Cognitive enhancement drug use among medical students and concerns about medical student well-being

Popping smart pills in medical school: Are competition and stress associated with the misuse of prescription stimulants among students?

BACKGROUND

There has been increasing attention in both popular and scientific circles to the misuse of prescription stimulants by students. However, it is unclear which student groups are most vulnerable and what environmental factors could influence this misuse. Medical students might be more at risk because of high levels of competition and related stress in medical school, making them a relevant population to explore these interrelationships.

OBJECTIVES

This study aims to answer two research questions: (1) Does competition lead to higher stress and greater likelihood of misuse? and (2) Do the levels of and interrelationships between competition, stress and misuse vary between students with different post-graduate aspirations?

METHODS

In total, 3159 Flemish medical students (48.99% response rate) participated anonymously in a 2016 questionnaire on stimulants. Misuse was defined as use to enhance study performance, but not as part of an applicable treatment. We performed (multiple group) structural equation modeling to answer the research questions.

RESULTS

Results indicate significant associations between competition, stress and misuse: the higher the perception of medical school as being competitive, the higher the stress level and the more likely the misuse. Against our expectations, the association between competition and stress was significantly stronger for future general practitioners (GPs) compared to future specialists.

CONCLUSION

The competitive climate in medical school creates high stress levels, rendering students vulnerable to misuse of stimulants. Students need to be educated about how to cope with stress in a non-pharmaceutical way, making them more resilient to stress during studentship and in their future careers.

Gender differences in substance use and psychiatric distress among medical students: A comprehensive statewide evaluation

BACKGROUND

Medical student wellness has emerged as an important issue in medical education. The purpose of the present study was to obtain a comprehensive assessment of substance use, psychological distress, and help-seeking among male and female medical students in order to identify targets for continued intervention efforts.

METHODS

Medical students from all 9 medical schools in the state of Florida were invited via e-mail and/or announcements to complete an anonymous online questionnaire assessing their well-being. Of 5053 matriculating medical students, 1137 (57.1% female) responded to the questionnaire. Descriptive statistics, t tests, and chi-square analyses were computed using SPSS 20.

RESULTS

Over 70% of students acknowledged binge drinking, with men reporting higher frequency than women (χ² = 13.90, P = .003), and 22.7% (n = 201) reported marijuana use during medical school, with higher rates (χ² = 9.50, P = .02) among men (27.0%, n = 99) than women (18.9%, n = 93). A significant minority of students reported nonmedical use of prescription stimulants and prescription opioids. In addition, 3.3% of male students (n = 12) compared with 0.6% of female students (n = 3) reported problematic drug use. Further, almost 2/3 of respondents reported decreased psychological health since beginning medical school, with women noting greater reductions (χ² = 12.39, P = .05) and higher levels of stress (χ² = 16.30, P = .003). Over 10% of students (n = 102) endorsed "thoughts of committing suicide" during medical school, and 70.1% felt they would benefit from mental healthcare (79.3% of women vs. 59.6% of men; χ² = 41.94, P < .001), although only 39.8% accessed help.

CONCLUSIONS

Despite efforts to address medical student wellness, students continue to report concerning levels of psychological distress, suicidal ideation, and substance use. More work is needed to effectively address medical student mental health and well-being.

Everyday drug diversions: a qualitative study of the illicit exchange and non-medical use of prescription stimulants on a university campus

This article investigates everyday experiences and practises that are associated with processes of pharmaceuticalization and with practices of 'drug diversion'--that is, the illicit exchange and non-medical use of prescription drugs. It reports results from a qualitative study that was designed to examine the everyday dimensions of non-medical prescription stimulant use among students on an American university campus, which involved 38 semi-structured interviews with individuals who used prescription stimulants as a means of improving academic performance. While discussions of drug diversion are often framed in terms of broad, population-level patterns and demographic trends, the present analysis provides a complementary sociocultural perspective that is attuned to the local and everyday phenomena. Results are reported in relation to the acquisition of supplies of medications intended for nonmedical use. An analysis is provided which identifies four different sources of diverted medications (friends; family members; black-market vendors; deceived clinicians), and describes particular sets of understandings, practices and experiences that arise in relation to each different source. Findings suggest that at the level of everyday experience and practice, the phenomenon of prescription stimulant diversion is characterised by a significant degree of complexity and heterogeneity.