Office of Diversion Control

US Department of

. .

Justice

Drug Enforcement Administration .

www.dea.gov

U.S. Department of Justice

Drug Enforcement Administration

Office of Diversion Control

www.dea.gov

www.DEAdiversion.usdoj.gov

US Department of

. .

Justice

Drug Enforcement Administration .
STEROID ABUSE BY

SCHOOL AGE CHILDREN

March 2004 1

Once viewed as a problem strictly associated with body builders,fitness “buffs,” and professional athletes, abuse of anabolic

steroids by school age children has significantly increased over the

past decade. The National Institute on Drug Abuse (NIDA) estimates

that more than a half million 8th and 10th grade students are now using

these dangerous drugs, and increasing numbers of high school seniors

do not believe steroids are risky.

Students are acquiring and taking anabolic steroids without any

knowledge of the dangers associated with steroid abuse. The shortterm adverse physical effects of anabolic steroid abuse are fairly well

known. However, the long-term adverse physical effects of anabolic

steroid abuse have not been studied, and as such, are not known. In

addition, this type of abuse may result in harmful side-effects as well

as serious injury and death. The abuser in most cases is unaware of

these hidden dangers.

This guide will help you understand why steroids are being misused,

and how you can provide counseling and implement procedures to

educate our youth about the dangers of these drugs. By working

together we can greatly reduce the abuse of anabolic steroids. It is

important to recognize this problem and take preventive measures to

protect our young people.

WHAT ARE ANABOLIC STEROIDS?

Anabolic steroids are synthetically produced variants of the naturally

occurring male hormone testosterone. Both males and females have

testosterone produced in their bodies: males in the testes, and

females in the ovaries and other tissues. The full name for this

class of drugs is androgenic (promoting masculine characteristics)

anabolic (tissue building) steroids (the class of drugs). Some of

the most abused steroids include Deca-Durabolin®, Durabolin®,

This publication is authorized for public dissemination.

All material in this publication is in the public domain and

may be reproduced without the expressed permission of the

Drug Enforcement Administration.

Citation of the source is appreciated.

March 2004

Presented as a public service by:

Drug Enforcement Administration

Office of Diversion Control

Washington, D.C. 20537
Steroid Abuse by School Age Children

2 March 2004 March 2004 3

Equipoise®, and Winstrol®. The common street (slang) names for

anabolic steroids include arnolds, gym candy, pumpers, roids,

stackers, weight trainers, and juice.

The two major effects of testosterone are an androgenic effect and an

anabolic effect. The term androgenic refers to the physical changes

experienced by a male during puberty, in the course of development to

manhood. Androgenic effects would be similarly experienced in a

female. This property is responsible for the majority of the side effects

of steroid use. The term anabolic refers to promoting of anabolism,

the actual building of tissues, mainly muscle, accomplished by the

promotion of protein synthesis.

WHY ARE STEROIDS ABUSED?

Anabolic steroids are primarily used by bodybuilders, athletes, and

fitness “buffs” who claim steroids give them a competitive advantage

and/or improve their physical performance. Steroids are purported to

increase lean body mass, strength and aggressiveness. Steroids are

also believed to reduce recovery time between workouts, which makes

it possible to train harder and thereby further improve strength and

endurance. Some people who are not athletes also take steroids to

increase their endurance, muscle size and strength, and reduce body

fat which they believe improves personal appearance. A small number

of youths may take steroids to increase their body size to protect

themselves from others.

WHERE DO YOU GET STEROIDS?

Doctors may prescribe steroids to patients for legitimate medical

purposes such as loss of function of testicles, breast cancer, low red

blood cell count, delayed puberty and debilitated states resulting from

surgery or sickness. Veterinarians administer steroids to animals (e.g.

cats, cattle, dogs, and horses) for legitimate purposes such as to

promote feed efficiency, and to improve weight gain, vigor, and hair

coat. They are also used in veterinary practice to treat anemia and

counteract tissue breakdown during illness and trauma. For purposes

of illegal use there are several sources; the most common illegal

source is from smuggling steroids into the United States from other

countries such as Mexico and European countries. Smuggling from

these areas is easier because a prescription is not required for the

purchase of steroids. Less often steroids found in the illicit market are

diverted from legitimate sources (e.g. thefts or inappropriate prescribing) or produced in clandestine laboratories.

HOW ARE STEROIDS TAKEN?

Anabolic steroids dispensed for legitimate medical purposes are

administered several ways including intramuscular or subcutaneous

injection, by mouth, pellet implantation under the skin and by application to the skin (e.g. gels or patches). These same routes are used for

purposes of abusing steroids, with injection and oral administration

being the most common. People abusing steroids may take anywhere

from 1 to upwards of a 100 times normal therapeutic doses of anabolic

steroids. This often includes taking two or more steroids concurrently,

a practice called “stacking.” Abusers will often alternate periods (6 to

16 weeks in length) of high dose use of steroids with periods of low

dose use or no drug at all. This practice is called “cycling.”

Doses of anabolic steroids used will depend on the particular objectives

of the steroid user. Athletes (middle or high school, college, professional, and Olympic) usually take steroids for a limited period of time

to achieve a particular goal. Others such as bodybuilders, law enforcement officers, fitness buffs, and body guards usually take steroids for

extended periods of time. The length of time that steroids stay in the

body varies from a couple of days to more than 12 months.

Examples of oral and injectable steroids are as follows:

 Oral Steroids Injectable Steroids

• Anadrol® (oxymetholone) • Deca-Durabolin®

• Oxandrin® (oxandrolone) (nandrolone decanoate)

• Dianabol® (methandrostenolone) • Durabolin®

• Winstrol® (stanozolol) (nandrolone phenpropionate)

• Depo-Testosterone®

 (testosterone cypionate)

• Equipoise®

 (boldenone undecylenate)

 (veterinary product)
Steroid Abuse by School Age Children

PHYSICAL & PSYCHOLOGICAL DANGERS

Steroid users are vulnerable to physical and psychological side effects,

many of which are irreversible in women. The short-term adverse

physical effects of anabolic steroid abuse are fairly well known. However, the long-term adverse physical effects of anabolic steroid abuse

have not been studied, and as such, are not known.

For Guys For Girls

• Baldness • Growth of facial and body hair

• Development of breasts • Deepened voice

• Painful erections • Breast reduction

• Shrinkage of testicles • Enlarged clitoris

• Loss of function of testicles • Menstrual irregularities

For Both

• Acne

• Jaundice (yellowing of the skin)

• Swelling – Fluid retention

• Stunted growth (close the growth plates in the long bones

and permanently stunt their growth)

• Increase in bad cholesterol levels

• Decrease in good cholesterol levels

• Mood swings

• Increase in feelings of hostility

• Increase in aggressive behavior

LAWS AND PENALTIES FOR ANABOLIC STEROID ABUSE

Concerns over a growing illicit market, abuse by teenagers, and the

uncertainty of possible long-term effects of steroid use led Congress in

1991 to place anabolic steroids as a class of drugs into Schedule III of

the Controlled Substances Act (CSA).

Under this legislation, anabolic steroids are defined as any drug or

hormonal substance, chemically and pharmacologically related to

testosterone (other than estrogens, progestins, and corticosteroids)

that promotes muscle growth.

The possession or sale of anabolic steroids without a valid prescription

is illegal. Simple possession of illicitly obtained anabolic steroids

carries a maximum penalty of one year in prison and a minimum

$1,000 fine if this is an individual’s first drug offense. The maximum

penalty for trafficking is five years in prison and a fine of $250,000 if

this is the individual’s first felony drug offense. If this is the second

felony drug offense, the maximum period of imprisonment and the

maximum fine both double. While the above listed penalties are for

federal offenses, individual states have also implemented fines and

penalties for illegal use of anabolic steroids. State executive offices

have also recognized the seriousness of steroid abuse and other drugs

of abuse in schools. For example, The State of Virginia enacted a new

law that will allow student drug testing as a legitimate school drug

prevention program. Additional states and individual school districts

are considering implementing similar measures.

The International Olympic Committee (IOC), National Collegiate

Athletic Association (NCAA), and many professional sports leagues

(e.g. Major League Baseball, National Basketball Association, National

Football League (NFL), and National Hockey League) have banned the

use of steroids by athletes, both because of their potential dangerous

side effects and because they give the user an unfair advantage. The

IOC, NCAA, and NFL have also banned the use of steroid precursors

(e.g. androstenedione) by athletes for the same reason steroids were

banned. The IOC and professional sports leagues use urine testing to

detect steroid use both in and out of competition.

COMMON TYPES OF STEROIDS ABUSED

The illicit anabolic steroid market includes steroids that are not commercially available in the U.S. as well as those which are available.

Steroids that are commercially available in the U.S. include

fluxoymesterone (Halotestin®), methyltestosterone, nandrolone

(Deca-Durabolin®, Durabolin®), oxandrolone (Oxandrin®),

oxymetholone (Anadrol®), testosterone, and stanozolol (Winstrol®).

Veterinary steroids that are commercially available in the U.S. include

boldenone (Equipoise®), mibolerone, and trenbolone (Revalor®).

Other steroids found on the illicit market that are not approved for

use in the U.S. include ethylestrenol, methandriol, methenolone, and

methandrostenolone.

4 March 2004 March 2004 5
Steroid Abuse by School Age Children

STEROID ALTERNATIVES

A variety of non-steroid drugs are commonly found within the illicit

anabolic steroid market. These substances are primarily used for one

or more of the following reasons: 1) to serve as an alternative to

anabolic steroids; 2) to alleviate short-term adverse effects associated

with anabolic steroid use; or 3) to mask anabolic steroid use. Examples of drugs serving as alternatives to anabolic steroids include

clenbuterol, human growth hormone, insulin, insulin-like growth factor,

and gamma-hydroxybutyrate (GHB). Examples of drugs used to treat

the short-term adverse effects of anabolic steroid abuse are erythropoietin, human chorionic gonadotropin (HCG), and tamoxifen. Also,

diuretics and uricosuric agents may be used to mask steroid use. The

following chart illustrates how masking is accomplished:

Drug Group Drug or Effect How Drug Masks

Steroid Use

Uricosuric Probenecid Decreases entry of

Agents steroids into the urine

Diuretics Spironolactone, Dilutes steroid concenFurosemide tration in the urine

Epitestosterone Decreases Testosterone Reduces detection of

to Epitestosterone ratio testosterone usage

Over the last few years, a number of metabolic precursors to either

testosterone or nandrolone have been marketed as dietary supplements in the U.S. These dietary supplements can be purchased in

health food stores without a prescription. Some of these substances

include androstenedione, androstenediol, norandrostenedione,

norandrostenediol, and dehydroepiandtrosterone (DHEA), which can

be converted into testosterone or a similar compound in the body.

Whether they promote muscle growth is not known.

6 March 2004 March 2004 7

ARE ANABOLIC STEROIDS ADDICTIVE?

An undetermined percentage of steroid abusers may become addicted

to the drug, as evidenced by their continuing to take steroids in spite

of physical problems, negative effects on social relations, or nervousness and irritability. Steroid users can experience withdrawal

symptoms such as mood swings, fatigue, restlessness, and depression.

Untreated, some depressive symptoms associated with anabolic

steroid withdrawal have been known to persist for a year or more after

the abuser stops taking the drugs.

STATISTICS

The “Monitoring the Future” study conducted in 2002, determined that

since 1991 there has been a significant increase of steroid use by

school age children. This annual study, supported by the NIDA and

conducted by the Institute for Social Research at the University of

Michigan, surveys drug use among eighth, tenth, and twelfth graders

in the United States. The first year data was collected on younger

students was in 1991. Since 1991 there has been a significant increase in reported steroid use by teenagers. For all three grades, the

2002 levels represent a significant increase from 1991. The following

chart illustrates the increase of steroid abuse among teenagers who

reported using steroids at least once in their lifetime:

Percent of Students Reporting Steroid Use 1991 - 2002

Year Eighth Grade Tenth Grade Twelfth Grade

1991 1.9% 1.8% 2.1%

1999 2.7% 2.7% 2.9%

2002 2.5% 3.5% 4.0%

The 2002 survey also indicated additional data related to steroid abuse

by school age children:
Steroid Abuse by School Age Children

Percent of Students Reporting Steroid Use in 2002

Student Steroid Eighth Grade Tenth Grade Twelfth Grade

Use

Past Month Use 0.8% 1.0% 1.4%

Past Year Use 1.5% 2.2% 2.5%

Lifetime Use 2.5% 3.5% 4.0%

In addition, the 2002 survey also determined how easy it was for

school aged children to obtain steroids. The survey indicated 22% of

eighth graders, 33.2% of tenth graders, and 46.1% of twelfth graders

surveyed in 2002 reported that steroids were “fairly easy” or “very

easy” to obtain. More than 57% of twelfth graders surveyed in 2002

reported that using steroids was a “great risk.” Also, another study

indicated that steroids are used predominately by males. The survey

determined the annual prevalence rates were two to four times as high

among males as among females.

The “Monitoring the Future” study also determined that misuse and

abuse of steroids is a major concern among school aged children.

Some of their findings are alarming and indicate a need for concern:

• A survey in 1999 determined that 479,000 students nationwide, or

2.9 percent, had used steroids by their senior year of high school.

• A survey in 2001 determined the percentage of 12th graders who

believed that taking these drugs causes “great risk” to health

declined from 68 percent to 62 percent.

The Center for Disease Control and Prevention (CDC) conducts the

Youth Risk Behavior Surveillance Study, a survey of high school

students across the United States. A survey conducted in 2001

indicated that 5% of all high school students reported lifetime use of

steroid tablets/injections without a doctor’s prescription. The survey

also indicated that 5.8% of ninth graders, 4.9% of tenth graders,

4.3% of eleventh graders, and 4.3% of twelfth graders reported

lifetime illegal use of steroids.

A majority of the studies performed on steroid abuse indicate males

are twice as likely to abuse steroids as females.

HOW CAN WE CURTAIL THEIR ABUSE?

The most important aspect to curtailing abuse is education concerning

dangerous and harmful side effects, and symptoms of abuse. Athletes

and others must understand that they can excel in sports and have a

great body without steroids. They should focus on getting proper diet,

rest, and good overall mental and physical health. These things are all

factors in how the body is shaped and conditioned. Millions of people

have excelled in sports and look great without steroids. For additional

information on steroids please see our website at

www.DEAdiversion.usdoj.gov

8 March 2004 March 2004 9
Steroid Abuse by School Age Children

10 March 2004 March 2004 11

NOTES NOTES
Steroid Abuse by School Age Children

12 March 2004

NOTES