STEROIDS MAY LEAD TO FURTHER DRUG USE

Counselors Call It A 'Gateway' To Opiate Dependence

WASHINGTON - 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, though Nubain
is considered to have less addictive potential.

"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.

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

And a letter in The New England Journal of Medicine indicates that steroids
may lead some bodybuilders into harder drugs. "Steroids may serve as
'gateway' drugs to opiod dependence," wrote Pope and Drew Arvary, substance
abuse counselors at Sunrise House, an in-patient 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 percent had a history of steroid use.
In contrast, among 197 similar admissions in 1990, only .5 percent 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 steroid-related 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,
Arvary said. "They don't feel pumped; they don't feel their muscles are
full," he said. "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 opiod 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 class 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 effect 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.