Evaluation of implementing drug checking services for anabolic androgenic steroids in Switzerland: a pilot study

BACKGROUND The use of anabolic androgenic steroids (AAS) among male recreational gym users has become a global substance use concern. A substantial black market for these substances exists with possibly extensive counterfeiting. Drug checking services (DCS) are established harm reduction services for people who consume illicit substances. To evaluate the feasibility of implementing a novel specialized DCS for AAS, a pilot study was conducted within a pre-existing DCS in Zurich (Switzerland). METHODS The reporting of this pilot study follows an adapted CONSORT statement. Further aims were to characterize AAS use as well as the chemical properties of customer-provided substance samples analysed through the DCS in a Swiss context. Customers could access DCS in Zurich from August 2023 onwards by providing a voluntary user questionnaire and dispense samples of AAS. Primary feasibility outcomes for this study were customer satisfaction metrics with the DCS received (i.e., customer satisfaction score (CSAT); net promoter score (NPS)). The chemical analytical method utilized was gas chromatography-mass spectrometry (GC-MS). Descriptive statistics were used. RESULTS Overall, 52 clients accessed DCS over the pilot period and 71 samples were chemically assessed. Excellent results regarding customer satisfaction metrics towards DCS for AAS were achieved (NPS: 97 (integer); CSAT: 93%). The typical clients were males partaking in recreational sports, between 22 and 40 years old, working, and with a higher education. The main motivation for using AAS was for aesthetic purposes. Patterns of AAS use were complex with frequent extensive concomitant substances use. Most AAS in this sample were acquired from non-medical sources. The sample analysis revealed that over half (52%) of the user-provided samples of AAS were fake. CONCLUSIONS We demonstrate that the implementation of DCS for AAS was feasible with high acceptance among clients. Those clients may engage in many high-risk behaviors and the use of substances with low chemical properties may expose them to additional unexpected health risks. As a harm reduction tool, DCS for these clients and substances appears to be feasible and it may further serve as monitoring tool for public health purposes. Upon the initial study results, DCS for AAS were continued with close monitoring.