Steroids Seen as Gateway to Hard Drugs

The trouble with addiction started as he tried to get off steroids, Tony recalled.

“When I came off them, I never got my energy back,” the bodybuilder said. “For me, it took a few months to feel I had a backbone.”

So the fellow bodybuilder who had supplied him with illegal steroids was now illegally offering him other drugs, including Nubain and Percocet, both prescription painkillers, said Tony, a Boston-area man who spoke on condition of anonymity.

He had bulked up on steroids, but felt he could not lose enough fat to win bodybuilding competitions. The other drugs were supposed to help him readjust to life without steroids, Tony said.

What he didn’t realize, he said, is that Nubain and Percocet could also lead to addiction. The drugs have similarities to morphine.

“I’m not using them now, but I do crave them,” Tony said. He is getting treatment from Dr. Harrison G. Pope, chief of the Biological Psychiatry Laboratory at Harvard-affiliated McLean Hospital in Boston.

Although Nubain is not supposed to be nearly as addictive as morphine, Pope said, his previous research indicates bodybuilders are getting hooked.

And a letter in the New England Journal of Medicine indicates that steroids may lead some bodybuilders to harder drugs. “Steroids may serve as ‘gateway’ drugs to [opiate] dependence,” wrote Pope and Drew Arvary, a substance abuse counselor at Sunrise House, an inpatient dependence treatment facility in Lafayette, N.J.

Pope and Arvary looked at 227 men admitted for dependence on heroin or similar drugs in 1999. They found 9.3% had a history of steroid use. In contrast, among 197 similar admissions in 1990, only .5% reported steroid use.

The men indicated they were introduced to the harder drugs through the bodybuilding community, the letter said. Eighty-one percent of the 1999 patients bought both drugs from the same supplier, it said.

And the men said they used the drugs to deal with problems such as irritability while on steroids or depression after they gave up steroids, the journal letter said.

“It’s almost become the same now--the drug culture is the gym culture,” Arvary said. Steroids themselves are not physically addicting, but when users go off the drugs, the shrinkage of muscle can be hard to handle, he said. “They don’t feel pumped; they don’t feel their muscles are full. The only way they can go out to function is some kind of narcotic--mainly heroin, in this case.”

The patients who went from steroids to heroin were hard to keep off drugs later, the letter said. “In the 1 to 11 months since their discharge from Sunrise House, 17 have relapsed into [opiate] use, and 2 have committed suicide,” it said.

Former steroid and opiate users are even harder to treat than opiate users alone, Arvary said. The ex-bodybuilders refuse to classify themselves with frail addicts who they picture as “sleeping in the streets,” he said. “It’s almost dealing with a perfectionistic type of behavior where they feel they are better than them.”

As a result, addiction groups tend not to work with these patients, who need one-on-one counseling, Arvary said.

The letter acknowledged several limitations. For one, the findings cannot prove that steroid use in itself led to use of the harder drugs. However, although the drugs are not similar, other studies have indicated the two drugs might affect the brain in similar ways, Pope said. Steroid users get “a withdrawal effect” when given drugs used to help heroin or morphine users with withdrawal, he said.

The letter gives rise to interesting speculation but should serve only as an indication that the issue deserves further study, said Charles Yesalis, a Penn State researcher who was not connected with the Pope-Arvary project.

He had reported earlier that steroid users had a higher likelihood of using other drugs. But as for a cause-effect relationship, “we are not even within five miles of articulating that,” Yesalis said.