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«Gregory Eells, PhD, Director Counseling & Psychological Services Associate Director, Gannett Health Service Cornell University Paper Presented at the ...»

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One access policy approach that has been adopted at campuses across the country is the prohibition of campus health centers to fill pre-existing prescriptions for commonly misused drugs from an off-campus physician. While this may limit some access for students, the policy may actually increase the sale or provision of drugs by fellow students. A more appropriate policy may be to insist that each prescription refill request be filled only after a physician’s approval, verified by an appointment between the doctor and student.

Encouraging students to maintain contact with a local or campus health clinic physician can both ensure the student’s medical needs are addressed while also providing tracking for prescription abuses.29 Several campuses have begun communicating to students about protecting their prescription medications by storing those substances in a locked compartment. This message, combined with messages about sales and provision, communicates to students a sense of community standards about non-medical prescription drug use, and when combined with appropriate education and appropriate enforcement and adjudication, send a clear message about non-medical prescription drug use on campus.

2) Brief intervention on prescription drug use by medical, judicial, housing and Greek Affairs staff Brief intervention strategies have proven to be a successful approach to addressing substance use in general30, and a variety of approaches have been taken to raise student awareness of potential substance use issues and to connect students to appropriate campus staff for assistance. On-line and in-person brief intervention systems are being actively used for alcohol and marijuana31, and other illicit drug use and are being developed for prescription drug use as well, but these programs have been designed to build student Prescription Drug Abuse: Assessing the Risks and Issues Page 13    awareness around recreational use. Critical to individual intervention in non-medical drug use is enabling students to connect a set of self-diagnosed symptoms to trained medical care.

This is best accomplished through standardized brief intervention and screenings where campus health care services, local clinic, and emergency room staff and physicians discuss potential substance use issues with students who come for reasons ranging from the flu to other illnesses or injuries. There is good evidence that these programs can be successful for prescription drug use.32-34 It is plausible that, despite the use of a prescription drug to increase concentration, an 18 to 20 year-old student may not recognize the lack of focus as a medical issue that can be accurately diagnosed and treated, or the chronic pain or lack of appetite control as a symptom of an underlying medical problem. Having clinic staff ask specific and pointed questions about self-treatment through non-prescribed medications, and then offering help in identifying the problem and treating it medically, holds promise in changing current behavior for the 7 – 10% of students engaged in this practice.35

3) Social norms correction education across campus Several campuses have added social norm marketing programs around prescription drugs to change student misperceptions that a majority of students are engaged in non-medical use.11 These programs are identical to the alcohol-related social norms programs that have been popular and effective on college campuses for more than a decade.36 In social norms marketing, students are exposed to actual rates of use or attitudes regarding prescription drug misuse. The strategy is most effective when the information used is from fellow students, the message dosing is consistent and comprehensive, and the messages are co-created by students. Norms programs are relatively inexpensive and have shown success in reducing student misperceptions about non-prescription drug abuse.37 The Ohio State University provides a model of a cooperative, comprehensive program that addresses the issue, though it remains to be seen if the effort can yield reductions in use across key populations. Titled the “Generation Rx Initiative,” the program was created by a grant to OSU’s College of Pharmacy, which has cooperative relationships campus wide across academic and student affairs units. The program reaches beyond the campus and includes education and outreach to elementary, middle, and high school populations as well as the general Prescription Drug Abuse: Assessing the Risks and Issues Page 14    community. The program combines social norms marketing, policy development, peer education, consistent student data collection, and research.27 Ultimately, any campus effort to address and reduce non-medical prescription drug use will need to also challenge the broader social and cultural beliefs that make up Generation Rx.

Institutions of Higher Education, however, have as their core mission the improvement of society, and in this case, such efforts are truly self-serving. National attitudes concerning tobacco use and alcohol abuse, particularly drunk driving, have been changed in part by college and university attention to the issues on their own campuses. Evaluations of environmental alcohol programs at campus-communities across the United States have shown that the simplest and perhaps most important action that can be taken is to increase community attention to the issue. 38 Discussion in a variety of contexts and setting across campus and the surrounding community is an essential first step.


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7.  The NSDUH Report: Trends in nonmedical use of prescription pain relievers: 2002 ‐ 2007.  Rockville, MD: Substance Abuse and Mental Health Services Administration , Office of Applied  Studies; February 5, 2009. 

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13.  Teter C, McCabe S, Cranford J, Boyd C, Guthrie S. Prevalence and motives for illicit use of  prescription stimulants in an undergraduate student sample. Journal of American College  Health. 2005;53(6):253‐262. 

14.  Barrett S, Darredeau C, Bordy L, Phil R. Characteristics of methyphenidate misuse in a university  student sample. Canadian Journal of Psychiatry. 2005;50(8):457‐461. 

15.  DeSantis A, Webb E, Noar S. Illicit use of prescription ADHD medications on a college campus: A  multimethodlogical approach. Journal of American College Health. 2008;57(3):315‐323. 

16.  McCabe S, Cranford J, Boyd C, Teter C. Motives, diversion and routes of administration  associated with nonmedical use of prescription opiods. Addictive Behaviors. 2007;32:562‐575. 

17.  Demographic characteristics of benzodiazepine‐involved ED visits: Substance Abuse and Mental  Health Services Administration, Office of Applied Studies; 2004. 

18.  Arria AM, Caldeira KM, Vincent KB, O'Grady KE, Wish ED. Perceived harmfulness predicts  nonmedical use of prescription drugs among college students: Interactions with sensation  seeking. Prevention Science. 2008;9(3):191‐201. 

19.  Gusfield JR. Contested meanings: The construction of alcohol problems. Madison, WI: University  of Wisconsin Press; 1996. 

20.  Hamilton C, Collins J. The role of alcohol in wife beating and child abuse: A review of the  literature. In: Collins J, ed. Drinking and crime: Perspectives on the relationship between alcohol  consumption and criminal behavior. London and New York: Tavistock; 1981:253‐287. 

21.  Rudgley R. Essential substances: A cultural history of intoxicants in society. New York: Kodansha  Globe; 1995. 

22.  Bernstein E. New addiction on campus: Raiding the medicine cabinet. The Wall Street Journal.  Monday March 24, 2008, 2008. 

23.  Schafer J. Down on the pharm, again. Slate. March 25, 2008. Available at:  http://www.slate.com/id/2187384/. 

24.  Lyng S, ed. Edgework: The sociology of risk‐taking. New York: Routledge; 2004. 

25.  Workman TA. To the edge and back again: Edgework and collegiate drug use. In: Chapman R, ed.  Collegiate drug use: A new look at an old problem. Glassboro, NJ: Rowan University Center for  Addiction Studies; 2009:24‐48. 

26.  McCabe SE. Misperceptions of non‐medical prescription drug use: A web survey of college  students. Addictive Behaviors. 2008;33(5):713‐724. 

27.  Kennedy‐Phillips L, Boehm C, Athas C. The "Pharming Phenomenon": The non‐medical use of  prescription drugs. NASPA Alcohol Prevention and Intervention Strategies Conference. New  Orleans, LA; 2010. 

28.  LaMastro V. Prevention strategies for prescription and other drugs on college campuses. In:  Chapman R, ed. Collegiate drug use: A new look at an old problem. Glassboro, NJ: Rowan  University Center for Addiction Studies; 2009:78‐92. 

29.  Bullman WR, Beatty S, Kweik N, Cable G, Hale K. Generation Rx, the abuse of medications, and  the Ohio Pharmacists Association. Annual  Conference of the Ohio Pharmacists Association.  Prescription Drug Abuse: Assessing the Risks and Issues Page 16   

30.  Moukaddam N. Alcohol/drug screening and brief intervention: Advances in evidence‐based  practice. Addictive Disorders and Their Treatment. 2009;8(2):116‐117. 

31.  Baer JS, Kivlahan D, Blume A, McKnight P, Marlatt G. Brief intervention for heavy drinking  college students: 4‐year follow‐up and natural history. American Journal of Public Health.  2001;91(8):1310‐1316. 

32.  Otto C, Crackau B, Lohrmann I, et al. Brief intervention in general hospital for problematic  prescription drug use: 12‐month outcome. Drug and Alcohol Dependence. 2009;105(3):221‐226. 

33.  Zahradnik A, Otto C, Crackau B, et al. Randomized controlled trial of a brief intervention for  problematic prescription drug use in non‐treatment‐seeking patients. Addiction.  2009;104(1):109‐117. 

34.  Cunningham R, Bernstein S, Walton M, et al. Alcohol, tobacco, and other drugs: future directions  for screening and intervention in the emergency room department. Academic Emergency  Medicine: Official Journal Of The Society For Academic Emergency Medicine. 2009;16(11):1078‐


35.  McCabe S, Boyd C, Cranford J, Morales M, Slayden J. Screening for Drug Abuse Among Medical  and Nonmedical Users of Prescription Drugs in a Probability Sample of College Students. Arch  Pediatrics and Adolescent Medicine. 2008;162(3):225‐231. 

36.  Perkins H. Social norms and the prevention of alcohol misuse in collegiate contexts. Journal of  studies on alcohol. 2002;Supplement No. 14:165‐172. 

37.  Martens M, Page J, Mowry E. Differences between actual and perceived student norms: An  examination of alcohol use, drug use, and sexual behavior. Journal of American College Health.  2006;54(5):295‐300. 

38.  A matter of degree initiative to reduce binge drinking at college and universities: Lessons  learned: The National Program Office of a Matter of Degree at the American Medical  Association; 2008.   

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