Trends in medical use, diversion, and nonmedical use of prescription medications among college students from 2003 to 2013: Connecting the dots

Attention-Deficit Hyperactivity Disorder Stimulant Therapy and Prescription Drug Misuse During Transition to Young Adulthood

OBJECTIVE

Limited prospective data exist about the impact of stimulant therapy for attention-deficit hyperactivity disorder (ADHD) during adolescence on the risk for later prescription drug misuse (PDM; i.e., of benzodiazepines, opioids, and stimulants).

METHODS

National longitudinal multicohort panels (baseline cohort years 2005-2017) of U.S. 12th grade students (N=11,066; ages 17 and 18 years) from the Monitoring the Future study were surveyed via self-administered questionnaires and followed up biennially during young adulthood (ages 19-24). A multivariable analysis was used to assess whether adolescents' lifetime history of stimulant therapy for ADHD was associated with subsequent PDM.

RESULTS

Overall, 9.9% of adolescents reported lifetime stimulant therapy for ADHD at ages 17 and 18. No significant differences were found in the adjusted odds of later incidence or prevalence of past-year PDM during young adulthood between adolescents with lifetime stimulant therapy and adolescents with no stimulant therapy. Over the 5-year follow-up, past-year PDM during young adulthood was most prevalent among adolescents who reported both stimulant therapy and prescription stimulant misuse (53.1%) and those who reported prescription stimulant misuse only (51.5%). Compared with adolescents in a control group without lifetime stimulant therapy or misuse, adolescents reporting prescription stimulant misuse had significantly higher adjusted odds of later incidence and prevalence of PDM during young adulthood.

CONCLUSIONS

Adolescents' stimulant therapy for ADHD was not significantly associated with increased risk for later PDM during young adulthood. In contrast, adolescents' misuse of prescription stimulants strongly predicted later PDM. Monitoring adolescents for prescription stimulant misuse may help identify and mitigate the risk for future PDM.

Alcohol withdrawal and amphetamine co-use in an animal model for attention deficit hyperactivity disorder

Background: Non-medical use of amphetamine and other stimulants prescribed for treatment of attention deficit/hyperactivity disorder (ADHD) is of special concern when combined with alcohol consumption. In a previous study, we modeled chronic ethanol-amphetamine co-use in adolescent Long-Evans (LE) rats and provided evidence that amphetamine attenuates alcohol withdrawal symptoms.Objectives: This project modeled co-use of amphetamine with alcohol in adolescents with ADHD-like symptoms by examining ethanol-amphetamine administration in adolescent Spontaneously Hypertensive Rats (SHR), an experimental model for the study of ADHD. Withdrawal symptoms were compared among SHR and two control rat strains, LE and Wistar Kyoto (WKY).Methods: At postnatal day 32, parallel groups of 12-24 male SHR, WKY and LE rats were administered a liquid diet containing ethanol (3.6%) and/or amphetamine (20 mg/L). Following administration periods up to 26 days, rats were withdrawn from their treatment and tested for overall severity of alcohol withdrawal symptoms, general locomotor activity, and anxiety-like behavior.Results: Overall withdrawal severity was lower for SHR than for LE (p < .001) or WKY (p = .027). Co-consumption of amphetamine decreased withdrawal severity for LE (p = .033) and WKY (p = .011) but not SHR (p = .600). Only WKY showed increased anxiety-like behavior during withdrawal (p = .031), but not after amphetamine co-administration (p = .832).Conclusion: Alcohol withdrawal severity may be attenuated when co-used with amphetamine. However, as a model for ADHD, SHR adolescents appeared resistant to developing significant signs of alcohol withdrawal following alcohol consumption. Whether alcohol withdrawal symptoms are attenuated or absent, potential consequences could include a decreased awareness of an emerging problem with alcohol use.

Pharmacotherapy for ADHD in children and adolescents: A summary and overview of different European guidelines

Attention deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention, hyperactivity, and impulsivity. It is the most common neurodevelopmental disorder presenting to pediatric services, and pediatricians are often involved in the early assessment, diagnosis, and treatment of children with ADHD. The treatment of ADHD typically involves a multimodal approach that encompasses a combination of psychoeducation, parent/teacher training, psychosocial/psychotherapeutic interventions, and pharmacotherapy. Concerning pharmacotherapy, guidelines vary in drug choice and sequencing, with psychostimulants, such as methylphenidate and (lis)dexamfetamine, generally being the favored initial treatment. Alternatives include atomoxetine and guanfacine. Pharmacotherapy has been proven effective, but close follow-up focusing on physical growth, cardiovascular monitoring, and the surveillance of potential side effects including tics, mood fluctuations, and psychotic symptoms, is essential. This paper presents an overview of current pharmacological treatment options for ADHD and explores disparities in treatment guidelines across different European countries.   Conclusion: Pharmacological treatment options for ADHD in children and adolescents are effective and generally well-tolerated. Pharmacotherapy for ADHD is always part of a multimodal approach. While there is a considerable consensus among European guidelines on pharmacotherapy for ADHD, notable differences exist, particularly concerning the selection and sequencing of various medications. What is Known: • There is a significant base of evidence for pharmacological treatment for ADHD in children and adolescents. • Pediatricians are often involved in assessment, diagnosis and management of children with ADHD. What is New: • Our overview of different European guidelines reveals significant agreement in the context of pharmacotherapy for ADHD in children and adolescents. • Discrepancies exist primarily in terms of selection and sequencing of different medications.

College Students' prescription drug misuse over time and links with their mental health and well-being

Prescription drug misuse (PDM) is a mounting public health concern in the U.S., particularly among college students. The field's reliance on cross-sectional designs and limited controls for other substance use has failed to capture the specific role of misuse for longer-term health. Therefore, the present study tested associations between trajectories of PDM problems and college students' mental health and subjective happiness over time. Participants were 300 students who completed a baseline assessment (T1) and follow-ups every 6 months for two years (T2-T5). Participants self-reported problems associated with PDM and mental health. Results from univariate latent growth models indicated that problems with PDM were initially on an increasing trajectory. Based on parallel process models, problems with PDM were concurrently associated with higher levels of depressive symptoms, disinhibition, callousness/aggression, and lower levels of subjective happiness at T1. Further, we found support for parallel trajectories between PDM problems and both depressive symptoms and general disinhibition. Participants whose PDM problems were on an increasing (worsening) trajectory at baseline showed an increase in depressive symptoms and general disinhibition over the next two years. Participants whose PDM problems accelerated over time (got worse at a faster and faster rate over time) also showed a significant increase in their depressive symptoms over time. Most findings, however, were no longer statistically significant in sensitivity analyses that controlled for alcohol and other drug problems. Findings highlight college as an important time for interventions to prevent substance use and its associated negative consequence on later young adult mental health.

Is age of onset and duration of stimulant therapy for ADHD associated with cocaine, methamphetamine, and prescription stimulant misuse?

BACKGROUND

To assess whether age of onset and duration of stimulant therapy for attention-deficit/hyperactivity disorder (ADHD) are associated with cocaine, methamphetamine, and prescription stimulant misuse during adolescence.

METHODS

Nationally representative samples of US 10th and 12th grade students (N = 150,395) from the Monitoring the Future study were surveyed via self-administered questionnaires from 16 annual surveys (2005-2020).

RESULTS

An estimated 8.2% of youth received stimulant therapy for ADHD during their lifetime (n = 10,937). More than one in 10 of all youth reported past-year prescription stimulant misuse (10.4%)-past-year cocaine (4.4%) and methamphetamine (2.0%) use were less prevalent. Youth who initiated early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years) did not have significantly increased adjusted odds of cocaine or methamphetamine use relative to population controls (ie, non-ADHD and unmedicated ADHD youth). Youth who initiated late stimulant therapy for ADHD (≥10 years old) and for short duration (<1 year) had significantly higher odds of past-year cocaine or prescription stimulant misuse in adolescence than those initiating early stimulant therapy for ADHD (≤9 years old) and for long duration (≥6 years). Youth who initiated late stimulant therapy for ADHD (≥10 years) for short duration (<1 year) had significantly higher odds of past-year cocaine, methamphetamine, and prescription stimulant misuse versus population controls during adolescence. No differences in past-year cocaine, methamphetamine, and prescription stimulant misuse were found between individuals who only used non-stimulant therapy for ADHD relative to youth who initiated early stimulant therapy (≤9 years old) and for long duration (≥6 years).

CONCLUSIONS

An inverse relationship was found between years of stimulant therapy and illicit and prescription stimulant misuse. Adolescents with later initiation and/or shorter duration of stimulant treatment for ADHD should be monitored for potential illicit and prescription stimulant misuse.

Expectancy for Adderall influences subjective mood and drug effects regardless of concurrent caffeine ingestion: A randomized controlled trial

RATIONALE

Nonmedical prescription stimulant use (NPS; use without a prescription or in ways other than prescribed) is common among college students. Despite the potential for negative consequences, students continue engaging in NPS for cognitive enhancement purposes, which may be maintained by expectancy and placebo effects.

OBJECTIVES

This study examined if a placebo administered under the guise of Adderall influenced subjective mood/drug effects and cognitive performance. Furthermore, this study examined if concurrent caffeine ingestion incrementally enhanced Adderall-related placebo effects.

METHODS

Undergraduate students with features that put them at elevated risk for NPS (N = 121) completed measures of mood and drug effects and cognitive assessments on two separate laboratory visits in this parallel randomized controlled trial. Visit 1 was a baseline control visit, on which no drug was expected or received. On visit 2, subjects were randomized to: (1) expect/receive no drug (control); (2) expect Adderall/receive placebo; or (3) expect Adderall/receive 200 mg caffeine.

RESULTS

There were several significant condition × visit interactions for subjective effects, including amphetamine effects, energy and efficiency effects, and feeling high. In most cases, participants who expected Adderall reported greater positive subjective effects on visit 2 compared to controls; however, there were generally not incremental enhancements for those ingesting caffeine compared to placebo. There were no significant effects for any cognitive tests.

CONCLUSIONS

Expectation for prescription stimulant effects influenced subjective outcomes in a sample of high-risk college students. These findings may inform expectancy challenge interventions to reduce NPS.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03648684.

Patterns of Drug Utilization and Self-Medication Practices: A Cross Sectional Study

BACKGROUND

Self-medication (SM) is a growing phenomenon worldwide that has recently been classified as one of the most serious public health problems. SM can result in an incorrect self-diagnosis, inappropriate treatment, potential adverse reactions, interactions, and the masking of more sinister disease.

OBJECTIVES

To assess the prevalence of SM practices amongst healthcare professionals and the general population in Saudi Arabia and to identify the sociodemographic contributing factors to this practice.

METHODS

A total of 540 participants were enrolled in this study. Participants were asked to complete the study questionnaire comprising two sections to gather demographic information and to collect data regarding SM practice.

RESULTS

The prevalence of SM practice among the study participants was 78.6%, and it was the highest among the middle age groups of (21-40 years) 82% compared to the younger and older age groups. The observed prevalence was higher in the female participants (53.7%) and those who live alone. Type of education did not affect the attitude of SM (p = 0.374); however, level of education strongly affected the prevalence of the SM, with higher incidence among university graduates (p < 0.001). Analgesics with antipyretics properties were the most self-medicated drugs. Patients considering their illnesses minor was the main reason behind the high prevalence of this practice. Among healthcare professions the highest prevalence of SM was found among pharmacists (95%), followed by physicians, nurses, and other medical practitioners.

CONCLUSION

The general population should be better educated and made conscious about the consequences, risks, and side effects of SM. Awareness campaigns may prove to be useful in this matter, allowing the patient to consider the appropriateness of this practice. Individuals in the age group of 21-40 years, females, and those who live alone should be considered priority target populations in the design and implementation of SM awareness projects.

Public perceptions of medical cannabis diversion: A legal and moral dilemma

The study examined public perception in Israel of the severity of medical cannabis diversion, its morality, and normativeness. The sample included 380 participants who completed a quantitative questionnaire to respond to four scenarios about diverting medical cannabis to a person with/without a license and with/without a small payment (a 2×2 design). The findings show that although the participants received advance information about the severity of medical cannabis diversion as a drug trafficking offense, they perceived the severity of the offense as moderate, and as an act that is at least moderately moral and normative. The findings are explained based on moral theories. We discuss the implications of the findings in relation to the gap between public attitudes and legal policy.

Insomnia Medication Use by University Students: A Systematic Review

Problematic sleep or insomnia has been a recognised issue for many individuals in society, and university students can be of particular concern due to unique academic pressures. A systematic review was designed to summarise the current evidence about the extent of insomnia medication used by university students and identify characteristics of those more willing to use medication to manage insomnia. Searches were undertaken using Psych INFO, PubMed, Embase, and Web of Science, resulting in 25 eligible studies across multiple countries between 1994 and 2020. The prevalence of sleep medication use by students varied widely, from 2% to 41.2%, with an average of 13.1%. Female gender, students experiencing poor sleep, smoking, drinking stimulant beverages, and undertaking fewer physical activities were associated with the use of insomnia medication. Insomnia medication use exists within university student populations but appears to vary considerably worldwide; identifying multiple population characteristics associated with such use would offer opportunities to identify and support those affected.

Other Momentary Substance Behaviors as Predictors of College Students' Prescription Drug Misuse in Daily Life: An Exploratory Study

Background

Limited prior research to examine co-occurrence of prescription drug misuse with other substances among young adults has documented outcomes that are more problematic for those with higher rates of co-ingesting alcohol. There is a need to understand how college students in this period of heightened risk use other salient substances in moments of their prescription misuse in daily life.

Method

Young-adult college students who engaged in recent prescription misuse (N = 297) completed ecological momentary assessment (EMA) over a 28-day period, resulting in 23,578 reports. Multilevel modeling examined within-person associations between other momentary substance use (including alcohol, nicotine, energy drinks, and marijuana) and prescription misuse in daily life. Analyses accounted for between-person characteristics, having a current focal prescription, and effects of reporting over time. Participant sex was also explored as a moderator.

Results

In adjusted multilevel models, college students' momentary nicotine use and energy drink use each were associated with their greater likelihood of prescription misuse in daily life. In contrast, momentary marijuana use was linked with lower likelihood of misuse. Moderation results indicated that males (but not females) were less likely to engage in prescription misuse in moments of their alcohol use.

Conclusions

Drawing from data obtained using EMA, findings provide novel insights about the real-world associations between prescription drug misuse and other salient substance behaviors during a developmental period that is important for establishing later substance use and health.

Application of The Consolidated Framework for Implementation Research to inform understanding of barriers and facilitators to the implementation of opioid and naloxone training on college campuses

BACKGROUND

The opioid epidemic in the US continues to worsen. Opioid-only and polysubstance-involved opioid overdose deaths are increasing among adolescents and young adults, who have limited knowledge of opioid overdose prevention, including recognition and response. College campuses have infrastructure to support national-level implementation of evidence-based public health strategies for providing opioid overdose prevention and naloxone training programs among this priority population. However, college campuses are an underutilized, understudied setting for this programming. To address this gap, we conducted research assessing barriers and facilitators to planning and implementing this programming on college campuses.

METHODS

We held 9 focus groups among purposively selected campus stakeholders whose perceptions were important to understand in planning for the dissemination and implementation of opioid overdose prevention and naloxone training. Focus group scripts were informed by The Consolidated Framework for Implementation Research (CFIR) to query about perceptions of opioid and other substance use, opioid and other substance use-related resources, and naloxone administration training. We used a deductive-inductive, iterative approach to thematic analysis.

RESULTS

Themes about implementation barriers included (1) the perception that problematic use of other (non-opioid) substances was more prevalent than opioid use on campus and focus on those substances would be a greater priority on college campuses; (2) student schedules were overwhelmed with academic commitments and extracurricular activities, making delivery of additional training challenging; (3) barriers related to the perceived complexity and decentralization of communication on campus, preventing students from knowing how to access substance use-related resources. Themes about implementation facilitators included (1) framing naloxone training as important in becoming a responsible leader on campus and in the broader community and (2) leveraging existing infrastructure, champions within existing campus groups, and tailored messaging to facilitate participation in naloxone training.

CONCLUSIONS

This is the first study to provide in-depth insights into potential barriers and facilitators to widespread, routine implementation of naloxone/opioid education on undergraduate college campuses. The study captured diverse stakeholder perspectives and was theoretically grounded in CFIR, contributing to the growing literature on the application and refinement of CFIR across diverse community and school contexts.

Pain-related disability and opioid use in a sample of young adults with current pain: The explanatory role of distress tolerance

Objective: The current study examined the mediating role of distress tolerance on the association between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use among an ethno-racially diverse sample of young adults with current pain.Methods: Participants were 141 undergraduate college students (78.7% female, M age = 22.50, SD = 5.41) who reported experiencing current pain.Results: Results indicated that distress tolerance statistically significantly explained the relationship between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use after controlling for the variance accounted for by pain intensity, negative affectivity, gender, and other substance misuses.Conclusions: Clinical implications are discussed in terms of targeting distress tolerance in the context of pain-related disability among young adults with pain who are at risk for opioid misuse.

The Effectiveness of CDC's Rx Awareness Campaigns on Reducing Opioid Stigma: Implications for Health Communication

Often health communication campaigns addressing misusing prescription opioids and opioid use disorder (OUD) do not pay enough attention to the associated stigma. This study investigated the effectiveness of a well-designed opioid awareness campaign on reducing stigma and provided evidence for future health communication design. CDC's Rx Awareness videos were used as the experiment material. 137 college students participated in this online experiment, and audience characteristics and video features were considered and tested. The results showed that Rx Awareness videos significantly reduced participants' stigmatizing attitudes and perceived public stigma and increased their empathy toward people with OUD. Empathy is a promising strategy to reduce opioid stigma. People with an opioid prescription history expressed more empathy. Recovery information, prescription history, and narrators' race influenced the audience's perceived public stigma. Implications for health communications and limitations of the study are discussed.

Sources for prescription stimulant misuse: A person-centered approach to understanding links to substance use and psychiatric impairment

Prescription stimulant misuse (PSM) is most prevalent among college students and is associated with numerous negative academic and psychosocial outcomes. A large body of literature has identified predictors of PSM in this population, however few studies have utilized a person-centered approach to examine how the sources from which students procure prescription stimulants are associated with substance-related and psychiatric impairment. We used latent class analysis (LCA) to classify a geographically and racially/ethnically diverse sample of U.S. undergraduates (N = 538) who misused prescription stimulants into groups based on their endorsement of nine sources of medication. We selected a five-group classification from the LCA with classes of peer/dealer, given by friend, own prescription, lower multiple sources (i.e., relatively infrequent endorsement of multiple sources), and any source. Compared to the reference group (given by friend), the own prescription class was less likely to report marijuana use, simultaneous alcohol and marijuana use, alcohol or marijuana consequences, and nonoral routes of administration. On the other hand, the own prescription class was more likely to screen positive for anxiety, anger, and suicidality. Similarly, the lower multiple sources group was more likely to screen positive for depression, anxiety, anger, and suicidality. Prevention and intervention efforts focused on PSM may be tailored differently for students who are misusing their own medication and/or endorsing multiple sources. Specifically, these students may need broader assistance with comorbid psychiatric conditions, particularly suicidality, while students who obtain stimulants from peers or a dealer may benefit more from substance-focused interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intranasal Use of Prescription Stimulants Among Adults Aged 18 to 30: Results From A Crowdsourcing Platform

OBJECTIVE

Few studies of prescription stimulant non-oral, non-medical use (NMU) (defined by use not as prescribed) have been conducted in adults beyond the college population. The purpose of this study was to characterize prescription stimulant non-oral use, specifically intranasal (IN) use (snorting) in young adults.

METHOD

Amazon's MTurk platform was used to recruit participants for an online survey. Data were collected from March to April 2020.

RESULTS

Thirty-two percent (n = 157) of survey respondents (N = 975), aged 18 to 30, reported IN prescription stimulant use (average of 32.1 episodes of lifetime IN use). Adderall was the most-reported prescription stimulant used intranasally (89.2%). Most IN users (82%; n = 68) reported spending no more than 5 minutes tampering with prescription stimulants. Intranasal users said they would take the medication orally if unable to tamper or manipulate medication for IN use.

CONCLUSION

These data help quantify a complex public health issue of ongoing IN use of prescription stimulants and suggest a potential role for manipulation-deterrent medications.

Academic factors associated with college students' prescription stimulant misuse in daily life: An ecological analysis of multiple levels

ObjectiveTo identify academic factors pertaining to college students, calendar timing, and particular moments that are uniquely associated with elevated likelihood of prescription stimulant misuse (intentions and actual behavior) in daily life. Participants: Participants were 297 freshmen and sophomores at a large public university in the United States in 2017-2019. Methods: Participants completed survey measures during lab visits and ecological momentary assessment procedures in daily life. Hypotheses were tested using multilevel models that accounted for the nested data and demographic covariates. Results: Student, calendar-based, and momentary academic factors were uniquely associated with stimulant misuse intentions in daily life. Real-time academic events, beyond the proportion of academic events experienced, emerged as a robust predictor of misuse behavior. Within-person links between real-time momentary predictors and misuse behavior were moderated by finals week timing. Conclusions: Findings offer implications for prevention and intervention strategies for college students at risk for prescription drug misuse.

Effects of Training on Use of Stimulant Diversion Prevention Strategies by Pediatric Primary Care Providers: Results from a Cluster-Randomized Trial

Pediatric primary care is a promising setting for reducing diversion of stimulant medications for ADHD. We tested if training pediatric primary care providers (PCPs) increased use of diversion prevention strategies with adolescents with ADHD. The study was a cluster-randomized trial in 7 pediatric primary care practices. Participants were pediatric PCPs (N = 76) at participating practices. Practices were randomized to a 1-h training in stimulant diversion prevention or treatment-as-usual. At baseline, 6 months, 12 months, and 18 months, PCPs rated how often they used four categories of strategies: patient/family education, medication management/monitoring, assessment of mental health symptoms/functioning, and assessment of risky behaviors. They completed measures of attitudes, implementation climate, knowledge/skill, and resource constraints. Generalized Estimating Equations estimated differences in outcomes by condition. Mediation analyses tested if changes in knowledge/skill mediated training effects on strategy use. PCPs in the intervention condition reported significantly greater use of patient/family education strategies at all follow-up time points. There were no differences between conditions in medication management, assessment of mental health symptoms/functioning, or assessment of risky behaviors. At 6 months, PCPs in the intervention condition reported more positive attitudes toward diversion prevention, stronger implementation climate, greater knowledge/skill, and less resource constraints. Differences in knowledge/skill persisted at 12 months and 18 months. Brief training in stimulant diversion had substantial and enduring effects on PCPs' self-reported knowledge/skill and use of patient/family education strategies to prevent diversion. Training had modest effects on attitudes, implementation climate, and resource constraints and did not change use of strategies related to medication management and assessment of mental health symptoms/functioning and risky behaviors. Changes in knowledge/skill accounted for 49% of the total effect of training on use of patient/family education strategies. Trial registration This trial is registered on ClinicalTrials.gov (NCT03080259). Posted March 15, 2017.

ADHD and Substance Use Disorders in Young People: Considerations for Evaluation, Diagnosis, and Pharmacotherapy

Co-occurring ADHD and substance use disorder (SUD) is a common clinical presentation associated with significant impairment requiring careful evaluation, diagnosis, and treatment. Treatment with medication, along with cognitive behavioral therapy, is generally regarded as effective in addressing symptoms and impairments associated with both disorders. Options for pharmacotherapy include stimulant and nonstimulant therapies administered with careful monitoring of dosage and compliance to optimize efficacy. In high-risk groups such as college students and/or those with SUD, prescribers should address risks of stimulant misuse and diversion through patient and family education, medication monitoring, and other risk-reducing practices.

Negative Consequences Related to Nonmedical Prescription Stimulant Use: Development and Psychometric Validation of the Prescription Stimulant Consequences Questionnaire

Nonmedical prescription stimulant use (NPS) is prevalent among undergraduates and associated with several negative consequences. However, no validated measures exist assessing NPS-related consequences. The present study aimed to develop and psychometrically validate a Prescription Stimulant Consequences Questionnaire (PSCQ) for use among college students. A multisite sample of college students endorsing NPS ( N = 715, 68.4% female) completed the PSCQ and measures of NPS frequency and correlates of NPS via an online survey. Exploratory factor analysis supported a 27-item measure, with three factors (i.e., Compulsive Behavior, Risky Behaviors, and Physical and Mental Health) and a total score. Each PSCQ factor and total score demonstrated good internal consistency, and were significantly positively associated with all NPS frequency indicators, route of administration, alcohol-related problems, sleep problems, and depressive/anxiety symptoms. Findings demonstrate support for the psychometric validity and reliability of the newly developed PSCQ, which may demonstrate potential as a screening and outcome measure for intervention.

Super-Men and Wonder-Women: the Relationship Between the Acceptance of Self-enhancement, Personality, and Values

Due to ongoing technological innovations, self-enhancement methods are publicly discussed, researched from different perspectives, and part of ethical debates. However, only few studies investigated the acceptance of these methods and its relationship with personality traits and values. The present study investigated to what extent people accept different enhancement methods and whether acceptance can be predicted by Big Five and Dark Triad traits, vulnerable narcissism, and values. In an online survey (N = 450), we measured personality traits and values. Additionally, participants read scenarios about enhancement methods and answered questions about their acceptance of these scenarios. Factor analysis indicated a general factor of acceptance across scenarios. Correlation analyses showed that high agreeableness, agreeableness-compassion, conscientiousness, conscientiousness-industriousness, and conservation- and self-transcendence values are related to less acceptance of self-enhancement. Moreover, individuals high on Dark Triad traits, vulnerable narcissism, and self-enhancement values exhibit more acceptance. Hierarchical regression analysis revealed that said values and Big Five traits explained unique variance in the acceptance of self-enhancement. These findings highlight the importance of considering personality and values when investigating self-enhancement—a topic that is receiving increasing attention by the public, politicians, and scientists.

Prescription opioid misuse among university students: A systematic review

Misuse of prescription opioids has substantially increased in the past decade among the general population, including among university students. Relative to the literature concerning opioid misuse among the general population, little information is available regarding the college student population. Objective: The purpose of the present study was to conduct a systematic review of the literature concerning the prevalence of prescription opioid misuse among the university student population. Results: The lifetime estimate for prescription opioid misuse among general populations of students ranged from 4% to 19.7%, with higher estimates for special student populations. Students most at risk for misuse of prescription opioids are those who report higher rates of psychological distress, depression, and suicidal thoughts and behaviors, and white, male students who use alcohol and illicit drugs. Conclusions: Findings from this study underscore the need for opioid prevention and intervention programs on university campuses.

Outcomes and Predictors of Stimulant Misuse in College Students with and Without ADHD

In recent years, rates of prescription stimulant misuse have increased among young adults ages 18 to 25 along with increases in dispensing rates of these medications. Preliminary studies suggest that college students with Attention-Deficit Hyperactivity Disorder (ADHD) may be more likely to misuse their stimulant medication than their non-ADHD peers. Research is needed to further explore possible rates, correlates, and outcomes of prescription stimulant misuse among college students with and without ADHD. Data regarding study strategies, psychological functioning, stimulant misuse, and GPA were collected from students from universities within the US (N = 144), showing significantly higher rates of misuse among college students with ADHD. With depression and anxiety entered into the predictive model, inattentive symptoms were the only significant predictor of misuse in the full sample. The present findings have implications for academic interventions aimed at supporting the success of college students with and without ADHD and inform academic outcomes of prescription stimulant misuse.

Prevalence and factors associated with non-medical prescription stimulant use to promote wakefulness in young adults

Objective: This study examined the prevalence and factors associated with non-medical use of prescription stimulants to promote wakefulness. Participants: We surveyed 3,160 university students aged 18-35 between June 2016 and May 2017. Method: Participants reported whether they used prescription stimulants non-medically to stay awake and completed measures of anxiety and depressive symptoms, sleep quality, insomnia, daytime sleepiness, and attitudes toward non-medical prescription drug use. Univariate and multivariate regression models were used. Results: Prevalence of non-medical prescription stimulant use to promote wakefulness was 3.1%. The following factors remained significant in the multivariate model: alcohol, tobacco, and nicotine vapor use, attitude toward non-medical use of prescription medication, poor sleep quality, and daytime sleepiness. Conclusion: Poor sleep, substance use and more liberal attitudes to non-medical prescription drug use were associated with the misuse of stimulants to promote wakefulness. Prevention/intervention programs should promote sleep hygiene and highlight the risks of using prescription drugs non-medically.

Medical and nonmedical use of psychiatric medications among medical students in Riyadh, Saudi Arabia

Introduction:

Psychiatric medication use has increased recently among college students. This includes antidepressants, opioids, stimulants, analgesics, sedatives, and anxiolytics, which could be self-administered without medical supervision.

Objectives:

To determine the prevalence of medical and nonmedical use of psychiatric prescription medications and its correlation with academic performance, demographic data as well as the motives for the nonmedical use.

Methods:

A cross-sectional study aims to assess the psychiatric medication use with or without prescription with the motives behind it, and demographic data of the students at medical colleges in Riyadh, Saudi Arabia.

Results:

A total of 1268 responded to the questionnaire. 251 (20%) of the participants reported using some psychiatric medications in their lifetime, while 191 (15%) participants used some psychiatric medications in the last 12 months. Antidepressants were most used in the surveyed population 144 (57%), followed by opioids/pain relief medications 62 (24%) and anxiolytics 39 (15%). Only 44 surveyed students (3.5%) reported nonmedical use of these psychiatric medications. As for the motives of nonmedical use, the greatest portion reported to use it for “relax or relieve tension” 12 (29%), followed by “relieve pain caused by other health problems” 8 (20%), and “medication to get through the day” 6 (15%).

Conclusion:

Nonmedical use of psychiatric medications among medical students in Riyadh is several times lower than reports by other researchers. Future research should focus on collecting more participants who are using medications without prescription and conduct cross-cultural studies to examine factors contributing to such low rates of illicit psychiatric medication use.

Encountering Overdose: Examining the Contexts and Correlates of US College Students' Overdose Experiences

BACKGROUND

As overdose rates increase, it is critical to better understand the causes and contexts of overdose, particularly for college students who exhibit high rates of alcohol and drug use. The purpose of this study was to examine the social contexts of U.S. college students' overdose experiences (their own, witnessed, and family'/friends'), and to assess the correlates of personal overdose.

METHODS

A cross-sectional survey containing open- and closed-ended questions about overdose encounters was completed by undergraduate students at a southeastern American university (n = 1,236). Descriptive frequencies assessed prevalence, substance involvement, and fatalities associated with different encounter types. A content analysis of open-ended responses examined the social contexts of encounters. Multivariate logistic regression was used to assess the correlates of personal overdose.

RESULTS

Forty-one percent of respondents reported at least one type of overdose encounter and witnessed overdose was most common. Substances involved varied across encounter type and 20-40% of respondents reported overdose-related fatalities. Students who encountered overdose often reported multiple experiences and many attributed overdoses to mixing substances. Respondents commonly encountered overdose as intervening bystanders and overdose events were often perceived to be intentional or the result of using substances to cope with stress/mental health concerns. Personal overdose was significantly associated with having ever mixed alcohol with prescription drugs, been diagnosed with a mental disorder, witnessed an overdose, and had a family member/friend overdose.

CONCLUSION

Findings suggest a need for future research into the contexts and consequences of students' overdose encounters to more effectively tailor overdose prevention/response initiatives within college communities.

Predicting college student prescription stimulant misuse: An analysis from ecological momentary assessment

Prescription stimulant misuse (PSM) is common in young adult college students, at over 10% in the past year, and it is associated with other substance use and risk behaviors. Research focused on the real-time drivers of PSM is absent, impeding prevention and intervention. This research aimed to fill that gap by examining the relationships between affect, global stress, or academic stress and PSM via ecological momentary assessment (EMA); we also investigated baseline predictors of PSM frequency during the 21-day EMA period. Forty-one full-time college students (mean age: 20.5, 66% female) who endorsed current PSM (≥ 6 past-year episodes) participated. Participants were asked to complete EMA questions in response to 3 daily investigator-initiated prompts and after every PSM episode. Assessments were selected based on affect regulation (e.g., positive affect [PA], negative affect [NA]) and drug instrumentalization (e.g., academic stress and/or demands) theories of substance use. Mixed-effects linear models examined EMA data, and negative binomial regression analyses examined baseline predictors of PSM episode frequency. PA was higher on PSM days and increased post-PSM, whereas NA was unrelated to PSM. Although global and academic stress were largely unrelated to PSM, when the motive endorsed for PSM was "to study," pre-PSM ratings of academic demand and stress were significantly higher. Finally, a history of recreational motives (e.g., to get high) or higher levels of attention-deficit/hyperactivity disorder symptoms predicted a greater number of PSM episodes over the EMA period. The results offered mixed support for both affect regulation and instrumentalization as applied to PSM. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological Distress and Use of Psychotropic Drugs Among University Students-the SHoT Study, Norway

Background: Students pursuing higher education are struggling with psychological distress, which in turn may negatively affect their academic self-efficacy and study progress. Although psychotropic drug use is widespread and increasing, patterns of psychotropic drug use among students are not well-known. Aim: To describe prevalence and gender differences in psychotropic drug use among Norwegian students in higher education, and to examine associations with level of psychological distress. Methods: The study is based on data from the Norwegian Student's Health and Well-being Study (SHoT), 2018, a national survey including all fulltime students aged 18-35 years in higher education. Our sample included 49,836 students, 69% females. Use of psychotropic drugs and psychological distress (The Hopkins Symptoms Checklist [HSCL-25]) were self-reported. Generalised linear models were used to assess associations between psychological distress and psychotropic drug use. Results: Psychotropic drug use was more frequent among female than male students: 4 vs. 2% daily antidepressants usage; 5 vs. 3% last month use of anxiolytics/tranquillisers; and 8 vs. 5% last month use of hypnotics. In contrast, male students reported use of performance enhancing drugs more often than females (7 vs. 5%). Adjusted associations between high level of psychological distress (HSCL-25 ≥ 2.0) and use of psychotropics, showed an about 2-fold increased relative risk, largely consequent across drug classes and genders. Conclusion: Prevalence and gender patterns of intake of the most common psychotropic drug classes among Norwegian students are comparable to previous studies. Unexpectedly, among students with moderate to severe psychological distress, the patterns of psychotropic drug use were more or less identical between genders.

Adolescents Treated for Attention-Deficit/Hyperactivity Disorder in Pediatric Primary Care: Characterizing Risk for Stimulant Diversion

OBJECTIVE

To describe the clinical and psychosocial characteristics, and their hypothesized interrelations, as it pertains to risk for stimulant diversion (sharing, selling, or trading) for adolescents in pediatric primary care treatment for attention-deficit/hyperactivity disorder.

METHODS

Baseline data for 341 adolescents in a cluster-randomized controlled trial of stimulant diversion prevention in pediatric primary care (NCT_03080259) were used to (1) characterize diversion and newly measured risk factors, (2) examine their associations with age and sex, and (3) test whether associations among risk factors were consistent with model-implied predictions. Data were collected through multi-informant electronic surveys from adolescents and parents.

RESULTS

Diversion was rare (1%) in this sample (Mage = 15, SD = 1.5, 74% male participants). Older age was associated with being approached to divert (r = 0.25, p < 0.001) and higher risk on variables pertinent to stimulant treatment, such as treatment disclosure (r = 0.12, p < 0.05), tolerance for stimulant misuse and diversion (r = 0.17, p < 0.05), and peer norms favorable to stimulant misuse and diversion (r values = 0.15-0.34, p < 0.001). Sex differences were minimal. Variables from our conceptual model and specific to stimulants (e.g., perceived likelihood of negative consequences from diversion and schoolmate stimulant misuse/diversion) were related in multivariable regressions to hypothesized immediate precursors of diversion (e.g., diversion intentions).

CONCLUSION

Although diversion was rare for these primary care-treated adolescents, risk levels appear to be higher for older adolescents. Prevention may be most effective by capitalizing on current psychosocial strengths and discussing stimulant-specific attitudes, behaviors, and social norms before vulnerability to diversion increases in the final years of high school and into college.

An exploratory study of indicators of recent nonmedical prescription stimulant use among college students

To explore the relationship between past 30-day nonmedical prescription stimulant use (NPSU) and past 30-day marijuana and/or alcohol use, past 30-day risky marijuana and/or alcohol use, student demographics, and student activity involvement among college students. Participants: Sample of 604 college-aged students at two large universities in the southeastern U.S. Methods: A cross-sectional survey was completed electronically. Logistic regression was used to identify and test covariates of past 30-day NPSU. Results: Over 20% of participants self-reported past NPSU. Using both marijuana and alcohol in the past 30 days (B = 3.293, p = .002, OR= 26.91, 95% CI OR= 3.42, 211.92) and engaging in both risky marijuana and alcohol use (B = 2.095, p < .001, OR = 8.13, 95% CI OR = 2.52, 25.17) were significantly related to past 30-day NPSU. Conclusions: NPSU may be indicative of broader polysubstance use problems among college-aged students.

A Preliminary Study Examining Self-Reported Invincibility, Alcohol Problems, and the Nonmedical Use of Prescription Stimulants in College Students

The nonmedical use of prescription stimulants (NMUPS) is becoming more common among college students. Identifying the variables associated with NMUPS is important for educational efforts and to promote wellness in vulnerable students. The present study examined the relationships between self-reported invincibility, alcohol problems, and NMUPS in 175 college students. Path analysis tested the hypotheses that males would report higher invincibility that would be related to alcohol use and alcohol problems. Using structural equation modeling, significant relationships were found between invincibility and alcohol-related problems. Alcohol problems may be related to NMUPS. A total effect of invincibility, mediated by alcohol use, may be a path whereby invincibility positively influences NMUPS. Students reporting high levels of invincibility may be at risk for the NMUPS and might benefit from efforts regarding the potential harmful consequences of taking these substances without a prescription.

Alcohol-related cognitions: Implications for concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse among young adults

INTRODUCTION

This study examined the associations between alcohol-related cognitions within the social reaction pathway of the Prototype Willingness Model and concurrent (use of two or more substances within a specified time period) use of 1) alcohol and marijuana and 2) alcohol and prescription stimulant misuse.

METHODS

A convenience sample of 1,062 emerging adults in the U.S. (18-20 years old; 54.5% female) who reported past 3-month alcohol use completed a baseline survey as part of a larger randomized controlled trial.

RESULTS

Results indicate that controlling for age, biological sex, race, ethnicity, and college enrollment, perceived descriptive norms and willingness to drink were associated with past 3-month concurrent alcohol and marijuana use and concurrent alcohol and prescription stimulant misuse. However, alcohol prototype similarity and alcohol-related perceived vulnerability were not associated with either concurrent use outcome examined.

DISCUSSION

These findings suggest that alcohol-related perceived descriptive norms and willingness to drink are associated with concurrent substance use among young adults. Thus, it is possible that existing efficacious alcohol interventions that target descriptive norms and willingness to drink may have the added benefit of also reducing concurrent substance cognitions and ultimately use.

Using a theoretical approach to predict college students' non-medical use of prescription drugs - a survival analysis

This study assesses students' non-medical use of prescription drugs (NMUPD) from college entrance to graduation, and examines factors that predict NMUPD. Participants: The study was conducted between May 2011 and September 2015 with 338 students. Methods: Longitudinal cohort study design was used to examine NMUPD across time, and NMUPD-related attitudes and subjective norms. Five yearly interviews were conducted to collect data. Cox proportional hazards regression analysis was used to examine time to NMUPD. Results: Thirty-five percent of study participants reported NMUPD; the majority of those initiated non-medical use before their third year in college. Analyses indicated that more positive attitudes towards NMUPD (HR = 1.73, p < 0.001), increased subjective norms regarding NMUPD (HR = 1.01, p < 0.01), and gender (male) (HR= 1.89, p < 0.001) were significantly associated with sooner NMUPD. Conclusions: Findings suggest that NMUPD prevention efforts that target mutable factors such as attitudes and subjective norms should be implemented early during students' college careers.

Clair CM, Hou JY, Khoury-Collado F, Gockley A, Accordino M, Melamed A, Hershman DL. Association of New Perioperative Benzodiazepine Use With Persistent Benzodiazepine Use

IMPORTANCE

Increased use of benzodiazepines has resulted in increasing rates of misuse and adverse effects associated with these drugs. Little is known about the initial exposure and source of benzodiazepines among those who use them persistently.

OBJECTIVE

To examine the frequency of use and persistent use of benzodiazepines among patients undergoing major and minor surgical procedures.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study included 2 509 599 adult patients who underwent 1 of 11 common surgical procedures in the United States from 2009 to 2017 and were recorded in the MarketScan database. The rates of perioperative and persistent benzodiazepine use were examined in benzodiazepine-naive patients. Data analysis was conducted from July to November 2020.

MAIN OUTCOMES AND MEASURES

Receipt of a perioperative benzodiazepine prescription and persistent use (ie, fill of a second prescription 90-180 days after surgery) among those who received a benzodiazepine perioperatively.

RESULTS

Among 2 509 599 included patients, the mean (SD) age was 54.4 (15.3) years, and 1 596 137 (63.6%) were women. Perioperative benzodiazepine use was noted in 63 931 patients (2.6%). The median (interquartile range) benzodiazepine supply was 10 (5-23) days. Among benzodiazepine-naive patients prescribed a perioperative benzodiazepine, the rate of persistent benzodiazepine use was 19.5% (95% CI, 19.2%-19.8%). During the 90 to 180-day period after surgery, 7013 of 12 468 patients (56.2%) received 1 prescription for benzodiazepines while 5455 (43.8%) received 2 or more prescriptions. Among patients prescribed a benzodiazepine, persistent use was more common in Medicaid recipients (vs patients with commercial insurance: adjusted rate ratio [aRR], 1.29; 95% CI, 1.03-1.62), patients 70 years or older (vs those aged 40-49 years: aRR, 1.14; 95% CI, 1.05-1.23), in women (vs men: aRR, 1.10; 95% CI, 1.06-1.15), in patients with more medical comorbidities (eg, Elixhauser comorbidity score ≥3 vs 0: aRR, 1.11; 95% CI, 1.04-1.19), and in those with diagnoses of anxiety, depression, insomnia or substance use disorder (eg, with vs without anxiety: aRR, 1.43; 95% CI, 1.37-1.50).

CONCLUSIONS AND RELEVANCE

In this study, a relatively small percentage of surgical patients were prescribed benzodiazepines in the perioperative period; however, 1 in 5 of these patients went on to persistent benzodiazepine use.

Nonmedical Prescription Opioid Use among a Sample of College Students: Prevalence and Predictors

Nonmedical use of prescription opioid medication (NMPO) in the United States is a public health crisis, resulting in high rates of emergency room visits, morbidity, and mortality. The purpose of this study was to explore prevalence estimates and correlates of NMPO among a convenience sample of college students in the northeast and southeast regions of the US to help generate directions for future research. Motivations for misuse, age of onset, access, concomitant substance use, and individual factors were investigated among a sample of undergraduate students from two universities. Participants (N = 847) completed a battery of various self-report measures. Findings revealed that 7.7% (Southeastern University) and 12.8% of students (Northeastern University) reported lifetime NMPO, whereas past-month NMPO was reported by 0.8% and 0.9% of participants, respectively. Lifetime history of regularly using alcohol, nonmedical use of benzodiazepine medication, nonmedical use of prescription stimulants, symptoms of depression and anxiety, and executive functioning (i.e., metacognition and behavioral regulation) were significantly related to lifetime history of NMPO in this college sample. These findings offer several potential subsequent lines of investigation regarding the associations between various demographic and psychological factors and NMPO. Future research is needed to help identify college students who are at risk of NMPO.

Empirically-informed guidelines for first-time adult ADHD diagnosis

INTRODUCTION

Adult Attention Deficit/Hyperactivity Disorder (ADHD) is prone to misdiagnosis because its symptoms are subjective, share features with a broad range of mental, behavioral and physical disorders, and express themselves heterogeneously. Furthermore, Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for adult ADHD diagnosis remain underdeveloped, prompting a need for systematic and empirically-informed guidelines.

METHOD

This article presents a brief history of research on adult ADHD and reviews common sources of false positive and false negative diagnoses. A systematic, stepped diagnostic procedure is described that adheres to DSM guidelines and integrates the latest science on adult ADHD assessment and diagnosis.

RESULTS

Seven steps are recommended: a structured diagnostic interview with the patient, collection of informant ratings, casting a wide net on symptoms using "or rule" to integrate informant reports, providing checks and balances on the "or rule" by enforcing the impairment criterion, chronicling a symptom timeline, ruling out alternative explanations for symptoms, and finalizing the diagnosis.

CONCLUSIONS

Based on the extant research, it is expected that the stepped diagnostic procedure will increase detection of malingering, improve diagnostic accuracy, and detect non-ADHD cases with subclinical difficulties or non-ADHD pathologies.

Use of Stimulant Diversion Prevention Strategies in Pediatric Primary Care and Associations With Provider Characteristics

PURPOSE

Diversion of stimulant medications for ADHD is a prevalent problem. Pediatric primary care providers (PCPs) are well-positioned to reduce diversion risk among adolescents prescribed stimulants, but little is known about their use of prevention strategies. The objectives of this study were to describe the frequency with which pediatric PCPs use diversion prevention strategies and examine potential determinants (facilitators and barriers) of strategy use.

METHODS

Participants were pediatric PCPs (N = 76) participating in a randomized controlled trial of stimulant diversion prevention strategies. At baseline, before randomization, PCPs rated the frequency with which they used specific strategies in each of four categories: patient/family education, medication management/monitoring, assessment of mental health symptoms/functioning, and assessment of risky behaviors. They completed measures of attitudes toward diversion prevention, subjective norms (i.e., implementation climate), and perceived behavioral control (i.e., knowledge/skill, resource constraints). Associations between determinants and strategy use were tested with correlational and regression analyses.

RESULTS

PCPs used strategies for assessing mental health symptoms/functioning most frequently and patient/family education strategies least frequently. Attitudes about the effectiveness of diversion prevention, implementation climate, knowledge/skill, and resource constraints were positively correlated with the use of at least one category of strategies. In regression analysis, PCP knowledge/skill was positively associated with patient/family education, medication management, and risk assessment strategies.

CONCLUSIONS

Findings suggest that improving knowledge and skill may increase the use of diversion prevention strategies by PCPs. Identifying provider-level determinants of strategy use informs implementation efforts in pediatric primary care and can facilitate efforts to prevent stimulant diversion among adolescents.

Predictors of controlled prescription drug non-medical and lifetime use among patients accessing public mental health services in Uganda: a cross-sectional study

OBJECTIVES

We determined the prevalence of controlled prescription drug (CPD) non-medical and lifetime use and their predictors among patients at three public psychiatric clinics in Uganda to identify missed care opportunities, enhanced screening priorities, and drug control needs.

METHODS

A cross-sectional survey of 1275 patients was performed from November to December 2018. Interviewer-administered semi-structured questionnaires, desk review guide and urine drug assays were employed. Questionnaire recorded CPD non-medical and illicit drug use history from patients' files, CPD lifetime use and risk factors. Desk review guide recorded recently prescribed drugs in patients' files to corroborate with urine assays. Predictors were analysed by multivariate logistic regression.

RESULTS

From desk review, 145 (11.4%) patients had history of CPD non-medical use and 36 (2.8%) had used illicit drugs. Of 988 patients who provided urine, 166 (16.8%) self-medicated CPDs, particularly benzodiazepines while 12 (1.2%) used illicit drugs. Of those with drug-positive urine, 123 (69.1%) had no documented history of CPD non-medical and illicit drug use. Being an inpatient (OR=10.90, p<0.001) was independently associated with CPD non-medical use. Additionally, being an inpatient (OR=8.29, p<0.001) and tobacco consumption (OR=1.85, p=0.041) were associated with CPD non-medical and illicit drug use combined. Among participants, 119 (9.3%) reported CPD lifetime use, and this was independently associated with education level (OR=2.71, p<0.001) and history of treatment for substance abuse (OR=2.08, p=0.018).

CONCLUSIONS

CPD non-medical use is common among Uganda's psychiatric patients, and more prevalent than illicit drug use. Rapid diagnostic assays may be needed in psychiatric care in resource limited settings. It is necessary to assess how CPD non-medical use impacts mental care outcomes and patient safety. High risk groups like inpatients and tobacco consumers should be prioritised in psychiatric screening.

The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review

INTRODUCTION

Cognitive enhancers (CEs), also known as "smart drugs", "study aids" or "nootropics" are a cause of concern. Recent research studies investigated the use of CEs being taken as study aids by university students. This manuscript provides an overview of popular CEs, focusing on a range of drugs/substances (e.g., prescription CEs including amphetamine salt mixtures, methylphenidate, modafinil and piracetam; and non-prescription CEs including caffeine, cobalamin (vitamin B12), guarana, pyridoxine (vitamin B6) and vinpocetine) that have emerged as being misused. The diverted non-prescription use of these molecules and the related potential for dependence and/or addiction is being reported. It has been demonstrated that healthy students (i.e., those without any diagnosed mental disorders) are increasingly using drugs such as methylphenidate, a mixture of dextroamphetamine/amphetamine, and modafinil, for the purpose of increasing their alertness, concentration or memory.

AIM

To investigate the level of knowledge, perception and impact of the use of a range of CEs within Higher Education Institutions.

METHODOLOGY

A systematic review was conducted in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Whilst 1400 studies were identified within this study through a variety of electronic databases (e.g., 520 through PubMed, 490 through Science Direct and 390 through Scopus), 48 papers were deemed relevant and were included in this review.

RESULTS

The most popular molecules identified here included the stimulant CEs, e.g., methylphenidate, modafinil, amphetamine salt mixtures and caffeine-related compounds; stimulant CEs' intake was more prevalent among males than females; drugs were largely obtained from friends and family, as well as via the Internet. It is therefore suggested that CEs are increasingly being used among healthy individuals, mainly students without any diagnosed cognitive disorders, to increase their alertness, concentration, or memory, in the belief that these CEs will improve their performance during examinations or when studying. The impact of stimulant CEs may include tolerance, dependence and/or somatic (e.g., cardiovascular; neurological) complications.

DISCUSSION

The availability of CEs for non-medical indications in different countries is influenced by a range of factors including legal, social and ethical factors. Considering the risk factors and motivations that encourage university students to use CE drugs, it is essential to raise awareness about CE-related harms, counteract myths regarding "safe" CE use and address cognitive enhancement in an early stage during education as a preventative public health measure.

College Students' Perceptions About Prescription Drug Misuse Among Peers

BACKGROUND

Prescription drug misuse is an escalating public health problem that is prevalent among college students. Various factors, such as sex, age, race, mental health conditions, and fraternity and sorority membership, increase the risk for prescription drug misuse. Peer influences may also pose significant risks for starting prescription drug misuse, because peers are the primary source of misused prescription drugs among college students.

OBJECTIVES

To examine college students' beliefs about prescription drug misuse among their peers and to understand their beliefs about the available and potential intervention efforts to reduce prescription drug misuse.

METHOD

We conducted a cross-sectional survey of 312 college students aged 18 to 30 years who were enrolled in a large midwestern US university. The survey included questions about the responders' demographic characteristics, beliefs, and perceptions regarding prescription drug misuse among their peers and potential reduction programs for prescription drug misuse.

RESULTS

The respondents' mean age was 21 years, and most (65%) respondents were women. A majority (90%) of the respondents were enrolled in the university as full-time students. More than 60% of the respondents reported knowing someone with prescription drug misuse in the past 12 months. Fraternity or sorority members were more likely to report peer prescription drug misuse than nonmembers (83% vs 60%, respectively; P = .017). Stimulants were the most misused drug class, accounting for 75% of all reported peer prescription drug misuse. Approximately 60% of the misused prescription drugs were sourced from peers, which included friends, roommates, and classmates. A total of 73% of respondents said that prescription drug misuse was a problem among college students and 67% agreed that interventions were needed to reduce prescription drug misuse. The perceived need for interventions varied by peer prescription drug misuse. A total of 90% of students whose peers did not misuse prescription drugs said that interventions were needed, but only 67% of those with peer prescription drug misuse thought that interventions were needed.

CONCLUSION

Our findings indicate that peer prescription drug misuse is very common among college students, and the most misused drug class is stimulants. Survey respondents perceived that the current interventions used to address prescription drug misuse are not very effective or may not be targeting the right population. Peer prescription drug misuse influences college students' perceptions about the risks and harms of prescription drug misuse, as well as the need for interventions.

ADHD stimulant medication misuse and considerations for current prescribing practice: a literature review

BACKGROUND

Stimulant medications have been prescribed to effectively treat childhood Attention Deficit Hyperactivity Disorder (ADHD) since the 1960's, with improved outcomes observed in the three core symptom domains. Over the course of these decades researchers and clinicians have debated the issue of negative outcomes with regard to later development of substance use disorders (SUD) for these children.

AIMS

To chronicle the development of medical and scientific opinion on the subject of SUD outcomes in ADHD and to appraise most recently published research in this sphere.

METHODS

A systematic search of the literature was conducted over 4 databases. Removal of duplicates, application of exclusion criteria and inclusion of publications identified through manual and citation-based search yielded 9 papers.

RESULTS

Prescriptions for stimulant medications are increasing worldwide and in tandem the prevalence of stimulant misuse. Much research focuses on non-medical stimulant misuse as a study aid; however, they are also used as recreational drugs with action on dopaminergic neurotransmitter pathways implicated in addiction disorders. Considering the risks and benefits of stimulant prescribing on later SUD development research in recent decades has produced inconsistent results. Current research supports the hypothesis of improved SUD outcomes for young people treated early and intensely, with poorer outcomes for those with less robust treatment histories.

CONCLUSIONS

Consideration of the impact that variable treatment trajectories may have on the risk of later SUD development is recommended, with further research potentially leading to the development of different management pathways based on an individual's multivariate treatment profile.

Achievement goal orientation and stimulant misuse in college students

Objective: The prevalence of stimulant medication misuse is rising in college students. Motivations to use stimulant medications differ from motivation to use other substances such as alcohol or cannabis. However, no previous research has examined the impact of achievement goal orientation on stimulant misuse in college students. Participants: 309 college students (mean age = 18.9; 117 males) without an ADHD diagnosis were invited to participate. Methods: Participants completed an online research questionnaire that assessed factors associated with stimulant medication misuse as well as achievement goal orientations (Learning and Performance Orientations). Results: Approximately 12% endorsed a history of stimulant misuse within the past year. More males (17.1%) than females (9.4%) reported stimulant misuse. Those with and without a history of stimulant misuse differed on Performance Orientation (misuse > no misuse) yet were comparable on Learning Orientation. Conclusions: Having a higher Performance Orientation independently predicted stimulant misuse.

Sources of prescription opioids and tranquilizers for misuse among U.S. young adults: differences between high school dropouts and graduates and associations with adverse outcomes

Background and Objectives: Prior research has identified that sources of prescription drugs for misuse vary based on educational attainment, which is important as certain sources are associated with adverse outcomes. The current research addressed limitations of the extant literature by creating distinct categories of push factors for high school dropout (e.g., negative school performance/experiences), pull factors for high school dropout (e.g., starting a family or getting a job), and high school graduates who did not attend college.Methods: Using data from the 2009-2014 National Survey on Drug Use and Health, prevalence of sources were estimated and design-based multivariable logistic regression investigated the association between sources and educational attainment. Additionally, multivariable logistic regression assessed the associations between sources and adverse outcomes (i.e., substance use, substance use disorders, and mental health) separately for each educational category.Results: College respondents were more likely to report "physician" and free from "friend/relative" and less likely to report "purchased" as sources. For most educational categories, "purchasing" prescription drugs was associated with adverse outcomes. Additionally, "theft/fake" prescription emerged as a source associated with adverse outcomes for college respondents, while "friend/relative" was associated with adverse outcomes for high school graduates that did not go on to college.Conclusions: This research has important clinical implications as it identified young adults with a college education as being less likely to obtain prescription drugs from sources known to be associated with adverse outcomes. It also highlighted how associations between sources and adverse outcomes vary based on educational attainment.

Patterns, Consequences, and Motives in Simultaneous Use of Prescription Stimulant Medication with Alcohol and Marijuana

Nonmedical use of prescription stimulants (NPS) continues to be a concern on college campuses. Previous research demonstrates a strong link between NPS and use of other substances, particularly alcohol and marijuana among college students. Simultaneous use of NPS with other substances has become an increasing concern. Given the high rates of NPS and simultaneous NPS with other substances, research examining substance use patterns and motives among students is warranted. Method: This study evaluated group differences in alcohol and marijuana use patterns, consequences, and motives among college students: a) with no NPS history (No NPS); b) engaged in NPS with no simultaneous use (Non-Sim NPS); and c) engaged in simultaneous NPS with alcohol and/or marijuana (Sim NPS). Participants included 1,108 students from three universities who reported past-year marijuana and alcohol use. Results: Overall, 32.8% reported lifetime NPS with 12.5% indicating NPS in the previous 3 months, of which 51.1% reported simultaneous NPS with alcohol and 40.2% with marijuana. Significant group differences for all drinking and marijuana outcomes were found, with heaviest rates among the Sim NPS group, followed by the Non-Sim NPS group, and the No NPS group. The Sim NPS group reported greater motives for using marijuana to alter the effects of other substances. Conclusions: College students engaged in simultaneous NPS with alcohol and marijuana are a high-risk group that should be the focus of prevention and intervention programs in the campus setting.

Social Norms vs. fear Appeals: Mixing Alcohol with Prescription Drugs - a Message Testing Study

The purpose of this study was to compare the perceived effectiveness of a social norms message to a fear appeal message regarding prescription drug use and alcohol interactions among college students. Participants: Participants (n = 378) were college students enrolled at a large public Midwest university. Methods: Researchers used a cross-sectional research design to collect data from undergraduate college students. Messages were randomly assigned to one of two residence halls and were assessed using an electronic survey. Participants anonymously evaluated the messages based on their understanding, interest, creativity, believability, relevance, and usefulness using an online questionnaire. Results: Results from the General Linear Model analysis indicated a significant effect for the gender x message interaction, with females rating the fear appeal message higher than males. Significant effects were also found for the main effects of gender, message type, and Greek status. Conclusion: Overall, students preferred the fear appeal to the social norms message. Participants found the social norms message less believable than the fear appeal and indicated they understood the fear appeal better than the social norms message. However, social norm messages appeared to resonate better with abstainers than with regular alcohol users.

How do medical and non-medical use of z-drugs relate to psychological distress and the use of other depressant drugs?

BACKGROUND

Z-drugs are hypnotic drugs used for insomnia with considerable potential of abuse. We investigated the relationship of past-year medical and non-medical use of z-drugs with past-year: i) psychological distress; ii) medical use, non-medical use, and DSM-IV use disorder of Benzodiazepine (BZD) tranquilizers; iii) use and DSM-IV alcohol and marijuana use disorders, recreational drugs with a depressant effect on the central nervous system.

METHODS

Data came from the 2015-2017 NSDUH (n = 128,740). Participants aged 18+ were asked if they had used any Z-Drug medically or non-medically in the past year. We investigated the associations between the three-level z-drugs variable with psychological distress and BZD, alcohol, and marijuana variables in multinomial logistic regression models.

RESULTS

Past-year prevalences of z-drug use were 3.3% for medical and 0.5% for non-medical use. Medical and non-medical users of z-drugs had higher risk of psychological distress, compared to non-users. Medical and non-medical users of z-drugs had higher risk of medical use, non-medical use, and BZD use disorders. Compared to non-users of z-drugs, medical users had higher risk of marijuana and alcohol use and alcohol use disorders, while non-medical users had higher risk of marijuana use and marijuana use disorders and alcohol.

CONCLUSION

Z-drug users have elevated risk of use and dependence of BZDs and recreational drugs, possibly due to concurrent prescribing and self-medication.

Nonmedical Use of Prescription Stimulants as a "Red Flag" for Other Substance Use

BACKGROUND

Nonmedical use of prescription stimulants (NMPS) has increased on college campuses during the past two decades. NMPS is primarily driven by academic enhancement motives, and normative misperceptions exist as well. However, large, nationwide studies have not yet been conducted to generalize findings more broadly and gain a deeper understanding of the relationship between NMPS and other substance use (e.g. alcohol use, marijuana, etc.). The present study was conducted to lay the foundation for prevention efforts related to NMPS by establishing NMPS prevalence, practices surrounding NMPS, and other substance use.

METHODS

N = 2,989 students from seven universities around the U.S. completed a web-based survey assessing NMPS practices and related behaviors. Prevalence and factors associated with NMPS were explored.

RESULTS

Analyses revealed a 17% past-year prevalence of NMPS with associated widespread misperceptions of peer use. NMPS was significantly related to alcohol use, binge drinking, and marijuana use, as well as skipped classes and affiliation with Greek life.

CONCLUSIONS

Although most college students do not report NMPS, those who do also are more likely to report alcohol use, binge drinking, and marijuana use, and NMPS could be a "red flag" for other risk behaviors worth exploring. Implications for prevention and intervention are discussed.

llicit Drug Use among College Students: The Importance of Knowledge about Drugs, Live at Home and Peer Influence

The problem of consumption of illicit psychoactive substances by students in higher education is not new, since it is in this age group that the highest prevalence of consumption of these substances continues to occur. This study aimed to describe the prevalence of illicit drug use among university students and to analyze the predictive factors and patterns of illicit drug use among university students in Portugal. A cross-sectional design and a stratified random sampling method were used (n = 840). A validated self-administered questionnaire was used, consisting of socio-demographic characteristics, information about the patterns of illicit drugs consumption, and knowledge and attitudes toward illicit drugs use. The prevalence of illicit drugs consumption was 22.2%, while overall students had a low level of knowledge and moderate scores when it came to the attitudes toward drug use. Being male, having changed residence after entering higher education, having friends who use illicit drugs and possessing knowledge on drugs increased the likelihood of consuming illicit drugs. The results of the study could help develop strategies to reduce use of illicit drugs in academic settings, giving special attention to the influence of peers and students who changed their residence after entering higher education.