The American College Health Association’s Alcohol, Tobacco and Other Drugs Coalition (ACHA ATOD) focuses on substance abuse prevention and treatment specific to the college student population. An issue of increasing concern for the coalition involves non-medical prescription drug use (NMPDU). Although its prevalence ranks a distant fourth to alcohol, tobacco and marijuana use on college and university campuses, non-medical use of prescription drugs far exceeds other illicit drug use. Of particular concern is the link between NMPDU and the use of other drugs, often in combination, which poses additional risks for students today.
For the purposes of this blog, non-medical prescription drug use is generally defined as the use of a prescription medication:
- For anything other than its intended purpose;
- By someone other than the person to whom it is prescribed; or
- In a dosage other than prescribed.
Non-medical prescription drug use is a problem throughout the United States and has been classified as an epidemic by the Centers for Disease Control and Prevention. Still, it is important for colleges and universities to assess the extent of use on their respective campuses. In the earliest studies, rates of non-medical prescription stimulant use on our Nation’s campuses were reported to range from 0 to 25 percent,1 and trend data between 1993 and 2005 alerted the public health community to rate increases between 93 percent and 450 percent across various prescription drugs (e.g., stimulants, painkillers, sedatives, and tranquilizers).2
In most cases, reported use rates on campuses around the country from 2008-2012 are less than 10 percent for any prescription drug category (e.g., painkillers and stimulants) and, in some instances, less than 5 percent (antidepressants, sedatives, and erectile dysfunction drugs) for past year use.3 These trends are consistent with results from both the Monitoring the Future survey4 and in ongoing longitudinal studies in the Northeast5 and Midwest.6 Nonetheless, these rates are unacceptably high, and campus officials may be unaware of the potential consequences of NMPDU, which can include drug-related emergency room visits, sexual assault, violent behavior, and academic misconduct (e.g., use of prescription drugs to improve test scores).
- Link NMPDU with alcohol use. College health professionals and other campus officials are only beginning to understand who is at risk for NMPDU. Institutions of higher education with advanced admissions standards located in the Northeast demonstrate disproportionately high rates of non-medical prescription stimulant use.1 Additionally, studies have consistently found that white, male, Greek-affiliated students are at the greatest risk.1,7,8,9 This profile is similar to that of individuals with a higher risk for alcohol use, as drinking and drug-use behaviors are highly correlated.10 College health professionals, therefore, should consider utilizing evidence-based practices that target high-risk alcohol use (e.g., brief motivational interviewing) to also address NMPDU.
- Increase perceived harmfulness. As with alcohol use, college students generally perceive NMPDU as relatively harmless. In one study,11 40 percent of students assigned only moderate risk to non-medical use of prescription stimulants (e.g., Adderall®) and analgesics (e.g., Vicodin®). Compounding the problem is that many students suffer from “optimistic bias,” mistakenly believing that the negative consequences associated with drug use happen to others and not themselves. Because prescription medications are produced legally and distributed through doctors, students often perceive them as safer than illicit drugs, further reducing the stigma associated with their use. College health professionals should consider increasing students’ awareness and assessment of the harm associated with non-medical prescription drug use through their social marketing and educational outreach efforts.12
- Leverage the prescribed user. Research shows that the prescribed user, under medical supervision, demonstrates the same risk as the average college student for illicit drug use. However, prescribed users who overuse and non-medical users both exhibit a much greater risk for illicit drug use.13 College health professionals should educate students in the appropriate use of prescription drugs and work to build their confidence in managing requests (from friends or other students, for example) to share or sell their medication.
- Utilize social norms marketing. Research indicates college students and others grossly overestimate the extent of non-medical prescription drug use.12 For instance, students may think that 75 percent of their peers use Adderall® non-medically, when in fact fewer than 10 percent do. Correcting these misperceptions may result in decreased NMPDU.
- Work with local partners. Because alcohol and other drug use impacts both the campus and the surrounding community, colleges and universities should seek to engage and work closely with local partners – healthcare providers, pharmacies, merchants, and law enforcement, to name a few. While many students obtain prescription medications from their peers for free, we also know that students are “doctor shopping” and selling medications to other students.4 Reducing access in the community can also help to reduce access on campus.12
Coalition and Related Reports
The ACHA ATOD Coalition provides resources related to alcohol, tobacco, and other drug prevention as well as evidence-based intervention strategies. A number of resources are currently available on the ACHA ATOD Coalition webpage, including the Non-Medical Prescription Drug Use Toolkit for Health Promotion Professionals and links to national data sources on ATOD issues on college and university campuses.
2. National Center on Addiction and Substance Abuse at Columbia University. (2007). Wasting the Best and Brightest: Substance Abuse at America’s Colleges and Universities. www.casacolumbia.org.
3. American College Health Association. (2012). American College Health Association-National College Health Assessment. www.acha-ncha.org.
4. Johnston, L.D., O’Malley, P.M., & Bachman, J.G. (2003). National Survey Results on Drug Use from the Monitoring the Future Study, 1975-2002. Volume II: College Students and Young Adults. Bethesda, MD: National Institute on Drug Abuse.
5. The College Life Study. (2013). Retrieved from http://www.cls.umd.edu/CLS.html on October 30, 2013.
6. Institute for Research on Women & Gender. (2013). Retrieved from http://irwg.research.umich.edu/resource/currentresearch.html on October 30, 2013.
7. McCabe, S.E., West, B.T., & Wechsler, H. (2007). Trends and college-level characteristics associated with the non-medical use of prescription drugs among U.S. college students from 1993 to 2001. Addiction,102,455-465.
8. Simoni-Wastila, L., Ritter, G., & Strickler, G. (2004). Gender and other factors associated with the non-medical use of prescription drugs. Substance Use and Misuse, 39, 1-23.
9. Simon-Wastila, L. & Strickler, G. (2004). Risk factors associated with problem use of prescription drugs. American Journal of Public Health, 94, 266-268.
10. McCabe, S.E., Cranford, H.A., Morales, M., & Young, A. (2006). Simultaneous and concurrent polydrug use of alcohol and prescription drugs: Prevalence, correlates, and consequences. Journal of Studies on Alcohol, 67, 529-537.
11. Arria, A.M., Caldeira, K.M., Vincent, K.B., O’Grady, K.E., & Wish, E.D. (2008). Perceived harmfulness predicts nonmedical use of prescription drugs among college students: Interactions with sensation-seeking. Prevention Science, 9, 191-201.
12. Arria, A.M., & DuPont, R.L. (2010). Nonmedical prescription stimulant use among college students: Why we need to do something and what we need to do. Journal of Addictive Diseases, 29, 417-426.
13. Arria, A.M., Caldeira, K.M., O’Grady, K.E., Vincent, K.B., Johnson, E.P., & Wish, E.D. (2008). Nonmedical use of prescription stimulants among college students: Associations with attention-deficit hyperactivity disorder and polydrug use. Pharmacotherapy, 28, 156-159.