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Assessing the Risks and Issues: Prescription Drug Abuse on Campus

Thomas A Workman, Ph.D.

Assistant Professor, School of Allied Health Sciences

Baylor College of Medicine

Assistant Professor, Health Communication

University of Houston-Downtown

Gregory Eells, PhD, Director

Counseling & Psychological Services

Associate Director, Gannett Health Service

Cornell University

Paper Presented at the 2010 National Conference for Law and Higher Education,

Stetson University College of Law, Orlando, Florida A student blog published on CollegeCandy.com in 2008 may best encapsulate the complexities of what many in college health prevention and treatment consider to be a

disconcerting trend of Generation Rx1:

Sunday night at 3 a.m. again. The lines on the page have long since run together. I have written the same sentence three times. My roommate is blaring the television set that is constantly tuned to E!. I have seen all of the True Hollywood stories. Twice.

“Bailey, can I have an Adderall?” “Sure. You know where to find them.” I rummaged around in the clutter of her desk drawer, and my fingertips having connected with the plastic of a prescription bottle, I tipped a tiny capsule into my palm.

Ah, yes, here was my chemical savior. Focus city, here I come.

Studying was never my forte. I had always managed to ace my tests and whip out my papers based on my class attendance and spectacular ability to bullsh*t.

When I got to college, I discovered that however wonderful my skills may be, Prescription Drug Abuse: Assessing the Risks and Issues Page 1    it is nigh-on impossible to BS a 15-page paper, even if it is philosophy. I was floundering, and here was my quick-fix. Because who wants to do things the hard way?

So Adderall became my study buddy and I owe many successful all-nighters to those tiny capsules. What’s more, with all of this extra energy and focus, I stopped munching on Cheetos and Doritos while studying and I lost a pants size (which I have since gained back).

Now, addictive tendencies run in my family, so I had to be careful. Adderall has the same chemical components as speed (so watch out if you’re going to be getting drug tested), and its dispensing is tightly regulated. Only one month’s supply at a time may be prescribed and a visit to the doctor is required in order to renew the prescription. Meaning: there can be habit-forming side effects and this is something to be monitored.

But, I never once had the least shadow of a negative side effect. No crashes, no moodiness, no nothing. Just complete focus and an increase to my G.P.A.

Obviously, I would do it again if it were available to me. I’ve even considered going to the psychiatrist myself and getting a prescription.

It’s not necessary, though; if you know the right people (and I do), you can usually just score on campus.2 The non-medical use of prescription drugs by college students – defined by most health researchers as “use without a prescription of the individual's own or simply for the experience or feeling the drugs caused3” – has been raised as a significant concern by many of the same institutions that rang the alarm bell about alcohol abuse among college students in the early 1990s.4 In fact, many aspects of the current discourse on collegiate prescription drug misuse mimics the early conversations about alcohol abuse on campuses during that decade. Much like then, the dialogue about prescription drug misuse is laden with conflicting views about the problem and its impact on the individual, the campus, and society in general. There is a great deal of anecdotal evidence that a problem exists, with sensational media accounts of collegiate “pharming parties” that rival the drug panic of the 1960’s,5 but little hard data available to provide an accurate assessment of the problem or identify clear environmental or individual Prescription Drug Abuse: Assessing the Risks and Issues Page 2    strategies to address it. Even the simple task of naming and defining the problem has created confusion and a bit of controversy among researchers, practitioners, and students. Most importantly, however, non-prescription drug use among college students, much like the uses and abuses of alcohol on and around campus, reflects and is influenced by a wide range of moral, ethical, biomedical, social, and cultural forces that make prevention strategies much more difficult to devise and enact.

In this paper, we will identify the current trends and issues surrounding the misuse of prescription drugs among college students with the intent of providing insight into appropriate directions for campus and community policies and prevention practices. To do so, we will first look at the prevalence data, then try to better capture the key issues surrounding the problem, and finally identify several implications for campuses attempting to address the issue.

Prevalence of Illicit and Non-Medical Drug Use   Studies indicate that three families of prescription medications have been used by college

students for non-medical purposes:

• Pain relievers (Opiods) such as OcyCotin®, Vicadin®, or Percocet®

• Stimulants such as Ritalin® or Adderall®

• Benzodiazapines such as Valium® or Xanax® Although drug use among various age groups has been collected for several decades by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institute for Drug Abuse (NIDA), among others, the first heavily publicized report about college student use came from the University of Michigan in 2005 using data from the Harvard College Alcohol Study. The study found that 7 percent of college students reported using stimulants for non-medical purposes, and that the most likely users were male, white, members of fraternities and sororities and earned lower grade point averages. According to the data, rates of non-medical stimulant use were higher at colleges located in the north-eastern region of the United States and at colleges with more competitive admission standards.6 More recently, SAMSHA produced two reports on the non-medical use of prescription drugs using data from the National Survey on Drug Use and Health (NSDUH). The first focused the non-medical use of pain relievers across multiple age groups and reported that there was an Prescription Drug Abuse: Assessing the Risks and Issues Page 3    increase of use among 18 – 25 year-olds, from 4.1 percent in 2002 to 4.6 percent in 2007.7 The second report looked at the nonprescription use of Adderall® among full-time college students, with results similar to the University of Michigan study.8 Data from NSDUH (2008) indicates that overall non-medical use of psychotherapeutic medications -- defined as including pain relievers, tranquilizers, stimulants, or sedatives -among 18 to 25 year olds in the past month actually remained the same or declined slightly from 15 percent in 2007 to 14.8 percent in 2008.3 Still, this represents a significant increase in use from 1992 for this age group, and the rate is cause for some concern.

NIDA’s Monitoring the Future study, which collects data from 8th, 10th, and 12th graders, serves as an important indicator of the types of substance use issues that colleges and universities will soon inherit. According to that study’s 2009 data, non-medical use of the painkillers Vicodin® and Ocycotin® have increased over the past five years among 10th graders. Nearly 1 in 10 high school seniors reported non-medical use of Vicodin®; 1 in 20 reported abuse of OxyContin®. The same study indicates that more than 5 percent of 10th and 12th graders reported non-medical use of stimulants in the past year.9 The National Center for Addiction and Substance Abuse (CASA) suggests that the usage of these medications and other prescription drugs has tripled since 1992.10 A study conducted at Ohio State University in 2008 found that the reported use of nonprescribed drugs at least once per year was 9.2% for pain medications, 5.1% for sedatives, and 4.4% for stimulants11. The “Non-medical Use of Prescription Drugs Survey,” a collaboration between Ohio State’s Office of Student Life and College of Pharmacy, assessed both student use rates as well as perceptions about the prescription drug misuse of fellow classmates12.

Each of these substances, however, is used for wildly different reasons, and it is important to note that significant research into understanding these motives is limited. Most clear to researchers is the motivation for the nonmedical use of the stimulants Ritalin®, Concerta® and Adderall®, which are used primarily as “performance enhancers” for students, like the young woman featured in the opening blog, who desire improved focus or stamina to accomplish their academic work. A 2007 study at the University of Michigan found that 69% of respondents said that the drugs helped them to concentrate, and 67% said the drugs helped them study.13 A 2005 study, however, reported that most students were using Ritalin® for recreational purposes.14 Prescription Drug Abuse: Assessing the Risks and Issues Page 4    This contradiction may, in fact, represent a change in motivation over time. Data from studies dated 2005 and earlier indicate more students reporting recreational use of stimulants than studies conducted in 2007 through 2009. 13, 15 Although a meta-analysis has yet to be conducted across the studies, the differences appear to be significant. There is a belief among researchers, however, that motives may be mixed; the same students who use stimulants for performance enhancement may also be using these drugs to get high13.

A single study published in 2007 found that among students using opiods, 63% stated that the drug was used to relieve pain while 32% stated that they used the drug to get high.

Another 27% used it simply as experimentation, and 14% reported using the drug to help them sleep.16 No studies have been conducted to determine the motives for benzodiazepines, though there is anecdotal evidence that these drugs are more associated with suicide attempts than others.17 While a clear picture of misuse emerges from the data, less is known about the primary or secondary harms (harms to the individual user or to others impacted by the user) created by the non-medical use of prescription drugs across any population and particularly for college students. None of the studies report harms data, including addiction rates. The NSDUH reports percentage of 18 – 25 year-olds with substance dependency or abuse at 7.8 percent. The CORE Institute of Southern Illinois University and the Harvard College Alcohol Study relates primary and secondary harms to both alcohol and other drug use, but does not distinguish effect between substances, and most harm is attributed to alcohol by the authors. Without specific data of resulting harm, it is difficult at best to determine the scope of the “problem” surrounding the non-medical use of prescription drugs.

Of course, a variety of real harms do exist around the non-medical use of prescription drugs for college students, ranging from overdose and other adverse events to dependency.

When these medications are combined with alcohol, these effects can be even more devastating.

CASA, for example, reported in 2005 that controlled prescription drug-related visits to emergency departments have increased three and a half times more than heroin related visits and four times more than visits linked to cocaine abuse, although they do not specify the college population in that statistic.10 SAMHSA also reports a sharp increase in emergency room visits for benzodiazepine misuse or overuse.17 Prescription Drug Abuse: Assessing the Risks and Issues Page 5    Much more importantly, however, is the fact that students themselves do not see the nonmedical use of prescription drugs as potentially harmful. A study published in 2008 found that only 25% of the 1,253 undergraduates students studied at the University of Maryland perceived any harm in the use of stimulants, and only 28% perceived any risk from the use of analgesics.

Low perceived harmfulness and high sensation-seeking were independently associated with the increased risk of non-medical use of prescription drugs across all demographics. Conversely, high perceived harmfulness of non-medical prescription drug use proved to be a key protective factor in all groups except for high sensation-seekers, who maintained use despite their knowledge of harm18.

Non-Medical Drug Use in Perspective: Five Key Issues Making sense of these statistics, particularly for the purpose of developing effective policies and prevention programs, requires a bit of perspective. Five key issues emerge from the

data that are worthy of consideration:

1) The data represents a significant trend in self-diagnosis and self-medication.

As the more recent (though limited) motive data indicate, the use of prescription drugs by college students may more likely be an issue of self-medication than one of illicit recreation.

The very definition of non-medical prescription drug use as outside of medical supervision or for the purposes of a specific effect may very well be viewed as an issue of insufficient or undesired access to medical care for college students, who are clearly experiencing the effects of a highly competitive socioeconomic social system with inadequate coping skills.

More importantly, the data may suggest a much more disconcerting cultural trend captured by Critser in 2005 as “Generation Rx”. Certainly, our broader culture has become focused on symptom-alleviation and enamored by the science of biochemistry which promises that a pill or substance can resolve a vast array of problems, or at least delay their experience for a period of time. The data from these studies may not paint an accurate picture of prescription medication use as many students – like their adult counterparts – have learned the fine art of describing a set of symptoms to one or more doctors that is sure to lead to a prescription.

This is one of many facets of the problem that must be addressed both on campus, in the immediate community, and in broader society. Students, like many non-students, are “selfPrescription Drug Abuse: Assessing the Risks and Issues Page 6    diagnosing” their conditions and are enacting their newfound roles as medical consumers, usually with little training or guidance.

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