The authors provided sufficient information in the methods section so that, by consensus between the reviewers (RM/PB/LF), we were confident to include the study for extraction and analysis. For one study, the study design (retrospective database analysis) did not qualify for the analysis by ToxRtool and was individually assessed by the study team . A total of 20 full-text articles were included for quality appraisal by the ToxRTool. The full-text screening stage of 24 articles led to 21 potential articles relevant in this systematic review and were thus eligible for quality appraisal. Qualitative and quantitative analysis according to the suggested classification of Neves , and Weber and colleagues into original, substandard or counterfeit and subclassifications with some adaptions for analysis
Furthermore, we assessed the different analytical methods used to determine the quality and quantity of AAS on the black market. We used a subclassification of "counterfeit" substances to comprise "adulterated", "substituted" and "inert"; and "substandard" substances to comprise "over- and under- concentrated" (Table 3). • to increase the homogeneity, article with mixed samples (e.g., if the analysis includes different classes of IPED) in which data on AAS are
For most original substances, we were able to extract qualitatively analyzed data (accurately labeled) and only for 37% were we able to extract qualitatively and quantitatively analyzed data (accurately labeled and concentration within range as declared on the label). The full extraction form can be found in Supplementary file 2; the summary form used for data analysis can be found in Supplementary file 3. Importantly, whenever anabolic agents were analyzed with other classes of substances, anabolic agents made the highest proportion of analyzed classes. In addition, other countries from this region (Switzerland, France, Italy, United Kingdom, Czech Republic and Slovakia, Austria, and Belgium) are represented in our list of included studies. The country with the highest number of included studies in this region is Germany with a total of three studies. The geographic scope of the included studies is limited to two world regions, where 37% and 63% respectively were conducted, and these studies reported findings from the Americas (AMR) and Europe (EUR). The detailed data extraction and data analysis plan have been published elsewhere .
With minimal to no sophisticated equipment or quality controls, products from these labs are at a higher risk of contamination and inefficacy. These labs usually invest in advanced equipment and adhere to some quality control measures, including testing their raw materials and finished products for purity and potency. Here, we differentiate between pharmaceuticalgrade steroids and those produced in underground labs (UGLs) and explore the various tiers of UGLs.
All authors contributed to refinement of the literature review and approved the final manuscript. LF/PB provided statistical and methodological expertise of the review. In some cases, the published data had to be manually adapted and transferred to fit our classification system. These harm reduction interventions may be especially effective in this user population as these drugs are used for an average of 20 weeks , compared to recreational illicit drug use that is often only used sporadically. Unfortunately, there are currently major limitations in identifying these fraudulent products by users and such services may become a cornerstone in accessing this hard-to-access user population . It is described that in order to provide good drug testing services, there must be a close collaboration between different stakeholders and actors, such as politicians, the police and medical treatment services .
AC provided methodological expertise on biochemical analysis of the samples. This may have resulted in some bias of the studies included and a bias in our statistical summary and conclusions. One strategy could entail the controlled use and availability of these substances through proper health channels. Different harm reduction strategies could be employed to limit this user community from either getting in contact with fake AAS from the black market or to promote safer use and informed decision making. There is a large and increasing number of individuals who are possibly exposed to these fake AAS on the black market. Graham and colleagues demonstrated contamination with bacterial skin commensals during microbiological analysis of their samples. We demonstrate that on some occasions completely different pharmaceuticals were identified during the analysis, such as quinine (antimalarial drug), instead of AAS.
There is a broad availability of different analytical tools used to identify counterfeit AAS on the black market, as included in this systematic review. Half of the studies presenting data on substandard substances were sub-analyzed into over-concentrated and under-concentrated samples. For counterfeit substances, most studies sub-analyzed data into inert, substituted, and adulterated samples. The studies included a median of 42 samples; the largest study had 2818 analyzed samples and the smallest 8 samples, and a cumulative sample size of 5,413 anabolic agents. After the quality appraisal stage, an overall number of 19 full-text articles were included for data extraction and analysis. A subgroup analysis was conducted for counterfeit AAS (proportions of adulterated, substituted and inert substances), substandard AAS (proportions of over-concentrated and under-concentrated substances) and based on geographical location. • articles that present proportions of original and/or counterfeit and/or substandard drugs

Gender: Female

Social links