Human Enhancement Drugs

Katinka van de Ven, Kyle Mulrooney, Jim McVeigh, Kyle J. D. Mulrooney

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780367670634
• eBook ISBN: 9781351373838
• Edition: 1
• Topic: Social Sciences
• Subtopic: Criminology
• Index: Social Sciences

Despite increasing interest in the use of human enhancement drugs (HEDs), our understanding of this phenomenon and the regulatory framework used to address it has lagged behind. Encompassing public health, epidemiology, neuroethics, sport science, criminology, and sociology, this book brings together a broad spectrum of scholarly insights and research expertise from leading authorities to examine key international issues in the field of HEDs. As "traditional" and other "new" drug markets have occupied much of the academic attention, there has been a lack of scholarly focus on human enhancement drugs. This book provides readers with a much-needed understanding of the illicit drug market of HEDs. The authors, from a variety of cultural contexts, disciplines and perspectives, include both academics and practitioners. Topics explored in this collection amongst others include:

• The anti-doping industry and performance and image enhancing drugs

• Steroids and gender

• The use of cognitive enhancing drugs in academia

• The use of sunless synthetic tanning products

• The (online) trade of HEDs

• Regulations of the enhancement drugs market

This collection will serve as a reference for students, academics, practitioners, law enforcement and others working in this area to reflect on the current state of research and consider future priorities. This detailed exploration will provide a valuable knowledge base for those interested in human enhancement drugs, while also promoting critical discussion.

1 An introduction to human
enhancement drugs

Katinka van de Ven, Kyle J. D. Mulrooney and
Jim McVeigh

Introduction

Each year people spend billions to get in shape and “restore” their health or to maintain a “healthy” lifestyle and an optimal image – from training gear and wearable tech to new nutrition plans, enhancement substances and even cosmetic surgery. For example, taken together, the global health and wellbeing market, encompassing fitness, healthy eating, wellness tourism, beauty and anti-aging, was estimated at $3.7 trillion in 2015 (11% year on year growth) and it was estimated that the industry would grow to $7.37 trillion by 2018 (Colling, 2016). However, not only do we see a large increase in the use of legal or so called “natural” wellbeing and “beauty” products and services but there are also indications of a significant growth in men and women using a diverse range of drugs and supplements to enhance wellbeing, physique and performance, some of which are illegal (Evans-Brown, McVeigh, Perkins, & Bellis, 2012).

The ambiguous legal status of many of these drugs (Lavorgna, 2014), the variable regulation and enforcement of this market (Paoli & Donati, 2015), global Internet marketing (van de Ven & Koenraadt, 2017), social-cultural drivers (Monaghan, 2001; van de Ven & Mulrooney, 2017) and scant public knowledge of their effects (Evans-Brown et al., 2012) are among the key drivers of this rapidly growing phenomenon in the last two decades. The potential impact of this rapid expansion of HED use on population health, healthcare systems and society in general is considerable (McVeigh, Evans-Brown, & Bellis, 2012). Additionally, this illicit market is difficult to regulate due to the complex nature of diverse classes of HEDs controlled under different forms of legislation. For instance, a large proportion of enhancement drugs are medicines that can be sold legally with a prescription and illegally through both (online) pharmaceutical and non-pharmaceutical sources (van de Ven & Koenraadt, 2017). Contamination and substitution of HED products is commonplace due to the unregulated nature of the production and supply of these substances (Evans-Brown, Kimergård, & McVeigh, 2009).

In addition to being adulterated with other drugs or including substances excluded from the label, many enhancement substances are untested and have failed tests to exclude adverse effects (World Health Organization, 2007). Some of these drugs have been shown to cause severe health issues including fatalities, such as 2,4-Dinitrophenol (DNP) (Grundlingh, Dargan, El-Zanfaly, & Wood, 2011) and been reclassified as a metabolic poison nearly a century ago (McVeigh, Germain, & Van Hout, 2017), while others are associated with a range of adverse effects and have restricted availability in most countries (Pope et al., 2014). However, it is important not to overlook or ignore the “pleasurable” or “beneficial” effects people may experience from using these substances (Mulrooney, van de Ven, McVeigh & Collins, 2019). Much discussion also exists regarding whether or not to allow the use of HEDs for non-medical/recreational purposes to enhance human capabilities, such as “love enhancement” through biochemical modulation of lust, attraction and attachment (Earp, Sandberg, & Savulescu, 2015), or the use of cognitive-enhancing drugs to improve work performance (Greely et al., 2008).

Multi-disciplinary research in the areas of public health, epidemiology, neuroethics, sport science, criminology, and sociology – to name a few – is therefore needed to obtain a better understanding of this illicit drug market and to develop effective responses. Nevertheless, research in this field has been largely ignored and is lagging far behind compared to both “traditional” and other “new” drug markets (Chatwin, Blackman, & O’Brien, 2018) – in terms of both their use and supply. Recognising the lack of high-quality research in this area, this edited collection provides a point of reference for academics, practitioners, law enforcement and others working in this area to reflect on the current state of research and consider future priorities. The initial idea to produce an edited collection came forward from a long-standing collaboration of members of the Human Enhancement Drugs Network (www.humanenhancementdrugs.com). The collection brings together a broad spectrum of scholarly insights and research expertise from leading experts in a single volume that examines key international issues in the field of human enhancement drugs. The authors come from a variety of cultural contexts, disciplines and perspectives and includes both academics and practitioners. Ultimately, this edited collection aims to serve as a valuable knowledge base for those interested in human enhancement drugs, while also intending to provoke critical discussion.

What are human enhancement drugs?

As “human enhancement drugs” is a rather broad concept it is important to first outline how the term is being applied in the context of this book. In the literature, a variety of terms are often used interchangeably to describe drugs used for lifestyle and well-being purposes, and/or to enhance performance and image. Indeed, the ways in which HEDs are conceptualized and operationalized differs widely: while some use the terms “lifestyle drugs” or “human enhancement drugs”, others prefer “lifestyle medicine” or “performance and image enhancing drugs”. We adopt the term “human enhancement drugs” which includes substances that are used as functional aids – their predominant purpose is not primarily immediate gratification or pleasure (in contrast to psychoactive drugs) but are utilized in the pursuit of excellence, the attempt to surpass one’s natural potential, and/or the attempt to retain, regain or recover a quality, skill or standard. In short, this may be expressed as “better than well” (Elliott, 2004; Hall, 2004; McVeigh et al., 2012).

Nevertheless, this broad-based term has its own drawbacks. Namely, it is also not always clear what type of substances is being referred to when talking about HEDs; from students using methylphenidate to enhance their study performance to bodybuilders using anabolic-androgenic steroids to increase their muscle mass. One broadly accepted classification of drugs was published by Evans-Brown et al. (2012) who divided HEDs into six sub-categories based on their primary reason for use: (1) muscle drugs; (2) weight-loss drugs; (3) skin and hair enhancers; (4) sexual enhancers; (5) cognitive enhancers; and (6) mood and social behaviour enhancers.

1 Muscle drugs are used to enhance the structure and function of skeletal muscle. These substances are consumed for cosmetic reasons (e.g. increase muscle definition), medical reasons (e.g. to increase weight in muscle wasting diseases), and to enhance physical performance (e.g. increase strength). Examples of muscle drugs are anabolic-androgenic steroids and human growth hormone. Importantly, “muscle” does not only refer to someone’s increase in muscle mass, but also in the ability to enhance speed, energy levels, strength, and/or other muscle-related qualities.

2 Weight-loss drugs are substances used to enhance weight-loss. Most of these drugs work by reducing appetite and/or stimulating metabolism, leading to a reduction in body fat and overall body weight. Examples of weight-loss drugs are sibutramine, clenbuterol, ephedrine and 2,4-dinitrophenol (DNP).

3 Skin and hair enhancers are drugs to enhance the appearance of the hair or skin are pharmaceutically diverse but in principle it may be divided into three types: (I) drugs to tan or lighten the skin, (II) products to stimulate hair growth or prevent hair loss, and (III) drugs to prevent wrinkles or smoothen the skin. Examples of image enhancers include Finasteride (hair growth product), Melanotan I and II (skin darkening drugs), and Botulinum toxin products (to reduce skin lines and wrinkles).

4 Sexual enhancers are drugs that enhance (normal/abnormal) erectile function and aphrodisiacs, which increase sexual arousal and desire. Examples of sexual enhancers used for erectile dysfunction are Sildenafil, Tadalafil and Yohimbe, while substances such as bremelanotide (PT-141) or Melanotan are more used to increase libido.

5 Cognitive enhancers, also known as “neuroenhancers”, “smart drugs” or “brain doping”, are used to enhance cognitive functions including short-term memory, concentration, comprehension and alertness. Examples of cognitive enhancers are methylphenidate, modafinil and piracetam.

6 The final, and perhaps most complex, category are the mood and social behaviour enhancers which are used for altering and/or improving one’s state of mind or feelings. There are different types of mood and social behaviour enhancers but in general they may be divided into three categories. First, drugs to suppress the effects of adrenaline and to calm the nerves. For example, consider an individual taking beta-blockers before his or her presentation to quell the physical sensation brought upon their “nervousness”. Second, drugs to suppress pain such as the use of painkillers, for instance, by professional athletes so they can keep playing despite injuries (Dunn, 2014). Finally, drugs to alter an individual’s mood, for example, someone using selective serotonin re-uptake inhibitors (SSRIs) (anti-depressant) to increase energy levels and to improve positive feelings of well-being. However, the latter seems to be used more often for therapeutic reasons rather than for enhancement (e.g. the use of SSRIs when someone is clinically depressed).

The last category is further complicated as some of the most common forms of mood enhancers are (“traditional”) psychoactive substances such as alcohol, cannabis and cocaine. The creation of this category therefore leads to two significant problems; (1) it may be questioned if this is a true form of enhancing (normal) abilities, or rather involves the use of drugs to return to a “healthy” or “normal” mental health; and (2) it obscures the differences and similarities between mood and social enhancers, and other illicit substances. Separating this class of drugs from established substances may be unhelpful and this type of drug should therefore not be classed as an “HED” per se. However, it is important to discuss this category as it illustrates the blurring of boundaries between various licit and illicit drug markets (see also next section).

One specific area of interest within the spectrum of HEDs are drugs that are more frequently associated with professional, amateur and recreational sport: the muscle enhancers, weight-loss drugs, and skin and hair enhancers. These two categories are commonly referred to when discussing performance and image enhancing drugs (PIEDs; originally an Australian term). The use of the term PIEDs has evolved over the last couple of decades. Originally, the term “performance enhancing drugs” (PEDs) (i.e. “doping”) was used to describe a wide variety of substances used by athletes to enhance their sport performance. However, it is now well-known that, in addition to athletes, there are multiple subgroups of people who use these types of substances including but not limited to fitness trainers, aging men, police officers and security personnel (Dawson, 2001; Hoberman, 2017; Korkia & Stimson, 1993; Mulrooney & van de Ven, 2017; Sagoe et al., 2015; Stubbe, Chorus, Frank, de Hon, & van der Heijden, 2013). Often, the main goals of these “non-athletic” using groups is aesthetic modification, such as to lose weight or to increase muscle mass, and to a lesser extent, athletic enhancement. As such, the term “performance and image enhancing drugs” (mainly used in Australia), and in certain cases “image and performance enhancing” (mainly used in the UK) or “appearance and performance enhancing drugs” (APEDs), is considered more suitable when describing these substances. Although it needs to be noted that the divide between athlete and non-athlete is not always clear (e.g. see Backhouse et al., 2014; Begley et al., 2017). What terms to use when discussing HED-type substances is therefore dependent on the social and cultural context, the substances under investigation, and the motivations for using.

These six tentative classifications are not limited to purpose or population but these categories are fluid and can overlap. Indeed, even within the categories listed above, many of the drugs may be used for various enhancement and other purposes (e.g. medical and recreational) and nor are they necessarily used for one specific type of enhancement or purely for enhancement reasons. Human enhancement drugs may be used by (1) different people and for different purposes, (2) the same people, at different times, for different purposes, and (3) the same people, at the same time, for multiple purposes. For instance, Melanotan II is used for its tanning effects but is sometimes also used for its perceived sexual enhancement properties (McVeigh et al., 2012). Similarly, human growth hormone is used for both its muscle enhancing effects and its weight-loss properties and prescribed legitimately for conditions such as Turner Syndrome, renal failure and short stature due to deficiency. Finally, it is important to note that people who use HEDs often report use of a range of other substances typically used to enhance the impact of their HED use and/or to counter side-effects (e.g. see Sagoe et al., 2015).

Nevertheless, classifications such as those listed above, can be useful when attempting to describe a broad phenomenon like drugs. As Potter and Chatwin (2018) note, grouping individual examples together based on similar characteristics¹ is important for understanding the broader class and its component categories, while at the same time it is essential to be critical of these categories. Indeed, “[t]ypologies reflect not just important similarities across those examples within the same type, but also important differences between categories” (Potter & Chatwin, 2018: 3). As such, for HEDs to be a useful category, academically and practically speaking, there should be recognized similarities across the substances within that category and important differences between those substances labelled as HEDs, and those that are not.

What separates HEDs from other drugs?

Finally, we also need to consider: what separates HEDs from the more traditional drugs, such as cannabis, and other “new” drugs, such as synthetic cannabinoids? There is a clear overlap between HEDs and other drug markets in that similar substances are used, albeit for different reasons. For example, while cocaine is predominately used as a recreational drug as it produces feeling of euphoria and wellbeing (and for this reason could also be classed as a “mood and social enhancer”), it is also...

Table of contents

• Cover Page
• Half Title Page
• Series Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of figures
• List of tables
• List of contributors
• Foreword
• Acknowledgements
• Abbreviations
• 1 An introduction to human enhancement drugs
• Part I Understanding the use of human enhancement drugs in society
• Part II Human enhancement drugs, harms and public health
• Part III Illicit human enhancement drug markets and their suppliers
• Part IV Responding to human enhancement drugs
• Index