A needle and syringe exchange service (NSES) can bring its challenges with the stereotypical drug-addled vagrant seeking “gear” for his next hit, annoying customers and lowering the tone of the neighbourhood as fellow-travellers congregate outside to “deal” in the street. The reality is nothing like this. Those injecting narcotics, and who have indeed pretty chaotic lives, are generally respectful and informed and normally come and go without any hassle or disruption. This is also down to how the service is managed so that they are not unnecessarily detained or made to feel stigmatized.
The pharmacy NSES is an important public-health disease-prevention service and is a key reason that N. Ireland has less prevalence of blood-borne viral infections compared to other regions with similar injection drug use. Recently, I have noticed a change in those who are requesting the service. The most common exchange now is steroid packs and the client is far from a stereotypical down-and-out drug addict rather it’s a trendy thirty-something just out of the gym, sporting a perma-tan and driving a top of the range BMW.
Once recreational drug injecting was the territory of the deeply depraved and highly addicted. Not anymore. People seem more than willing to give themselves a jab if promised a benefit. It might be those; wishing to experience the wonders of Vit B (cyanocobalamin), those gambling on the masculine merits of Testosterone Replacement Therapy (TRT), those simply needing a hurried tan or those wishing for the six-pack anabolic steroids promise and off course to get the “golden dose” out of the Mounjaro pen (more about the golden dose later).
I do wonder if we are experiencing a new craze of in-vogue-drugs in the wellness arena that are only effective when injected. Off course protein-based medicines mostly need injected. But let’s not forget that in addition to; fear, pain and discomfort, injecting brings many risks not least transmission of blood borne viral infection. Most Hep B infection is from bad injecting practice. So where is the role of the NSES in this new wellness medicine trend? Who does my needle and syringe exchange service cover in this mission creep?
Wolverine Stack Peptides
A few weeks back a client asked which needles he needed for his “amino acid cocktail” and if I could supply. He produced a small vial sealed at the top with a rubber bung and clasped at the rim by a metal surround; like the vials used for Covid19 vaccines. This vial, without any markings, labels or other form of identification or instructions, contained a whitish opaque liquid. This was his “amino acids cocktail” he confidently told me. I enquired if the injection was to be intra-muscular or sub-cutaneous. He didn’t know. Was it in-date, was it sterile?
He seemed a shy, sensible man probably in his mid-thirties and I politely asked where he got the vial. A friend at the gym sold it to him; his friend is an agent for this new fitness-aid which would; improve strength, prolong training stamina, aid recovery from injury and help him lose weight. But you don’t know what it is, I challenged. It’s an “amino acid cocktail” and everyone is using it, he retorted.
Perhaps noticing my reticene, his attitude became assertive; was I giving him the needles or not. He was very welcome to the needles and syringes, I said, but I was advising him not to inject it. He became confrontational. What would I know with all the toxic medicines I hand out daily, he shouted, and he stormed off.
It was an unsettling and unpromising start to my day and all I could do was to make a note that I needed to get a better understanding of this new area of wellness medicine.
Dr Google
A simple Google search brought me to a website, unpromisingly titled, the “Intelligent Pea”. On this platform, clients were gushingly enthusiastic about two amino acids they were using BPC-157 and TB-500. Asked if anyone had used these amino-acids one replied;
“Yes, I had fantastic results with BPC 157 and TB-500. I was feeling pretty hopeless with daily pain in both knees. I dealt with the pain and tried for multiple years with zero success. Pt, stem cell therapy, massage, supplements, rest, ice, flexibility training, nothing helped resolve it. Now I am building muscle again in the quads whereas before I just could not do anything even bodyweight without aggravating the issues.”
Positive indeed. And from a cursory view of other similar sites it seems, for a growing number of middle-aged men injectable peptides (amino-acids), these experimental compounds promising; rapid recovery, fat loss and muscle gain, are all the rage.
On my Google searches, I repeatedly came across the term “Bio Hack”. Bio Hack seems to suggest that these peptides somehow re-programme cells so that they respond in the way we wish they would. Unsurprisingly these peptides are not approved for human use as they lack basic clinical and safety testing.
The marketing techniques are straight out of the para-pharmaceutical/snake oil rule book. Advertisements consist of testimonials, influencer hype and the seductive promise of turning back time. These substances operate in a medical grey-zone, with unknown long-term risks, questionable manufacturing standards, and in some cases, life-threatening side-effects.
BPC-157 and T-500 have shown some promise in animal studies. BPC-157, first discovered in human gastric juice, is attracting attention since early animal studies suggested it may help repair damaged tissue throughout the body.
Studied on mice, rats, rabbits and dogs did not find serious side-effect and there is evidence of improved healing of tendons, teeth and the GI tract including the stomach, intestines, liver and pancreas.
They are thought to trigger several biological processes essential for healing. The compound appears to help cells to areas of damage, promotes the growth of new blood vessels that brings nutrients and oxygen.
It also helps protect cells from further harm by reducing inflammation. The combination of BPC-157 and TB-500 has earned the nickname “the Wolverine stack”, after the Marvel superhero famous for his rapid healing and his ability to regenerate injured body parts
The small number of human studies into these compounds offers inconclusive results. One study claimed that patients using BPC-157 had reduced knee-pain but the study lacked a control group. As knee-pain reduces over time naturally a control is essential.
While there’s no direct evidence linking compounds like BPC-157 or TB-500 to cancer, researchers emphasise that the long-term effects remain unknown because these substances have never undergone proper human trials. The World Anti-Doping Agency has banned these compounds, noting they lack approval from any health regulatory authority and are intended only as research tools.
These peptides represent a dangerous gamble with long-term health. The appeal is understandable but until proper human trials are conducted, users are essentially volunteering as test subjects in an uncontrolled experiment. My advice was correct it seems but abuse was the thanks I got for my efforts.
The Golden Dose
I, and my staff, are also experiencing even higher levels of abuse dealing with those trying to extract the Golden Dose from their Mounjaro pens. They are trying to access our NSES and demanding needles and syringes so they can use the remaining liquid. We are instructed by the Public Health Agency that the service is not to be used for this purpose. Some clients pathetically pretend to be diabetics and are out of needles and syringes, others claim the pen is broken and they can’t get the last one or two doses out, others just blatantly explain what they are doing. When we try to explain we can’t supply and that they should not be doing this they flip to overt aggression and some interestingly suggest that we don’t see the irony (or is it hyprocrisy) in what we are doing; denying good solid citizens like them needles when we are supplying to wastrel-junkies on heroin every day of the week.
Pharmacies selling the GLP-1s are already live to this trend and have in-store signage and web notices warning against attempts to extract the Golden Dose; it’s illegal to interfere with medical devices, there is a risk of underdosing with medical consequences, embolism is a possibility, and legal liability is lost, etc. This might be more to do with commercial expediency than patient safety but it’s helpful for me in making my argument to their clients.
The Golden Dose is a result of bad product design and thankfully Lilly have now agreed to redesign and reduce the amount of liquid needed to prime the device. This will happen next month; the sooner the better as I can’t take much more of this middle-class, sharp-elbowed, self-entitled abuse. Give me the old-fashioned drug addict any day!
I am a pharmacist in Belfast.
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