Illicit Use of Specific Prescription Stimulants Among College Students:  Prevalence, Motives, and Routes of Administration

Background:  The illicit use of prescription stimulants has been well studied over the past 5 years; however, most of the information available only includes methylphenidate formulations of stimulants and does not assess the abuse of amphetamine-methamphetamine products. 

 

Objective:  The purpose of this study was to explore the illicit use of specific prescription stimulants among college students and to add to our understanding of the motives and routes of administration associated with the illicit use of these drugs.

 

Methods:  This was a cross-sectional, observational study.  The study was conducted at a midwestern university between the months of January and February of 2005 and consisted of a web-based survey pertaining to the illicit use of prescription stimulants.  A random sample of 5389 full-time undergraduate students was drawn from the total population of 20,138 full-time students.  In addition the surveyors over sampled 652 Hispanics, 634 African-Americans, and 244 Asians.  Sixty-six percent of the sample completed the survey, leading to a final sample size of 4580 undergraduate students.  The primary outcome measures were the overall prevalence rates for lifetime and past-year illicit use of prescription stimulants, prevalence rates of motives of use, and the prevalence rates of the routes of administration.  The secondary outcome measures were the prevalence rates for illicit use of prescription stimulants, motives for use, and routes of administration for subgroups defined by sex, race-ethnicity, and age of onset.  Multiple logistic regression analyses and Chi-Square tests were used to evaluate the study.

 

Results:  The prevalence rates for lifetime and past-year illicit prescription stimulant use were:  8.3% and 5.9%, respectively.  Approximately 75.8% of users admitted to taking amphetamine-dextroamphetamine products, and approximately 25.5% reported using methylphenidate products.  There were statistically significant ethnic-racial differences in the past-year use:  Hispanics 8.5%, Caucasians 7.0%, Asians 3.4%, African-Americans 1.9%, and others 3.6% (p<0.001).  Sixty-five percent of the reported lifetime users reported they started taking prescription stimulants while in college compared to 34.8% who started before college.  The most commonly reported motives for use were help with concentration 65.2%, help study 59.8%, increase alertness 47.5%, get high 31.0%, and experiment 29.9%.  Men were more likely than women to report using prescription stimulants to experiment (p<0.05) and to counteract the effect of other drugs (p<0.05).  Women were more likely to report using prescription stimulants to lose weight (p<0.001), to help study (p<0.05), and to increase alertness (p<0.001).  Approximately 95.3% of stimulant users reported oral administration, 38.1% reported snorting these drugs, 5.6% reported smoking these drugs, and <1% reported other uses of these drugs.  Students who began using stimulants before college were more likely to report snorting these drugs than students who started during college (p<0.01).  Students who started using stimulant drugs during college were also less likely to report smoking these drugs (p<0.01).  The authors conclude amphetamine-dextroamphetamine was the most prevalent stimulant drug used illicitly by college students, at a rate 3 times higher than that of the methylphenidate formulations.  Therefore, studies, which use methylphenidate as the only indicator for abuse, may underestimate the prevalence of this form of drug abuse.  The findings of high rates of intranasal use of these drugs, highlights the need for education and prevention efforts aimed at reducing this dangerous behavior.

 

Strengths:  The design of this study was appropriate for the information requested.  An institutional ethical review board at the midwestern university reviewed the study.  The statistical tests were appropriate for this type of data.

 

Weaknesses:  This study was a cross-sectional observational study and only measures the current status of a condition at one point in time.  The survey was only conducted at one university, which may misrepresent the true population.  The possibility of bias or false reporting is always an issue to consider when evaluating data presented from a survey.  The power of the study was not reported.

 

Conclusion:  Amphetamine-methamphetamine formulations may be more prevalent than methylphenidate formulations in prescription stimulant drug abuse.  However, the study only provides information provided by one university and may not represent the national population.  This study raises many new questions regarding the illicit use of prescription stimulant drugs and may be a key in understanding this issue as a whole.

 

Teter CJ, McCabe SE, LaGrange K, Cranford JA, Boyd CJ.  Illicit use of specific prescription stimulants among college students:  prevalence, motives, and routes of administration.  Pharmacotherapy 2006;26(10):1501-1510.

 

Carrie M. Simpson, Pharm.D. Candidate