The National Institute on Drug Abuse (NIDA) has announced the start of a major initiative to combat ominous trends in the use of anabolic steroids by high-school students. Use of steroids is rising in these teens, while among high-school seniors, steroid use is perceived as less dangerous than it once was.

"We knew," said NIDA Director Alan I. Leshner, Ph.D., at a press briefing last month, "that we had to take steps to reverse this trend before it gained momentum."

The increased use of anabolic steroids by teens was revealed by the 1999 Monitoring the Future survey by the University of Michigan. This survey, which the university has conducted each year for the past 25 years, looks at 8th, 10th, and 12th graders across America. In the 1999 survey, 2.7 percent of 8th and 10th graders and 2.9 percent of 12th graders reported that they had used anabolic steroids at least once. This is a significant increase since 1991, the first year that steroid-use data were collected, when 1.7 percent of teens used steroids. This alarming increase is made even more ominous by the secondary finding that the perception that steroid use is harmful was held by fewer teens in 1999 (62 percent) than in 1998 (68 percent).

Anabolic steroids are synthetic derivatives of the male hormone testosterone. They are clinically useful in several accepted indications. All anabolic steroids are Class III controlled substances under the Anabolic Steroid Control Act of 1990. They have significant adverse effects, especially when used in the much higher doses commonly found in competitive athletics. Used in this setting for their ability to add bulk to muscle fiber, they are commonly taken at two to 10 times the accepted therapeutic doses. In addition, they are often combined by abusers for quicker, added effects. Under these conditions, anabolic steroids can cause serious health concerns, including death.

In males anabolic steroid abuse can cause enlargement of the breasts, balding, acne, and shrunken testicles, increased aggression and hostility, as well as increased risk of heart attack, stroke, and certain types of cancer. In females, it can lead to heart disease, kidney and liver cancer, depression, hostility and aggression, eating disorders, acne, excess facial hair, and stunted growth.

These drastic adverse effects are the centerpiece of the campaign led by NIDA. NIDA has partnered in the initiative with the National Collegiate Athletics Association, American College of Sports Medicine, American Academy of Pediatrics, National Association of School Nurses, National Federation of High Schools, International Students in Action, and Dr. Drew Pinsky, the host of MTV’s "Loveline" and the Web site <www.drDrew.com>.

The partnership will work to distribute 500,000 postcards in bars, health clubs, gyms, movie theaters, shopping malls, restaurants, and youth centers across the country emphasizing the adverse effects of steroids; one card is aimed at males, another at females. In addition, 150,000 copies of a NIDA-produced "research report" on steroids and 250,000 copies of a NIDA Community Drug Alert Bulletin will be distributed, all in an effort to educate the public about the potential dangers of these abusable medications. In addition, a new Web site has been launched at <www.steroidabuse.org>.

One of the difficulties in controlling steroid abuse has been the conflicting messages that our society sends to teens. "We have all seen the ad campaigns for the product that is ‘new and improved,’ " said Linn Goldberg, M.D., a leading researcher in steroid abuse prevention at the Oregon Health Sciences University. A couple years ago, Saab used the slogan that its new model was like a Volvo on steroids. We have come to accept in our society the perverted notion that something is automatically better because it’s on steroids."

Gary I. Wadler, M.D., an associate professor of clinical medicine at New York University School of Medicine, agreed. In comments to the press, Wadler pointed out that while anabolic steroids are regulated as controlled substances, their precursors, such as androstenedione, which the body converts into anabolic steroids, were deregulated by Congress in 1994 and can be bought in any health-food or vitamin-supplement store.

"Federal legislation has sent conflicting messages." Wadler said, "You can’t have it both ways!"

NIDA and its partners hope that by proactively distributing accurate, scientifically based information regarding the dangers of steroid misuse and abuse, they can educate the public and turn around the trends seen in the 1999 survey.

"Studies have shown, over and over again, that fear is the best reducer of drug use and abuse," said NIDA’s Leshner. "If we can get them appropriately afraid of steroids, they won’t use them."