Non-medical use of prescription medications associated with drug abuse among college students

College students who take frequently abused medications without a prescription appear to have a higher risk for drug abuse than those who use such therapies for medical reasons, according to a report in the March issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

“Several studies have reported recent increases in the prescription rates of abusable medications in the United States, including stimulants, opioids and benzodiazepines,” the author writes as background information in the article. “These increases are likely the result of many factors, including improved awareness regarding the signs and symptoms of several disorders, increased duration of treatment, availability of new medications and increased marketing. The increases in prescription rates have raised public health concerns because of the abuse potential of these medications and high prevalence rates of non-medical use, abuse and dependence, especially among young adults 18 to 24 years of age.”

Sean Esteban McCabe, Ph.D., M.S.W., of the University of Michigan, Ann Arbor, assessed prescription drug use and potential drug abuse in a survey of 3,639 college students (average age 19.9 years). The survey asked whether the students had been prescribed or had used without a prescription four classes of prescription drugs—opioids, stimulants, sleeping aids and sedative or anxiety medications. Questions about whether the students had experienced drug-related problems (for instance, performing illegal activities to obtain drugs, having withdrawal symptoms or developing medical problems as a result of drug use) were used to screen them for drug abuse.

Most of the students (59.9 percent) reported having used at least one of the drugs with a prescription for medical reasons, while approximately one in five reportedly took them without a prescription for non-medical reasons. A total of 1,412 (39.7 percent) reported that they had used the drugs only by prescription; 156 (4.4 percent) were never prescribed any of the medications but had used them anyway; and 563 (15.8 percent) had used some of the medications both with and without a prescription.

Those who had reported that they used drugs without prescription—whether or not they had also used them for medical reasons—were more likely to screen positive for drug abuse than those who had used the drugs only for medical reasons or had never used them at all. There was no difference in the rate of positive screening between those who had reported using the drugs by prescription and those who reported never having taken them.

The findings have important implications for prescribing frequently abused drugs to college students, Dr. McCabe notes. “Clearly, appropriate diagnosis, treatment and therapeutic monitoring of college students who are receiving abusable prescription medications is crucial, not only to improve clinical outcomes but also to help prevent the abuse of these medications within a population that is largely responsible for its own medication management,” he concludes. “Finally, any efforts aimed at reducing non-medical use of prescription drugs will have to take into consideration that these drugs are highly effective and safe medications for most patients who use them as prescribed.”

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(Arch Pediatr Adolesc Med. 2008;162[3]:225-231. Available pre-embargo to the media at www. jamamedia.org.)

Editor’s Note: This study and the development of the manuscript were supported by research grants from the National Institute on Drug Abuse, National Institutes of Health, Bethesda, Md. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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