Appearance- and Performance-Enhancing Drugs and Substances Use Among Adolescents: Physician Reports

OBJECTIVE: The aim of this study was to identify and describe the experiences of adverse events from appearance- and performance-enhancing drugs and substances (APEDS) use among adolescents in Canada. Second, to determine pediatricians' self-reported knowledge of APEDS and their screening practices for patients. METHODS: Adverse events from APEDS use among adolescents (10-18 years) were identified via a cross-sectional survey of pediatricians participating in the Canadian Paediatric Surveillance Program. RESULTS: A total of 55 cases of adolescents (56.4% 13-15 years, 89.1% cisgender boys) with adverse events from APEDS use were identified by 857 pediatricians. Of the 55 cases, 40.0% included the use of whey protein powders or protein shakes. Nearly a quarter (23.7%) of cases included the use of illegal APEDS (eg, anabolic-androgenic steroids). Body systems reported to be affected included the renal (30.9%) and gastrointestinal (25.5%) systems. Outpatient monitoring (36.4%) was the most common form of medical care; however, 23.6% reported emergency department care or hospital admission. Of the 857 participants, 28.1% reported having no knowledge of APEDS, and 53.4% reported never screening for APEDS in routine practice. CONCLUSIONS: APEDS use among adolescents may result in adverse events, including effects on the renal and gastrointestinal systems, requiring ongoing medical monitoring from pediatricians. Cisgender boys and early- to mid-adolescents may be at particularly high risk for adverse events, as well as users of dietary supplements. Knowledge and screening practices were low among participants. These findings underscore the need for increased training and education on APEDS use for pediatricians in Canada.