Prescriptions and Prevention
PHOENIX -- Judging by the turnout at a session on non-medical prescription drug use at the American College Health Association's annual conference here on Wednesday, the issue is one colleges are well aware of. But considering that research on the topic is only beginning to emerge, and that some major surveys of student drug use don't even inquire about prescription medicines, it is likely that most of those colleges aren't so well-equipped with prevention methods.
That's what Stacy Andes, director of health promotion at Villanova University, said in an interview after her presentation. "I think they're becoming more concerned," she said, while adding, "I think they're not measuring the problem to the extent that they need to be, so they're not implementing the prevention methods they need to."
Case in point: Core, the oft-referenced student health survey out of Southern Illinois University at Carbondale, does not ask about prescription drug use. (Not for much longer, though; the survey is being revised and the No. 1 request its authors have received is a question about these drugs, Andes said.) "We only have several years of data on this, so we're still collecting," Andes said. "There's a lot more that we need to know."
But there are some data available. The Monitoring the Future survey out of the University of Michigan expanded only last year to include use of prescription drugs other than Ritalin, and Adderall debuted with 7.9 percent of students reporting non-medical use of the drug annually (compared to 1.7 percent use of Ritalin). It came in second only to Vicodin. Oxycontin was a close third at 7.3 percent. And their use has been rising rapidly: multiple studies have found that the number of college students misusing prescription drugs increased fivefold from 1999 to 2005.
Prescription drugs occupy something of a gray area in the minds of students, research has shown. Their perceived level of danger -- medically and legally -- lies somewhere between that of the most risky, cocaine, and least risky, marijuana, and because they're generally used academically rather than socially, to focus in and buckle down on schoolwork, many students think of them more as "study aids" than as substances that can be abused.
There's a perception that "these are not drugs, this is medicine," said Ross Aikins, a co-presenter with Andes and graduating doctoral student at the University of California at Los Angeles education school, who is studying prescription stimulant use among college students. "They do not feel the legal consequences. It's very hard and very problematic from a prevention standpoint." So it's not surprising that prescription drug misuse is most common at Northeastern institutions with very competitive admissions standards.
Administrators struggle with these questions, too. Last year Wesleyan University took an unusual step in revising its student honor code to ban the misuse of prescription drugs, the implication being that to use such drugs would be cheating. (It is not at all uncommon, however, for such substances to be prohibited in student conduct codes, along with other drugs and alcohol.)
Regardless of the ethical questions surrounding misuse, research has repeatedly shown that there is not necessarily a positive correlation between stimulants like Adderall and high academic performance. One study cited Wednesday found that non-medical prescription drug users had "significantly lower" grade-point averages in high school and skipped 21 percent of their college classes. Users tend to have lower grades than their peers in college do, as well, and Andes's own research of students at four Northeastern universities found a "significantly positive relationship" between non-medical prescription drug use and negative academic performance.
Looking to examine motives and usage habits, Aikins conducted 53 interviews with students at an "elite West Coast university." He asked for "students using any kind of drug for school," but most of the respondents used stimulants. What they said reinforced the notion of "perceived self-efficacy": that certain prescription drugs can aid career trajectory, creativity and academic performance. (A sampling of student remarks: "When I first took it, it was amazing. It was incredible how well I studied." "It turned me from like a C+ paper to an A-, B+ paper." Another student spoke about an incredibly smart peer trying to get into medical school who became "literally dependent on Adderall.")
Despite their intentions, students who misuse prescribed medications are more likely than their peers to use illicit drugs. "[Researchers are] finding that connection over and over and over again," Andes said. "We see this intermingling of the illicit drug use, high-risk alcohol use and the prescription drug issue."
For instance, according to the most recent National Survey on Drug Use and Health, 80 percent of students who used Adderall non-medically in the past year also used marijuana. The same survey found that as of 2008, psychotherapeutics like stimulants and sedatives were the fourth most common drug of choice among 18- to 25-year-olds, with about 5 percent preferring them over alcohol, tobacco or marijuana.
To break it down further, most students (15 percent) who said they had used a drug not prescribed to them in the past year reported using more than one, according to the National College Health Assessment-II Annual Use Data. About 10 percent used painkillers; antidepressants, stimulants and sedatives were each used by about 5 percent of students. The researcher Alan DeSantis has found that stimulant use prevalence in Greek houses can be as high as 80 percent, perhaps because of their culture of helpfulness and resourcefulness -- not to mention the fact that white males are among those most likely to use that type of drug.
While students' largely nonchalant attitudes toward prescription drugs don't make for an ideal prevention climate, there is room for successful efforts, Andes and Aikins said. Comprehensive environmental efforts at Villanova and Ohio State Universities involve people on and off the campus: police, health and wellness centers, medical colleges and judicial affairs. And online resources like those at the University of Washington and the University of Southern California provide one-stop shopping for students and parents looking for information on prescription drugs, risks and what to do in emergencies.
The key -- as it always is in environmental prevention -- is knowing your campus, they said.
Colleges need to track student prescriptions and use -- medical and non-medical -- and consider how difficult the drugs are to obtain. They should also consider students' perceived benefits for usage, and how many drug incidents involve prescriptions. Strategies such as focus groups, research or capstone projects, first-year and senior surveys, and social networking sites can also provide insight into individual campus cultures. "It is so critical for you to really localize your problem to your campus," Andes said. "If your campus falls in a 2 percent rate you're not going to look the same as a campus that falls in the 25 percent rate."
As colleges ponder these strategies, prescription drugs become ever more common on campuses, Aikins told Inside Higher Ed. "Students are weighing the ethical pros and cons on their own, and overwhelmingly they're saying, 'I don't see anything wrong with that.' "
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