Performance-Enhancing Drugs on the Web: A Growing Public-Health Issue

Background and Objectives Today's Internet provides extensive underground guidelines for obtaining and using illicit substances, including especially anabolic-androgenic steroids (AAS) and other appearance- and performance-enhancing drugs (APEDs). We attempted to qualitatively characterize APED-related Internet sites. Methods We used relevant Internet search terms (eg, steroids bodybuilding and buy steroids online) to assess (i) the numbers of site visitors; (ii) offers of drugs for sale; and (iii) the quality of online medical information. We also chose the examples of (iv) site-enhancing oils and (v) cattle implants to illustrate the volume of available Internet information as compared with that in the medical literature. Results We found thousands of sites involving AAS and other APEDs. Most sites presented an unabashedly pro-drug position, often openly questioning the qualifications and motivations of mainstream medical practitioners. Offers of AAS and other APEDs for sale, together with medical advice of varying legitimacy, was widespread across sites. Importantly, many sites provided detailed guidelines for exotic forms of APED use, some likely associated with serious health risks, which are probably unknown to most practicing clinicians. Conclusions and Scientific Significance It seems important for practitioners to be aware of the extent of this underground literature, which may strongly influence their patients' decisions about use and abuse of APEDs. (Am J Addict 2013;22:158-161)