Anabolic-androgenic steroid testing as a tool for consumer engagement and harm reduction: a sequential explanatory mixed-method study.

Introduction: Anabolic-androgenic steroid (AAS) use is widespread, yet regulation remains limited, exposing consumers to misidentified and contaminated products. This study expands AAS testing by enhancing purity analysis, identifying branding inconsistencies, and examining consumer responses. It aims to evaluate the impact of enhanced testing and feedback on consumer behaviour and harm reduction.

Methods: This is a sequential explanatory mixed-methods study incorporating chemical analysis of community-submitted AAS samples and interviews with participants. Interviews used semi-structured formats, focusing on participants' understanding of the testing results, and how it influenced their AAS usage decisions. We sampled from community harm reduction organisations across two drug checking sites in Queensland, Australia.

Results: Between April 19 and August 16, 2024, 58 AAS samples were submitted. Chemical analysis was conducted using Radian-ASAP direct mass spectrometry and Orbitrap Liquid Chromatography Mass Spectrometry to verify the identity and dosage of the submitted AAS. Of the 46 analysable samples, 9 exhibited presence issues (i.e., the compound differed from expectations), while 15 demonstrated purity issues (i.e., the concentration was either too low or too high). Twenty-five AAS consumers were interviewed, with follow-up interviews conducted with 15 participants to assess their behaviour changes. Interviews (N = 40) indicated that consumers' trust in the substances they used was reduced, leading to more cautious approaches and reconsideration of usage practices.

Conclusion: This study demonstrates that chemical analysis can be a powerful tool in influencing AAS consumers' practices, highlighting the need for further research on how testing, coupled with harm reduction interventions, can improve consumer safety and decision-making.