Anabolic Steroid Use and Abuse by Police Officers: Policy & Prevention

By Commander Kim R. Humphrey, Professional Standards Bureau, Phoenix, Arizona, Police Department; Kathleen P. Decker, M.D., U.S. Air Force; Linn Goldberg, M.D., Oregon Health and Science University, Portland, Oregon; Harrison G. Pope Jr., M.D., Harvard Medical School; Joseph Gutman, M.D., Practicing Endocrinologist,Tempe, Arizona; and Gary Green, M.D., University of California at Los Angeles (UCLA)

from Police Chief Magazine:
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Although physical fitness is an essential part of policing, as described in the previous article, some officers go too far to ensure their strength—endangering not only themselves but also the public they are sworn to defend.
officer crashes a police car and seriously injures an innocent bystander. The investigation reveals that the officer was acting erratically, had bloodshot eyes, and slurred his speech. The officer’s supervisor is called, and the decision is made to test for alcohol consumption. The test results determine that the officer was in fact intoxicated. Disciplinary action is taken, resulting in the officer’s termination for drinking alcohol while driving on duty. Though exposed to liability, the department recognizes the dangers of alcohol abuse and appropriately responds when a dangerous situation presents itself. Another officer, involved in several shootings and use-of-force incidents, garners significant attention within his agency and the media. Investigations reveal that the unrelated incidents were questionable but lawful and, according to the officer, justified based on perceived threats. The agency’s use-of-force review reluctantly finds the officer within policy but awaits the next incident. How many police leaders would recognize that this of ficer could have a problem similar to the one in the first example? If the officer’s appearance indicated he was exceptionally muscular, would they consider the possible abuse of anabolic steroids? What would prompt them to believe that excessive use of force could be associated with “’roid rage,” a hyperaggressive, violent state of mind supposedly brought on by steroid use? When and how would they confirm that their suspicions are true? What if a defense or civil attorney proposed that an officer was a steroid abuser based on the officer’s appearance and witnessed behaviors? Compared with alcohol and other illicit drugs, anabolic steroids (also known as anabolic-androgenic steroids, or AASs) are not easily detected. Supervisors typically are trained to look for inappropriate behaviors that might justify a “just cause” drug screen; however, with AASs the behaviors and other indicators might not be as easily recognized. Recently, accounts of major league baseball’s steroid era have come to light, Olympic athletes have admitted use, and many other major sporting icons have been stripped of their titles after being caught using performance-enhancing drugs such as AASs and human growth hormone (HGH). Unfortunately, growing evidence suggests a similar abuse of AASs and other performance-enhancing drugs by law enforcement professionals. Across the United States, several investigations associated with Internet pharmacies and “antiaging” clinics in association with unscrupulous physicians have revealed officers caught up in this web of illicit drug use. Although the traditional reason for the use of AASs is to improve athletic performance, AASs also appeal to officers wanting a tactical edge or an intimidating appearance. Unlike with other forms of drug abuse, steroid users do not take their drug recreationally; on the contrary, some state they need these drugs in order to do their job effectively or improve their “job performance.” From street officers who consider themselves vulnerable to bigger, more aggressive criminals to special-assignment officers who are regularly tested for their physical abilities, officers are turning to performance-enhancing drugs such as AASs and HGH as a shortcut to improved performance. This article will not delve into the abuse of HGH, which is not a controlled substance but is obtained by prescription only and has very limited use—none for normal adults. In addition to the normal health concerns, there is one further issue when discussing abuse of steroids by those in the law enforcement profession. Officers carry weapons, are authorized to use lethal force, and are often involved in physically controlling or restraining people. If the stories of ’roid rage are true, how often are the officers who use anabolic steroids involved in unnecessary use-offorce incidents that could become a major liability for their agencies? Considering the legal issues, health effects, and commensurate costs associated with inappropriate use, agencies should proactiv ly address this issue. Rather than look back on what could be an embarrassing “steroid era” of law enforcement—one in which the profession might be riddled with lawsuits, corruption, and claims of heavy-handedness—it is critical to address the current and future impact of this issue head-on. Over the past few decades, several stories have surfaced regarding law enforcement personnel involved with anabolic steroids. The U.S. Drug Enforcement Administration (DEA) recently led Operation Raw Deal, considered the largest international steroid investigation to date. The operation discovered several links to current or former law enforcement officers. This was predicted almost 20 years ago by an article in the FBI Law Enforcement Bulletin that stated, “Anabolic steroid abuse by police officers is a serious problem that merits greater awareness by departments across the country.”1 In addition, a story on the television program 60 Minutes in 1989 titled “Beefing up the Force” featured three police officers who admitted steroid use and claimed that their resulting aggression got them in serious trouble. In the past year, a book titled Falling Off the Thin Blue Line was written and published by former Texas police officer David Johnson, who describes his addiction to steroids and speaks about the prevalence of steroid abuse in the law enforcement community.2 Recently, investigations into illegal steroid purchases revealed the names of several officers on pharmacy distribution lists, garnering national media attention. Unfortunately, agencies looking for methods to confront steroid abuse find few examples of effective policies and practices. This article summarizes the Phoenix, Arizona, Police Department’s experience in this area over the past several years and suggests policy and testing considerations for anabolic steroids in the law enforcement community. Problems with Testing In 2005, the Phoenix Police Department (PPD) investigated several incidents either directly or indirectly involving officers accused of abusing anabolic steroids. As a result, the city formed a committee to determine policy changes and address the issue with public safety agencies (that is, police and fire departments) as well as all other city employees. Due to the demands of the law enforcement profession and the legal precedent supporting random drug testing, policies are naturally more stringent for police than for other city departments. The police department, with support from its labor organization, added anabolic steroids to the random testing process for all officers and the preemployment screen. Research is clear that significant health risks result from nontherapeutic uses of anabolic steroids. 3 For this reason, the PPD’s focus on prevention revolved around a prevention video with questions and answers from a local endocrinologist who specializes in steroid abuse treatment. Regarding testing, the task seemed simple enough: contact a local laboratory and test officers for performance-enhancing substances. However, implementation proved less than simple. First, adding AASs to the PPD’s random test tripled its drug testing costs. Additionally, local laboratories were able to provide only an initial urine screen that tested for a handful of the growing number of AASs. Furthermore, compounding the difficulty of the task, testing for anabolic steroids goes beyond looking for the specific synthetic AAS; it also needs to detect compounds naturally created by the human body, such as testosterone. This entails an analysis of an individual’s ratio of testosterone to epitestosterone (abbreviated T/E); when this value is found to be out of normal range, it may indicate the use of illegal substances. Additionally, as noted previously, HGH does not fall under the Anabolic Steroid Control Act, and currently there is no reliable test to detect it in the human body. Testing for performance-enhancing substances presents a myriad of challenges:
How can an agency test for “all” illegal AASs, and what does it do if a T/E ratio is not normal?

How can an agency prove that someone is illegally or inappropriately using anabolic steroids?
What if an officer who tests positive provides a prescription, and the prescribing physician indicates that the officer has a condition that necessitates the use of these drugs? Additionally, what constitutes abuse of prescribed drugs?
Do ’roid rage and other psychiatric disturbances claimed to result from steroid abuse actually exist, and do they present a liability to an abuser’s organization? Jumping into a testing policy before answering these questions will lead agencies to the realization that testing for these substances is not as straightforward as, say, discovering heroin in a drug screen. Officers might present a prescription or might have ordered something over the Internet in what they believe is a legal transaction. The DEA works regularly to shut down numerous unscrupulous doctors who seek to make money by connecting with pharmacies and engaging in illegal distribution, using the few very specific legitimate uses for AASs as cover for their operation. In these cases, ignorance is a common excuse from officers, who typically state that a doctor prescribed the drug, so it must be “okay.”

Illicit “Benefits” of AASs AASs can be taken orally, by injection, as a skin patch or cream, or sometimes by placing them between the cheek and gum. When combined with a high-protein diet and vigorous weightlifting, AASs “work.” That means that they stimulate the formation of muscle tissue and are known to cause enlargement of muscle fibers. It is widely understood that testosterone (the major natural male AAS hormone in normal, healthy men) stimulates an increase in fat-free muscle mass while at the same time decreasing fat. Doses of AASs that exceed the normal production rate of testosterone can amplify this effect, resulting in supernormal gains in lean muscle mass and strength.
Patterns of Illegitimate Use
Many users reported taking a weekly dose in excess of (the equivalent of) 1,000 mg of testosterone. For comparison, adult human testicles normally produce 5–10 mg of testosterone per day—generally less than 100 mg/week.
Most AAS users reported self-administering by injecting the drug directly into their muscles.
Some studies reveal that approximately 25 percent of those who inject AASs share needles or vials, increasing the risk of HIV infection, viral hepatitis, or other infections.
Over 95 percent of AAS users reported self-administering multiple substances, with 25 percent taking growth hormone and/or insulin in addition to AASs.
Users have been found to move on to illegal drugs other than athletic performance enhancers.
Nearly 100 percent of AAS users reported noticeable side effects—but most users claim that these effects are mild and do not deter them from continuing to use AASs.
Users often become fixated on their muscularity and are reluctant to stop using AASs for fear that they will get smaller again.
General Medical Effects of Use
Decreased sperm production
Abscess at the site of injection
Increased or even severe acne
Increased blood pressure
Increased “bad” (LDL) and lower “good” (HDL) cholesterol, with attendant increased risk of heart attack
Thickening of the wall of the heart (especiall y in the left ventricle)
Increased or decreased sex drive (libido)
Increased appetite
Liver disease, especially with AASs taken orally (infrequent)
Death from several causes, including suicide, atherosclerosis (hardening of the arteries leading to heart attacks or strokes), and cardiac complications
HIV and similar risk issues associated with the sharing of needles or the use of nonsterile needles
Psychological Effects Users of AASs can experience psychiatric symptoms during use, abuse, or withdrawal. Symptoms differ depending on the drug’s absence or presence in the body. Symptoms tend to correlate with the size of the weekly dose and can worsen with long-term use. Importantly, the psychiatric symptoms are idiosyncratic; some men taking=2 0a given dose of AASs may show no psychiatric effects at all, whereas a few men taking an identical dose might show extreme effects.6 The reasons for this variability are not known, but it is clear that reactions to AASs cannot be predicted on the basis of an individual’s baseline personality. In other words, even if a man has a mildmannered, gentle personality when not taking AASs, there is still a risk that he might develop a sudden personality change and become uncharacteristically aggressive and violent while taking AASs.7
Symptoms Associated with Use or Abuse:
Mania or hypomania (high energy levels associated with increased self-confidence, increased activity, impaired judgment, and reckless behavior)
Psychosis—loss of touch with reality (for example, paranoia or delusions of grandeur; infrequent)
Personality changes
Laws and Regulations Associated with AASs The use of AASs for per formance enhancement is banned by all major sports bodies, including the International Olympic Committee, the National Basketball Association, the National Hockey League, the National Football League, Major League Baseball, the Union of European Football Associations, and Fédération Internationale de Football Association. In the late 1980s, the U.S. Congress considered listing AASs in the Controlled Substances Act. Based on evidence of widespread abuse, AASs are now classified by the FDA and DEA as Schedule III controlled substances. The Crime Control Act of 1990, approved on November 29, 1990, includes provisions for control of these drugs and penalties for inappropriate trafficking in them. The Anabolic Steroid Control Act of 2004 further amended this law to increase the number of AASs that were included and make it easier to add additional drugs.
The drug or other substance has a potential for abuse that is less than the drugs or other substances in Schedules I and II.
The drug or other substance has a currently accepted medical use in treatment in the United States. Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.

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