The death of a passionate and adored personal trainer in a Sydney gym toilet should lead to better quality discussions on doping health risks, a coroner says.
Jesse Drabsch, 31, rapidly lost consciousness in November 2017 after injecting himself with insulin in a toilet cubicle in a 24-hour Anytime Fitness gym in Castle Hill.
Although he collapsed at 6pm on a Thursday, his whereabouts weren't discovered until - at the behest of his worried mother - gym staff checked internal CCTV the following afternoon.
Another hour passed before police opened the door at 2pm and found Mr Drabsch unconscious and frothing at the mouth.
As well as investigating the delayed discovery of Mr Drabsch, the coroner heard of his substantial history of using performance and image enhancing drugs (PIEDs) including insulin, peptides and testosterone.
She found reliable evidence about the prevalence of PIEDs use was "limited" while there was a "somewhat surprising gap" of specific educational and treatment strategies and support for users.
Anytime Fitness and NSW Health were asked to consider liaising with industry body Fitness Australia and health experts to implement strategies to address those gaps.
Ms Grahame also recommended NSW Health try to boost the Google ranking of Your Room, a state-run drug education service, in search results for PIEDs, "fitness drugs" and other related terms.
She said the topic of PIEDs appeared "somewhat taboo" for gyms despite witnesses speaking of the view that people "need" to use the drugs to compete in bodybuilding competitions.
While she accepted the view of the global gym chain's Australian branch that PIEDs use masked deeper issues, the coroner said she was convinced by the experts.
"To squarely engage with the issue is not to condone or encourage use," Ms Grahame said.
"One cannot help but be reminded of the positive health benefits achieved by harm reduction strategies and education in relation to 'street drugs' and anticipate their usefulness in this context."
Harm reduction was also a focus of Ms Grahame's recommendations in 2019 into the deaths of six illicit-drug-related deaths at music festivals, when she echoed experts' calls for pill testing and public safety warnings.
Effective harm reduction strategies would require involvement from all stakeholders, including users, the coroner said on Friday.
She directed several further recommendations at Anytime Fitness's Australian branch, including making permanent a trial policy for two-hourly bathroom welfare checks.
The trial was implemented in April, seven months after another gym user collapsed in a northern Sydney bathroom. A staff member knocked on the door, received no response and - in breach of protocol - opened the door instead of calling and waiting for emergency services. The gym user made a full recovery.
Other recommended safety measures would have staff learn how and when it was appropriate to open toilet doors from the outside and an inquiry into the cost of introducing a check-out system at all gyms.
She also noted how Mr Drabsch's "terrible last day doesn't sum up who he was as a person", recalling the deep affection both his family and clients had for the carpenter-turned-PT.
His older sister Eryne Davies spoke of how her cheeky brother's smile would travel from his mouth to his glimmering electric blue eyes, as he played tricks or pranks on his siblings when they were children.
Later in life, he found in fitness "a really nice sense of who he was and loved being able to help people and share knowledge," she said.