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Volume 342:1532 May 18, 2000 Number 20
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Anabolic–Androgenic Steroids as a Gateway to Opioid Dependence

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To the Editor: Athletes who abuse anabolic–androgenic steroids may go on to abuse opioid agonist–antagonists such as nalbuphine1,2,3 or even classic opioids such as heroin.2,3 We studied this phenomenon among patients treated at Sunrise House, a private inpatient facility for substance-dependence treatment in northern New Jersey. Among 227 men admitted for dependence on heroin or other opioids in 1999, we found that 21 (9.3 percent) had a history of anabolic–androgenic steroid use. In contrast, among 197 men admitted for opioid dependence in 1990, only 1 (0.5 percent) reported prior use of anabolic–androgenic steroids (P<0.001 by two-tailed Fisher's exact test).

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