“Blood letting”—Self-phlebotomy in injecting anabolic-androgenic steroids within performance and image enhancing drug (PIED) culture

Background: New evidence with regard to a previously undocumented practice – self phlebotomy, known as ‘bloodletting’ – incontemporary injecting performance and image enhancing drug (PIED) culture is the subject of this paper. While self phlebotomy has been evidenced in psychiatric patients previously, it was performed here in people who inject AAS as a self directed health care procedure. Methods: Data was collected from five publicly accessible internet discussion forums and coded using NVivo software. For the purposes of this study, posts in relation to bloodletting were extracted from the final set of records for analysis Results: Motivation to perform bloodletting or to 'self – bleed’ was largely grounded in experiencing symptoms of high blood pressure or a high red blood cell count (RBC).Instructions on how to perform bloodletting were found within discussion threads. Conclusion: This study is intended to provide the first snapshot of online communal activity around practice of self-phlebotomy or bloodletting amongst people who inject AAS. Further research in this area is warranted, and will be of benefit to healthcare workers, treatment providers and policy makers particularly as this relates to evidence informed and targeted harm reduction policies and effective public health interventions.