• steroid;
  • needle and syringe program;
  • injecting;
  • performance- and image-enhancing drug;
  • policy


Introduction and Aims

Needle and syringe programs (NSP), which provide sterile injecting equipment, are a cornerstone of Australia's drug harm reduction strategy and assist in reducing the spread of blood-borne virus infections, such as HIV and hepatitis C, among people who inject drugs. Some reports suggest that steroid users are an increasing proportion of clientele at NSPs. In this research, we investigate the experience of NSP workers who come into contact with people who use steroids and other performance- and image-enhancing drugs (PIED).

Design and Method

Thirteen NSP workers were recruited using purposive sampling strategies. Participants were interviewed using a semi-structured interview guide. Interviews were recorded, transcribed and coded for themes.


There are three key findings of this study. Firstly, NSP workers do not feel well informed about the substances that PIED users are injecting. Secondly, they were unsure what equipment PIED users required. Thirdly, PIED users were perceived to differ from other client groups, and these differences impacted upon the level of rapport staff could build with this group.

Discussion and Conclusion

PIED users pose unique challenges for NSP workers compared with other NSP client groups. The PIEDs used and the way in which they are used are substantially different compared with other NSP clients, and there appears to be a lack of knowledge within the workforce about these substances. This study highlights the need to engage in workforce training, but also the need to more effectively engage with PIED users in relation to effective harm reduction strategies. [Dunn M, McKay FH, Iversen J. Steroid users and the unique challenge they pose to needle and syringe program workers. Drug Alcohol Rev 2014;33:71–77]