Making ‘safer injecting’ matter for people who inject image and performance enhancing drugs

Piatkowski, T ORCID: 0000-0002-6177-0266, Kill, E, Weith, S, Reeve, S, Cox, L, Coomber, R ORCID: 0000-0002-8144-1996, Puljevic, C, O’Connor, T and Ferris, J (2026) Making ‘safer injecting’ matter for people who inject image and performance enhancing drugs Health United Kingdom, 30 (4). pp. 516-537. ISSN 1363-4593, 1461-7196

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Abstract

Image and performance-enhancing drugs (IPEDs) are primarily injected intramuscularly or subcutaneously, yet traditional harm reduction strategies, focused on blood-borne virus prevention, often overlook the specific health enhancement goals of people who use IPEDs. This study advocates for a collaborative approach to safer injecting practices, informed by the lived-living experiences of people injecting IPEDs, to develop targeted messaging that aligns with their unique motivations. Thirty participants who inject IPEDs were recruited through community networks and partnerships. The study used qualitative focus groups and semi-structured interviews to explore injection practices and safety strategies. Data analysis followed an inductive, line-by-line approach, identifying themes related to injection methods and safer techniques, drawing on matters-of-concern. Stigma and misinformation about IPED injection practices were prevalent, contributing to a heightened risk of infection. Participants expressed anxiety about injection site reactions and reported limited knowledge of safe techniques, with poor injecting literacy leading to risky behaviours like needle reuse and inadequate hygiene. Importantly, participants highlighted that IPED injecting knowledge is often shared through peer support networks. This research calls for reframing harm reduction to focus on health enhancement, optimising injecting techniques, and integrating evidence-based resources, empowering peer-led harm reduction to better support the health aspirations of this population.

Item Type:	Article
Uncontrolled Keywords:	Humans, Substance Abuse, Intravenous, Focus Groups, Health Knowledge, Attitudes, Practice, Harm Reduction, Risk-Taking, Qualitative Research, Adult, Middle Aged, Female, Male, Interviews as Topic, Performance-Enhancing Substances
Divisions:	Faculty of Humanities & Social Sciences Faculty of Humanities & Social Sciences > School of Law and Social Justice Faculty of Humanities & Social Sciences > School of Law and Social Justice > Sociology, Social Policy and Criminology Faculty of Humanities & Social Sciences > Faculty of Humanities & Social Sci (All T&R Staff) Faculty of Humanities & Social Sciences > School of Law and Social Justice > School of Law and Social Justice (T&R Staff)
Depositing User:	Symplectic Admin
Date Deposited:	10 Nov 2025 09:29
Last Modified:	08 Jul 2026 06:52
DOI:	10.1177/13634593251388294
Open Access URL:	https://journals.sagepub.com/doi/10.1177/136345932...
Related Websites:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3195293
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