Prescription Drug Abuse among College Students

Prescription drug abuse among college students is a growing trend on most campuses. According to one large study, the nonmedical use of prescription medications is second only to marijuana as the most common form of illicit drug use; in addition, the percentage of students reporting the abuse of prescription stimulants can be as high as 25% on some campuses (McCabe et al, 2005).

Students are using these drugs inappropriately to not only “get high”, but to help with concentration when cramming for papers or tests, to self-medicate for anxiety or depression, and even to enhance their stamina when playing sports. Increasing numbers of students think of prescription stimulants as safe “brain steroids” that help maximize performance with minimal risk (Kadison et al, 2005).

Many of the same environmental problems that contribute to high-risk alcohol use also contribute to the abuse of prescription medication. Students are unable to find healthy ways to deal with stress and other mental health issues and believe that using prescription drugs inappropriately is socially acceptable and safer than the abuse of other illicit substances (CASA, 2005). Friends will share their medications or sell pills for a few dollars to roommates and acquaintances, making the drugs readily available and inexpensive. Laws and policies may be difficult to enforce when students claim to have a prescription if caught with medication.

To aid prevention professionals tasked with addressing this problem, the Higher Education Center has compiled the following list of useful links and information.

Assessing the Problem

Before choosing a prevention strategy, you must start with assessment—the same as you would when addressing high-risk alcohol abuse or violence on campus. While national data are important and regional/state data are also relevant, campus data are the most important sources for piecing together the problem on your campus. The following options may help you gather data related to your campus community:

Student body-wide health assessment surveys (CORE, NCHA, or create your own)
Students: Employ student workers, conduct focus groups
Environmental scanning, including physical and online social networking environments
Campus and local police
Hospitals and campus health services
Residence hall staff
Other local institutions of higher education and high schools
Feeder schools
Enhancing Prevention Efforts

Prevention Approaches

As with alcohol and other drug use, prescription drug abuse is shaped by the physical, social, economic, and legal environment. Educational approaches and awareness activities help students when part of a comprehensive prevention approach, but the following environmental strategies show promise in the battle against prescription drug abuse among college students:

Strengthen campus policy, enforcement
• Drug-Free Schools and Campuses Act: update your written policy & inform faculty, staff, students of AOD policies, penalties
• Enforce & increase publicity of disciplinary actions associated w/ policy violations
• Inform parents of trends, prevention efforts: consider parental notification
• Increase detection efforts
Focus on the normative environment
• Conduct social norms marketing campaigns…if misperceptions exist
• Add commitment to avoid prescription drug abuse to academic honor code
• Work with faculty, staff, RAs to avoid skewing norms & spreading misperceptions; increase faculty-student contact and mentoring
Brief motivational enhancement interventions in student health centers
Challenge expectancies around prescription misuse
Enhance awareness of personal liability
Offer social, recreational, extracurricular, public service options
Survey and test to be sure messages are appealing
Expand student center/gym/library hours

Engage Campus Health Services*
• Develop comprehensive policies related to prescription drugs and be sure that all providers are aware of them
• Increase mental health screening and support services
• Require a full medical history before dispensing medication
• Hesitate to increase dosage at student’s request
• Require an office visit before prescribing refills
• Limit prescriptions to a month’s supply or less
• Limit replacements for “lost” pills
• Prescribe controlled-release tablets when possible
* These strategies were developed by Higher Education Center staff in consultation with P. Davis Smith, Medical Director at the Davison Health Center at Wesleyan University in Connecticut.

National and Regional Data Sources

The Core Institute provides results from The Core Alcohol and Drug Survey, which assesses the nature, scope, and consequences of alcohol and other drug use on college campuses. The most recent statistics are drawn from a sample of 33,379 undergraduate students from about 53 colleges in the United States. These colleges conducted Core Survey during 2005. All institutions used methods to insure a random and representative sample of their respective student bodies. Results include statistics on demographics, prevalence, heavy and frequent usage rates, and substance use-related consequences.
Monitoring the Future (MTF) is an ongoing study of the behaviors, attitudes, and values of American secondary school students, college students, and young adults.
The National Survey on Drug Use and Health (NSDUH) provides annual data on drug use in the United States. The survey provides yearly national and state level estimates of alcohol, tobacco, illicit drug, and non-medical prescription drug use. Other health-related questions also appear from year to year, including questions about mental health.
The American College Health Association National College Health Assessment (NCHA) is a nationally recognized research survey that can assist administrators in collecting precise data about students’ health habits, behaviors, and perceptions, including smoking habits, contraception use, mental health issues, relationship difficulties, sexual behaviors, exercise habits, preventive health practices, and perceptions of drug and alcohol use.

Key Resources

Reports
National Center on Addiction and Substance Abuse at Columbia University (CASA). Wasting the Best and the Brightest: Substance Abuse at American Colleges and Universities (New York: 2007).

National Center on Addiction and Substance Abuse at Columbia University (CASA). You’ve Got Drugs: IV: Prescription Drug Pushers on the Internet (New York, 2007).

Teens and Prescription Drugs: An Analysis of Recent Trends on the Emerging Drug Threat (Washington, D.C.: Office of National Drug Control Policy, 2007).

Research Articles
Barrett, S. P.; Darredeau, C.; and Pihl, R. O. “Patterns of Polysubstance Use in Drug Using University Students.” Human Psychopharmacology Clinical Experience 21: 225–263, 2006.

Kadison, R. “Getting an Edge: Use of Stimulants and Antidepressants in College.” New England Journal of Medicine 353: 1089-1091, 2005.

McCabe, S. E.; Cranford, J. A.; Morales, M; and Young, A. “Simultaneous and Concurrent Polydrug Use of Alcohol and Prescription Drugs: Prevalence, Correlates, and Consequences.” Journal of Studies on Alcohol 67: 529–537, 2006.

McCabe, S. E.; Knight, J. R.; Teter, C. J.; and Wechsler, H. “Nonmedical Use of Prescription Stimulants among U.S. College Students: Prevalence and Correlates from a National Survey.” Addiction 99: 96–106, 2005.

McCabe, S. E.; Teter, C. J.; Boyd, C. J.; Knight, J. R.; and Wechsler, H. “Nonmedical Use of Prescription Opioids among U.S. College Students: Prevalence and Correlates from a National Survey. Addictive Behaviors 30: 789–805, 2005.

Quintero, G.; Peterson, J.; and Young, B. “An Exploratory Study of Socio-cultural Factors Contributing to Prescription Drug Misuse among College Students.” Journal of Drug Issues 22: 903–926, 2006.

Shillington, A. M.; Reed, M. B.; Lang J. E.; Clapp, J. D.; and Henry, S. “College Undergraduate Ritalin Abusers in Southwestern California: Protective and Risk Factors.” Journal of Drug Issues 100–114, 2006.

Teter, C. J.; McCabe, S. E.; LaGrange, K; Cranford, J. A.; and Boyd, G. J. “Illicit Use of Specific Prescription Stimulants Among College Students: Prevalence, Motives, and Routes of Administration.” Pharmacology 26: 1501–1510, 2006.

Wax, P. M. “Just a Click Away: Recreational Drug Sites on the Internet.” Pediatrics 109: 1–4, 2007.

White, B. P.; Becker-Blease, K. A.; and Brace-Bishop, K. “Stimulant Medication Use, Misuse, and Abuse in an Undergraduate and Graduate Student Sample.” Journal of American College Health 54: 261–168, 2006.