Home > Image and performance enhancing drugs (IPEDs): literature review.

Lifeline Project. (2016) Image and performance enhancing drugs (IPEDs): literature review. London: Lifeline Project Ltd.

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This report aims to summarise the currently available evidence and knowledge around IPED use, examine the challenges faced by drug service providers working with IPED users, and look at how we can better work with this group.

Executive summary

  • IPEDs are substances used to alter or enhance or alter a person’s appearance or abilities. The most prominent are anabolic steroids, ‘smart drugs’, and skin-enhancement drugs (for example Botox).
  • Evidence is fairly thin on prevalence and impact of all three groups of substances, though use appears to be growing.
  • Most IPEDs are self-prescribed and administered by users without medical guidance. Substances themselves tend to be produced and sold without the legal regulation or safeguards that would usually surround most medicines.
  • IPED use has traditionally been seen as outside of drug services’ remit and most IPED users unlikely to view themselves drug users in the traditional sense.
  • There are comparable numbers of injecting steroid users and injecting heroin users in England, with some reports indicating up to 300,000 injecting steroid users. Numbers injecting cosmetic drugs such as Botox are likely even higher.
  • The most significant risks to steroid and Botox users are around injecting. Rate of HIV amongst steroid users are approximately the same as amongst heroin users. There is great need for safer injecting advice and needle exchange amongst these groups.
  • Aside from risks related to injecting, illicit steroid use also risks liver damage, kidney damage, cardiovascular issues, dependency, depression, insomnia, and unwanted changes to sexual characteristics (eg breast growth, hair loss, or impotence).
  • There is a strong community around steroid use within gyms and online, and similarly a strong online community around smart drugs. Personal experience and word of mouth in these contexts is the usual source of dosing and usage guidance and information on health risks.
  • Steroid users themselves are likely to be more knowledgeable on how different gym-drugs work and interact than drugs workers or other professionals due to the vast range of substances often used. Unless a worker is an experienced IPED user, they are unlikely to be able to give substance-specific guidance or advice.
  • Aside from the strongest substances (such as amphetamines or methylphenidate), most smart drugs have little to no significant negative impact on users.
  • Building on personal qualities such as self-acceptance, positive self-image, or stress-management may help those with dependent or problematic IPED use, though we should be careful not to stigmatise all IPED use – the desire to improve oneself is not unusual and not all IPED use is necessarily harmful.
Item Type
Publication Type
International, Report, Review
Drug Type
Substances (not alcohol/tobacco), CNS stimulants, New psychoactive substance
Intervention Type
Harm reduction
November 2016
23 p.
Lifeline Project Ltd
Corporate Creators
Lifeline Project
Place of Publication

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