Trends in medical use, diversion, and nonmedical use of prescription medications among college students from 2003 to 2013: Connecting the dots
Introduction
Although several studies have reported recent increases in the prescribing of controlled medications (e.g., sedative/anxiety, opioid, sleeping, stimulant) among children, adolescents and young adults in the United States (Fortuna et al., 2010, Thomas et al., 2006, Zuvekas and Vitiello, 2012), there is a lacuna of knowledge regarding recent trends in medical use of controlled medications among college students in the United States, and related behaviors such as diversion and nonmedical use. And once medical users divert (e.g., sell, trade, or give away) their own medications to peers, these medical users create nonmedical users (e.g. a person who uses controlled medications without their own prescription). In this way, medical use, diversion and nonmedical use of prescription medications are inter-related behaviors, especially among adolescents and young adults who rely primarily on their peers as sources of diversion for nonmedical use (Arria et al., 2008, Arria and DuPont, 2010, Johnston et al., 2013, McCabe et al., 2011).
Analyzing data from the Monitoring the Future (MTF) study, Johnston, O'Malley, Bachman and Schulenberg (2013) examined the trends in nonmedical use of prescription medications among college students and found evidence of significant changes over the past decade. However, the MTF study does not report trends in diversion and medical useamong college students, and study measures for nonmedical use changed over time, combining “street” drugs in some prescription categories. For example, the MTF study introduced new medications (e.g. Adderall® in 2007) and included “street” drugs (e.g. crystal methamphetamine) in the same question with prescription amphetamines (e.g. Ritalin®). As a result, trends in nonmedical use of prescription medications among college students over the past decade that are estimated using the MTF data are difficult to interpret. The National Epidemiologic Survey on Alcohol and Related Conditions and the National Survey on Drug Use and Health both suffer from similar measurement limitations (Boyd and McCabe, 2008, Hubbard et al., 1992).
The past-year prevalence of nonmedical use of prescription medications increased significantly between 1993 and 2001 among U.S. college students and varied considerably between individual U.S. colleges (McCabe, Teter, Boyd, Knight and Wechsler, 2005, McCabe, West and Wechsler, 2007, McCabe et al., 2011). For example, College Alcohol Survey (CAS) data collected from 10,904 college students who were randomly selected from a nationally representative sample of 119 U.S. colleges in 2001 revealed that the past-year prevalence rates of nonmedical use of prescription medications (i.e., sedative/anxiety, opioid, sleeping, and stimulant) ranged from zero percent at the lowest use schools to 31% at the highest use school (McCabe et al., 2011). Unfortunately, the CAS did not contain measures of diversion and medical use of prescription medications and has not collected data recently.
Although previous college-based cross-sectional regional and national studies indicate that the nonmedical use of prescription medications is generally more prevalent among males, Whites, members of social fraternities and sororities, and those with a lifetime history of medical use of prescription medications (Johnston et al., 2013, McCabe, 2008a, McCabe, 2008b, McCabe, Cranford, Boyd and Teter, 2007, McCabe, Schulenberg, et al., 2005, McCabe, Teter, Boyd, Knight and Wechsler, 2005), it remains unknown whether these characteristics remain significantly associated with nonmedical use of prescription medications over time. The main objectives of the present study were to 1) examine the trends in lifetime and past-year prevalence of medical use, diversion, and nonmedical use of prescription medications between 2003 and 2013 among college students; and 2) identify demographic and background characteristics associated with trends in nonmedical use of prescription medications between 2003 and 2013.
Section snippets
Data collection
After receiving Institutional Review Board approval [H03-00002776-R2], the College Student Life Survey (CSLS) was conducted during a one-month period, drawing on the total undergraduate population of full-time students attending a large public research university located in the Midwest United States in the winter semesters of the 2003 (N = 21,294), 2005 (N = 20,138), 2007 (N = 25,555), 2009 (24,574), 2011 (N = 25,874) and 2013 (N = 26,156) school years. A simple random sample of full-time students was
Trends in prevalence and frequency of nonmedical use of prescription medications
As illustrated by Table 2, we examined the trends in lifetime and past-year prevalence of nonmedical use of prescription medications between 2003 and 2013. There was evidence of a non-linear trend in the estimated lifetime prevalence of non-medical use of any prescription medications, marked by a general decrease from 2003 to 2009 and then an increase from 2009 to 2013. The estimated lifetime and past-year prevalence of nonmedical use of prescription stimulants increased significantly between
Discussion
The present study represents the first investigation to demonstrate that the changes in medical use of prescription medications appear to mirror similar changes in the diversion and nonmedical use of prescription medications among college students. More specifically, increases over the past decade in the past-year medical use of prescription stimulants to treat ADHD (1.9% in 2003 to 4.7% in 2013) appear to parallel similar increases in the past-year diversion and nonmedical use of prescription
Role of funding sources
The development of this manuscript was supported by research grants R01DA024678 and R01DA031160 from the National Institute on Drug Abuse, National Institutes of Health. The National Institute on Drug Abuse, National Institutes of Health had no role in the study design, collection, analysis or interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the
Contributors
SEM and CJB developed the original survey. SEM conceived the original idea for the study and drafted the introduction and discussion sections. SEM and CJT jointly conducted the literature review. BTW conducted all of the data analyses and interpretation. SEM and BTW jointly drafted the methods and results sections. All authors contributed to and have approved the final manuscript.
Conflict of interest
There are no conflicts of interest by any author.
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