Misuse of Prescription Stimulant Medication Among College Students: Summary of the Research Literature and Clinical Recommendations

Prevention Strategies for the Individual

The research findings summarized in this review suggest several specific strategies for preventing and reducing the misuse of stimulant medication among college students, a high-risk population. First, college students with a prescription for stimulant medication play a critical role. Not only do these students have a high rate of misuse themselves [28,66], but they are also the most common source from which other students obtain stimulant medication to misuse [11,67]. It is therefore important for physicians who provide college students with prescriptions for stimulant medications to discuss the possible consequences of misusing or diverting medication, including potential negative health outcomes, legal consequences, and on-campus repercussions, for students caught diverting stimulant medications. These practitioners should also monitor their patients for signs of diversion, such as finishing a prescription early, doctor shopping, or urine drug screen which is negative for the prescribed substance. Utilizing a prescription monitoring program to access information on the prescribing and filling of controlled substances can be a valuable tool in detecting multiple concomitant prescriptions for stimulant medications, number of providers writing stimulant medication, and information on the use of other prescribed controlled medications. Providers should also discuss safe storage of stimulant medications with patients, particularly if the student is currently living in a dorm setting or another community-type setting with the potential for lots of individuals in and around their personal belongings. Additionally, providers may wish to consider dispensing a small amount at each office visit until the patient has established responsible use of the medication, particularly if there are other findings or comorbidities that perhaps increase their risk of misuse. Pill counts and frequent office visits, as noted earlier, may also help prevent diversion.

Perceived risk/harm associated with the use of stimulant medications has been negatively related to misuse [18,20]. If college students were more aware of the risks associated with stimulant medication misuse, with regards to both health and legal consequences, fewer students may choose to misuse stimulants. Educating patients and their families about the abuse potential of stimulants, as well as consequences of misuse such as psychosis and agitation, when prescriptions are given for stimulant medication, may help address the misperception that stimulant medications are benign, safe and without adverse consequences.

College Policy Changes for Prevention of Misuse

Policy changes on college campuses could also help to reduce diversion of stimulant medications. For instance, education about the risks associated with stimulant medication misuse could be incorporated into other alcohol and drug prevention programs that are already in place at colleges and universities. Many colleges/universities require all first-year students to complete an online substance use education/prevention/assessment tool. Some of these, such as AlcoholEdu and The Alcohol eCHECKUP TO GO have demonstrated some success in reducing college student alcohol use in follow-up evaluations [68]. Information about misuse of stimulant medication could be included in these existing programs. Moreover, members of certain organizations (eg, fraternities or sororities) that are known for an increased risk of substance use/abuse among members are also sometimes required by their national chapters or host colleges/universities to complete a “risk management” class, which addresses behaviors such as binge drinking and drunk driving. Since one of the demographic factors most strongly related to stimulant medication misuse is Greek organization membership [14], presenting information about stimulant medication misuse to these groups during these classes could help reduce misuse on college campuses.