title: Polypharmacy among anabolic-androgenic steroid users: a descriptive metasynthesis.
abstract: BACKGROUND
  As far as we are aware, no previous systematic review and synthesis of the qualitative/descriptive literature on polypharmacy in anabolic-androgenic steroid(s) (AAS) users has been published.
  
  
  METHODS
  We systematically reviewed and synthesized qualitative/descriptive literature gathered from searches in electronic databases and by inspecting reference lists of relevant literature to investigate AAS users' polypharmacy. We adhered to the recommendations of the UK Economic and Social Research Council's qualitative research synthesis manual and the PRISMA guidelines.
  
  
  RESULTS
  A total of 50 studies published between 1985 and 2014 were included in the analysis. Studies originated from 10 countries although most originated from United States (n=22), followed by Sweden (n=7), England only (n=5), and the United Kingdom (n=4). It was evident that prior to their debut, AAS users often used other licit and illicit substances. The main ancillary/supplementary substances used were alcohol, and cannabis/cannabinoids followed by cocaine, growth hormone, and human chorionic gonadotropin (hCG), amphetamine/meth, clenbuterol, ephedra/ephedrine, insulin, and thyroxine. Other popular substance classes were analgesics/opioids, dietary/nutritional supplements, and diuretics. Our classification of the various substances used by AAS users resulted in 13 main groups. These non-AAS substances were used mainly to enhance the effects of AAS, combat the side effects of AAS, and for recreational or relaxation purposes, as well as sexual enhancement.
  
  
  CONCLUSIONS
  Our findings corroborate previous suggestions of associations between AAS use and the use of other licit and illicit substances. Efforts must be intensified to combat the debilitating effects of AAS-associated polypharmacy.
authors.affiliation: Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway. dominic.sagoe@psysp.uib.no.
authors.forename: Dominic
authors.initials: D
authors.lastname: Sagoe
authors.affiliation: Centre for Public Health, Liverpool John Moores University, 15-21 Webster Street, Liverpool, L3 2ET, UK. j.mcveigh@ljmu.ac.uk.
authors.forename: Jim
authors.initials: J
authors.lastname: McVeigh
authors.affiliation: Department of Physical Medicine and Rehabilitation, Unit of Neuropsychology, Oslo University Hospital, Kirkeveien 166, Ullevål, Norway. astrid.bjornebekk@psykologi.uio.no.
authors.forename: Astrid
authors.initials: A
authors.lastname: Bjørnebekk
authors.affiliation: Departments of Surgery and Paediatrics, La General Hospital, PMB, Accra, Ghana. Essilfie@gmail.com.
authors.forename: Marie-Stella
authors.initials: MS
authors.lastname: Essilfie
authors.affiliation: Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway. cecilie.andreassen@psych.uib.no.|The Competence Centre, Bergen Clinics Foundation, Vestre Torggate 11, 5015, Bergen, Norway. cecilie.andreassen@psych.uib.no.
authors.forename: Cecilie Schou
authors.initials: CS
authors.lastname: Andreassen
authors.affiliation: Department of Psychosocial Science, University of Bergen, Christiesgate 12, 5015, Bergen, Norway. staale.pallesen@psysp.uib.no.
authors.forename: Ståle
authors.initials: S
authors.lastname: Pallesen
mesh_terms: D045930:Anabolic Agents / Q000627:therapeutic use*; D000728:Androgens / Q000627:therapeutic use*; D055030:Drug Users; D006801:Humans; D019338:Polypharmacy; D012651:Self Medication
chemical_list: D045930:Anabolic Agents; D000728:Androgens