Stacking the Risks: Fatal Consequences of Anabolic Steroid Misuse and Stacked Substance Use in FAERS Data

Area of Science:

• Pharmacology
• Toxicology
• Public Health

Background:

• Anabolic-androgenic steroid (AAS) misuse is prevalent and associated with severe health risks.
• The practice of "stacking" multiple AAS and other substances exacerbates these dangers.
• Understanding risk factors for severe outcomes in AAS misuse is critical for public health.

Purpose of the Study:

• To analyze the FDA's Adverse Event Reporting System (FAERS) data on intentional AAS misuse.
• To identify specific drug combinations and demographic factors associated with serious adverse drug reactions (ADRs).
• To evaluate predictors of life-threatening events in individuals misusing AAS.

Main Methods:

• Retrospective analysis of 286 FAERS reports of intentional AAS misuse, with 218 unique cases included.
• Categorization of drugs, ADRs, and demographic data.
• Logistic regression analysis to determine associations between substance stacking and serious outcomes, and to identify predictors of severe events.

Main Results:

• Serious outcomes occurred in 46.8% of male cases, with cardiovascular, endocrine, and psychological ADRs being most common.
• Stacking AAS with other drugs, particularly CNS depressants, fat-burning agents, and endocrine modulators, showed strong associations with serious outcomes (P < .001).
• Younger age, higher drug count, and more recent report year were significant predictors of life-threatening events.

Conclusions:

• Intentional AAS misuse, especially polypharmacy (stacking), significantly elevates the risk of severe health consequences.
• Younger individuals engaging in AAS stacking are particularly vulnerable to life-threatening events.
• Public health strategies, including education, harm reduction, and healthcare provider training, are essential to mitigate AAS misuse risks.