Preventing, producing, or reducing harm? Fitness doping risk and enabling environments

Policies and approaches addressing image and performance enhancing drug (IPED) use in the gym and fitness context, also known as fitness doping, vary widely by country. Fitness doping, and those who participate in it, maybe met with individual-level strategies ranging from criminal penalties to harm reduction efforts. This research compares two distinct approaches to fitness doping: Sweden’s prevention-based approach and Scotland’s harm reduction approach. Drawing on the risk environment framework, we show how national-level policies around possession, sale, and use that represent different approaches to IPEDs structure how to use is understood and experienced using two case studies: Sweden’s national PRODIS program and a steroid clinic in Glasgow, Scotland. The results highlight how individuals and communities respond to environmental constraints around IPEDs. Restrictive anti-doping environments produce a range of risks for people who use these substances and may prevent harm reduction. Less restrictive environments may allow for more harm reducing work, but the remaining prohibitions may still produce social, economic, and policy risks. We argue that formal harm reduction focused on the health and needs of those who use IPEDs offers an environment in which safer use is supported and promoted.