The national conversation about prescription drug abuse has college and university administrators trying to determine what exactly it means for their institutions. While many schools are well positioned to address alcohol abuse on campus, others are wondering about the best approach to addressing misuse and abuse of prescription drugs among their students. Some are focused on conversations about whether or not to provide Naloxone to students and staff (see: The Campus Debate Over Naloxone). There are also those who have chosen not to address it at all, taking the position that the issue has not yet become critical enough on their campus to warrant additional time and resources.
One of the central challenges to understanding which position to take on the issue is a lack of available college-specific data. Much of the research on the college population has focused on the why and how of prescription drug use. One study identified the impact that perceived harm has on use by finding that “most students associated occasional nonmedical use of prescription stimulants and/or analgesics with a high degree of harmfulness.” Other researchers have found that there is great disparity in college students’ level of use and perceived use among their peers. This research base has contributed to an understanding of the potential drivers of prescription drug misuse and how schools might consider addressing it (e.g., through social norms campaigns). But if a school doesn’t perceive this issue as problematic, then the why and how don’t matter.
So what is the extent of the problem on campuses? SAMHSA has historically provided helpful treatment center admissions data for those who started using substances between the ages of 18-24, but how that translates specifically to the college population is unclear. Popular college health surveys include some questions about illicit drug use, but only scratch the surface of what is needed in order to get a clear picture of what is happening on our campuses. Additionally, many schools have had to rely on anecdotal evidence collected via one-on-one interactions with students, including those who are referred for an alcohol or other drug policy violation. As we know of course, these individual perspectives are highly influenced by their proximate social networks, leading to what could potentially be significant misrepresentation of the extent of the problem, whether that be over- or under-estimating. But how can we know for sure?
The first step to solving any challenge is to understand how much of a challenge it is. Not doing so risks countless resources being directed at efforts that don’t address the true problem. Data from 20,000+ college students who have participated in Vector Solutions (formerly Everfi's Campus Prevention Network) Prescription Drug Abuse Prevention course has provided a helpful starting point for determining the impact of misuse and abuse of prescription medications on campus. According to our sample, 63% of students have used an opiate under a doctor’s order, and 24% have been prescribed a stimulant for ADHD or a related condition. While this makes “supply” greater for opioids, only 2% of students report misusing these drugs, while two and a half times as many students (5%) report misusing stimulants. This is consistent with data from the 2015 College Prescription Drug Study which identified the justifiable concern over opioid abuse – which is more likely to lead to addiction, overdose, and death – while recognizing that stimulants are being misused and abused at the greatest rate.
At the same time, these numbers underscore one of the reasons that many schools choose inaction: prescription drug misuse and abuse by students is far outweighed by the number of those who are misusing and abusing alcohol. Does this mean campuses should not be directing efforts at prescription drug prevention? Not at all. As noted previously, while there is a far lower percentage of students abusing prescription drugs compared to alcohol, the pharmacological risks associated with overdose (e.g., death, permanent brain damage) are much greater for illicit drug abuse than for alcohol. The dose of alcohol needed to cause pharmacological damage is considerable, while the effects of a single pill can be potentially life-altering. Applying the earlier referenced 2% prevalence rate of opiate misuse/abuse to a campus of 10,000 students translates to potentially 200 students with a greater risk of dying from opiate overdose than from alcohol poisoning.
This is not to say that we should set aside our alcohol prevention efforts. Instead, we need to find the necessary resources and support to incorporate appropriate strategies aimed at preventing prescription drug misuse and abuse alongside our current alcohol prevention programs. Shifting normative misperceptions is one of those opportunities. Vector's course data has identified some promising insights to help institutions craft messages that highlight the majority of students who have healthy attitudes and behaviors around prescription drug misuse and abuse. For example, 78% believe that it is their responsibility to help prevent prescription drug misuse at their institution, 88% would reach out to offer support to a friend who they suspect is abusing prescription drugs, and 90% believe that sharing medication can cause harm to themselves or someone else. Using social marketing campaigns that highlight positive and healthy attitudes also provides opportunities for institutions to incorporate information on campus and local resources.
For institutions that believe prescription drug misuse and abuse isn’t a problem on their campus, it is important to identify whether or not that is indeed the case. At the very least, schools should be asking students about their attitudes and beliefs and then leveraging whatever healthy norms are identified to ensure that it remains a “non-problem.” One area of research has made clear that in addition to the risk of overdose, misuse of opioid drugs in young adulthood can quickly transition to a substance use disorder; so for even the small number of students that indicate they are misusing these drugs, the stakes are incredibly high. Ultimately, even if prescription drug misuse and abuse is not considered a critical issue on your campus, let’s not lose sight of the fact that the whole idea of prevention is to ensure that it never becomes one.
For information on how to design an evidence-based prescription drug abuse prevention program, download the Campus Prevention Network’s Developing a Prescription Drug Prevention Strategy: Challenges and Considerations.