorities are not necessarily new but have remained important long-standing issues.