Elsevier

Addictive Behaviors

Volume 30, Issue 4, May 2005, Pages 789-805
Addictive Behaviors

Nonmedical use of prescription opioids among U.S. college students: Prevalence and correlates from a national survey

https://doi.org/10.1016/j.addbeh.2004.08.024Get rights and content

Abstract

Objectives

This study examined the prevalence rates and correlates of nonmedical use of prescription opioid analgesics among U.S. college students in terms of student and college characteristics.

Methods

This study analyzed data from a nationally representative sample of 10,904 randomly selected students attending 119 four-year colleges in 2001.

Results

The lifetime prevalence of nonmedical prescription opioid use was 12% and the past year prevalence was 7%. Approximately one in every four colleges had a prevalence of 10% or higher for past year nonmedical use of prescription opioids. Multivariate regression analyses indicated nonmedical use was more likely to occur among college students who were white, residents of fraternity and sorority houses, attended more competitive colleges, earned lower grade point averages, and reported higher rates of substance use and other risky behaviors.

Conclusions

This study provides evidence that the nonmedical use of prescription opioids represents a problem on college campuses. These findings have important implications for developing prevention efforts and therapeutic strategies aimed at reducing the nonmedical use of prescription opioid analgesics among college students while not hindering necessary medication management for pain.

Introduction

Prescription opioid analgesics are potent pain relievers that are efficacious when utilized in both acute and chronic pain related conditions (Savage, 2003). Yet, despite the medical necessity of prescription opioid analgesics, there is growing concern regarding the high abuse potential of these medications (Zacny et al., 2003). Indeed, several national studies and reports (e.g., Johnston et al., 2003a, Johnston et al., 2003b, Johnston et al., 2003c, SAMHSA, 2002a, SAMHSA, 2002b, SAMHSA, 2003a, SAMHSA, 2003b) as well as anecdotal case reports (e.g., Crowther, 1974, DeSio et al., 1993, Reynaud et al., 1998, Yewell et al., 2002) provide strong evidence that the nonmedical use and abuse of prescription opioids represents an increasing problem among young adults and college students in the United States. The Monitoring the Future (MTF) study reported that the nonmedical use of many prescription opioids by college students and other young adults aged 18–22 is now at its highest level in the past two decades (Johnston et al., 2003a, Johnston et al., 2003b, Johnston et al., 2003c).

Currently, approximately 1 in every 10 Americans between the ages of 18 and 25 report the nonmedical use of opiate analgesics in the past year (Johnston et al., 2003a, SAMHSA, 2002a). Among four different classes of psychotherapeutic drugs (opioid analgesics, tranquilizers, stimulants, and sedatives), opioid analgesics was the class with the greatest nonmedical use, abuse, and dependence according to the 2001 National Household Survey on Drug Abuse (NHSDA) (Zacny et al., 2003). The NHSDA incidence data revealed a fourfold increase in the overall nonmedical use of prescription opioids in the past two decades. In particular, more than two million individuals in the United States aged 12 or older initiated nonmedical use of opioid analgesics for the first time in 2000; this is in contrast to only 400,000 annual initiators in the mid-1980s. Within those aged 18–25 years, there were statistically significant increases in the lifetime nonmedical use of a variety of opioid analgesics between 2000 and 2001 (e.g., hydrocodone, morphine, and oxycodone) (SAMHSA, 2002b).

National studies of college students have reported increases in the nonmedical use of prescription opioid analgesics; The Harvard School of Public Health College Alcohol Study (CAS) reported an increase in the nonmedical use of opioid-type drugs in the past decade (Gledhill-Hoyt et al., 2000, Mohler-Kuo et al., 2003) and the MTF study found an appreciable increase over the past two decades in the nonmedical use of opioid analgesics among high school seniors and college students (Johnston et al., 2003a, Johnston et al., 2003b, Johnston et al., 2003c). Table 1 illustrates the databases used to determine recent national prevalence rates of nonmedical use of prescription opioid analgesics among college students and young adults.

While these national reports clearly provide valuable information regarding the prevalence of this form of drug abuse, unfortunately, they offer a limited understanding of the risk factors associated with the nonmedical use of opioid analgesics on college campuses. Information concerning the prevalence of nonmedical use of prescription opioid analgesics at individual colleges or universities remains very limited as compared to what is known about heavy drinking and other drug use behaviors (Gledhill-Hoyt et al., 2000, Johnston et al., 2003a, O'Malley & Johnston, 2002, Strote et al., 2002, Wechsler et al., 2002). While the national prevalence of heavy drinking among college students has remained steady for the past decade, the nonmedical use of prescription opioid analgesics has increased significantly among college students (Gledhill-Hoyt et al., 2000, Johnston et al., 2003a, Mohler-Kuo et al., 2003). Little epidemiological research exists that accurately assesses the characteristics of those individuals most at risk for nonmedical use of prescription opioid analgesics (Zacny et al., 2003).

Anecdotal case reports also documented the nonmedical use of prescription opioid medications in the United States among college student and young adult populations (e.g., Crowther, 1974, DeSio et al., 1993, Reynaud et al., 1998, Yewell et al., 2002). As early as the mid-1970s, Crowther (1974) reported on the nonmedical use of opioid analgesics in college populations, and more recently, DeSio et al. (1993) noted that the fentanyl patch was being abused intravenously. Anecdotal case reports illustrate the severe consequences that can occur among young adults. For example, the harmful consequences from the intranasal abuse of prescription opioid analgesics, including hydrocone, codeine, oxycodone, and methadone, have been reported in a case series of five patients (Yewell et al., 2002). The Drug Abuse Warning Network (DAWN) data also suggest that there are harmful consequences associated with the nonmedical use of prescription opioid analgesics (SAMHSA, 2003a). For instance, DAWN data indicate that the overall mention of opioid analgesics/combinations by Emergency Departments (EDs) significantly increased from 1995 to 2002 (163%). Emergency department visits naming hydrocodone/combinations increased 160% in 2002 and hydrocodone/combinations were the most commonly named pain reliever/s reported to DAWN (SAMHSA, 2003a). These anecdotal case reports and surveillance data provide valuable information about the potential risks associated with the nonmedical use of opioid analgesics but provide little specific information about what subpopulations are at the greatest risk for the nonmedical use of opioid analgesics.

If health professionals are to develop evidence-based prevention and treatment practices to reduce the nonmedical use of opioid analgesics, it is apparent that more information about this abuse problem is needed (Zacny et al., 2003). To date, there have been no studies that have examined the risk factors associated with the nonmedical use of prescription opioid analgesics within a nationally representative sample of college students. Thus, the purpose of the present study was: (1) to assess the prevalence of nonmedical use of prescription opioid analgesics within a large representative sample of college students and (2) determine the factors associated with nonmedical use in terms of student and college characteristics and other substance use behaviors.

Section snippets

Study population and data collection

The present study used data from the 2001 CAS of 119 American four-year colleges and universities in 40 states. An administrator from each college or university provided a random sample of 215 college students. One school was excluded because the response rate was considerably lower than the other 119 schools. A total of 10,904 students returned questionnaires, yielding an overall response rate of approximately 52% (range 22%–86%). Response rate was not associated with the main outcome variable

Prevalence of nonmedical use

Approximately 12% of college students reported lifetime nonmedical use of prescription opioid analgesics, 7% reported nonmedical use in the past year, and 3% reported nonmedical use in the past month. As illustrated in Table 2, according to bivariate analyses, the past year prevalence of nonmedical use of prescription opioid analgesics differed significantly as a function of race/ethnicity, living arrangement, and grade point average. Gender, age, fraternity/sorority membership, and parental

Discussion

The prevalence rates of nonmedical use of prescription opioid analgesics in the present study were slightly higher than prevalence rates based on 2001 MTF results of college students nationally (Johnston et al., 2003a), but lower than American young adults ages 18–25 according to the 2001 NHSDA results (SAMHSA, 2002a). The different prevalence rates between the present study and other national studies can be partially attributed to differences in survey modes, question wording, and study

Acknowledgements

The College Alcohol Study data were collected under a research grant from the Robert Wood Johnson Foundation. The authors would like to thank Jeff Hansen and Mark Seibring for their assistance in preparation of the data. The authors would like to thank Meichun Kuo, Hannah d'Arcy, and Brady West for their consultation in analyzing the data. The authors would like to thank the students and college personnel for their participation in the study.

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