Despite increasing interest in the use of human enhancement drugs (HEDs), our understanding of this phenomenon and the regulatory framework used to address it has lagged behind. Encompassing public health, epidemiology, neuroethics, sport science, criminology, and sociology, this book brings together a broad spectrum of scholarly insights and research expertise from leading authorities to examine key international issues in the field of HEDs. As "traditional" and other "new" drug markets have occupied much of the academic attention, there has been a lack of scholarly focus on human enhancement drugs. This book provides readers with a much-needed understanding of the illicit drug market of HEDs. The authors, from a variety of cultural contexts, disciplines and perspectives, include both academics and practitioners. Topics explored in this collection amongst others include: the anti-doping industry and performance and image enhancing drugs, steroids and gender, the use of cognitive enhancing drugs in academia, the use of sunless synthetic tanning products, the (online) trade of HEDs, regulations of the enhancement drugs market. This collection will serve as a reference for students, academics, practitioners, law enforcement and others working in this area to reflect on the current state of research and consider future priorities. This detailed exploration will provide a valuable knowledge base for those interested in human enhancement drugs, while also promoting critical discussion.

Recently the journal Performance Enhancement & Health put out a call to produce a special issue on the dark side of human enhancement, including the use of legal and illegal substances, leading us to ponder whether the “dark side” of anabolic-androgenic steroids (from here on, “steroids”) has been overstated. In this commentary, we will briefly engage with this question by unpacking what we describe here as the “narrative of harm”, which tends to dominate discourses on steroid use in wider society. We then consider an alternative perspective on steroid use which focuses on the users’ experience and understanding, with particular attention to the role of pleasure. Finally, we conclude by exploring some of the negative policy consequences arising from the dominance of the “narrative of harm” and advance a regulatory approach grounded in rational and research informed discussions around both the pleasures and pains of steroid use. A more developed version of this argument can be found in the forthcoming collection Human Enhancement Drugs, published by Routledge in 2019 (Mulrooney, van de Ven, McVeigh, & Collins, 2019).

Anti-doping has evolved from a historically independent and un-coordinated movement to what is now a largely coherent and unified crusade, inclusive of global government, national government and sport authorities, and headed by the World Anti-Doping Agency (WADA). The growth of the anti-doping movement has not been limited to size but the scope has likewise expanded as the movement has consistently called for and successfully accrued more powerful weapons in the doping fight. While doping controls within sport have been successively ratcheted up, our attention here is with the breach of anti-doping beyond the boundaries of sport, to target social consumers and traffickers of performance and image enhancing drugs (PIEDs).

Doping in sport has become progressively viewed as a social problem and a number of actors have been successively identified as the ‘carriers of this social harm’ (Ellis, 1987; in DeKeseredy & Dragiewicz, 2012). As a result the list of ‘folk devils’ (Cohen, 1985) has grown and so too have the control mechanisms employed to combat them. Performance and Image Enhancing Drugs (PIED) are deemed morally reprehensible by the general population, and considered a practice that should be banned and criminalized (Coomber, 2013; Coakley, 2014). However, there seems to be a tendency amongst policy makers to frame steroid or PIED use outside of elite sport as an issue within sport, and to call for the same types of policies that are being used in anti-doping (Kimergard, 2014). This paper will briefly explore the PIED policies of three countries, Sweden, Belgium and Denmark, highlighting the ways in which anti-doping in elite sport is informing national drug policy and encouraging a zero tolerance approach to PIEDs as a social health issue.

The recreational use of steroids and other image enhancing drugs (SIEDs) to enhance image and/or performance has been firmly recognized as a public health concern (McVeigh, et al. 2016). In a meta-analysis of 187 studies exploring the recreational use of SIEDs, an overall global lifetime prevalence of 3.3 percent, and a lifetime prevalence of 2.3 percent for high school students who use SIEDs, was found (Sagoe, et al. 2014). In addition, looking at fitness training-related groups, such as bodybuilders, we see much higher numbers, with prevalence rates in gyms as high as almost half of all members. While most countries focus on prevention and education to deal with this growing issue, a handful have taken the drastic step of introducing dope-testing programs in gyms (only EU countries) and high schools (mainly the United States).

Has the “dark side” of anabolic-androgenic steroids been overstated? In what follows, we examine this question with the intention of injecting some nuance and much-needed debate into discussions surrounding the non-medical use of steroids. We set out by unpacking what we call here the “narrative of harm” which has tended to dominate discourses around steroids. Next, we introduce an alternative perspective on steroid use which focuses on the user’s voice and understanding, particularly with respect to the capacity of these drugs to provide pleasure. Finally, we explore some of the policy consequences which arise from these outlooks.

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.

Most media reports would have you believe steroid users are predominantly young men suffering a “crisis of male ego” who are on a “deadly crusade to get ripped”. The focus tends to be on health harms and the danger associated with using these substances. After critically assessing the research in this field, we found people use steroids for a variety of reasons. And while steroid use does carry risks, not all users will develop personal problems or cause harm to others.

While there are different harms that are related to sport/exercise (hooliganism, gambling, drug use, violence, etc.), in this chapter we are particularly interested in exploring the ‘subjective harms’ and ‘embedded harms’ associated with the exercise regime known as CrossFit, with specific attention to the use of performance and image enhancing drugs (PIEDs) and dietary supplements within this milieu. Drawing on the deviant leisure perspective, the chapter explores the possible ways in which CrossFitters may ‘self-harm’ in their conformity to social norms and values and specifically the cultural injunction to either perform or be aesthetically appealing and, more importantly, how these harms may be mitigated, meditated or exacerbated by a CrossFit leisure identity. The main purpose of this chapter is to (1) empirically investigate the reported prevalence of supplements and PIEDs in CrossFit within the UK, (2) examine the relationship between CrossFit and (un)healthy behaviours and practices more generally and (3) situate our findings within the broader theoretical lens of deviant leisure.

Earlier this month the 11th annual CrossFit Games took place in the US. While the event has come a long way from humble beginnings, the prizemoney and fame now attached to it have led to concerns that competitors may be doping to gain an unfair advantage. CrossFit is a fitness regime practised by people all around the world. But the majority of those who take part in its high-intensity competitive workouts are not elite athletes: they do so on an amateur level or recreationally.