title: Performance-enhancing drugs on the web: a growing public-health issue.
abstract: OBJECTIVE
  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
  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.
authors: Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA 02478, USA. bbrennan@partners.org
authors: Brian P
authors: BP
authors: Brennan
authors: Gen
authors: G
authors: Kanayama
authors: Harrison G
authors: HG
authors: Pope
mesh_terms: D054626:Consumer Health Information; D006801:Humans; D020407:Internet / Q000191:economics; D058573:Performance-Enhancing Substances / Q000191:economics / Q000600:supply & distribution*; D011634:Public Health / Q000191:economics
chemical_list: D058573:Performance-Enhancing Substances