AAAP 2008: US College Students Abuse Stimulants More than Opioids

Study Reveals a "Startling Number" Use Injection as Mode of Delivery

Marlene Busko

December 12, 2008

December 12, 2008 (Boca Raton, Florida) — College students in the United States report abusing stimulants more than opioids, and a "startling number" use intravenous injection as a mode of opioid delivery, new research suggests.

Results from a national online survey examining nonmedical prescription drug use in this population showed that 29% of respondents used stimulants, 21% used opioids, and 50% used both. In addition, the results showed that a significant proportion commonly used injection as a route of administration.

"Almost 10% of students using prescription pain killers said that they injected the drugs, and this has major public-health implications, including the possibility of transmission of hepatitis or AIDS," the study's principal investigator, Richard C. Dart, MD, PhD, from the Rocky Mountain Poison and Drug Center, Denver Health and Hospital Authority, in Colorado, told Medscape Psychiatry.

"Psychiatrists treating college students for substance abuse should ask about the routes by which their patients are using the drugs, because this could identify more problematic drug users," he said.

The study was presented here at the American Academy of Addiction Psychiatry 19th Annual Meeting and Symposium by coinvestigator Alicia Montoya, from the Rocky Mountain Poison and Drug Center.

Dramatic Rise in Prescription Drug Abuse

According to the Centers for Disease Control and Prevention, poisoning is a leading cause of accidental death in the United States, second only to motor-vehicle accidents, and abuse of prescription drugs, a major component of poisoning, has been increasing "dramatically," said Dr. Dart.

Prescription drug abuse is increasingly seen among college students, but the motives, routes of administration, and sources of the drug are not well described. Better understanding is needed to develop effective prevention and intervention efforts, he said.

To explore the characteristics of college students who use prescription opioids and/or stimulants for nonmedical reasons, the researchers examined data from the Researched Abuse, Diversion, and Addiction-Related Surveillance (RADARS) system.

In December 2007, students who had attended college during the fall of 2007 were invited to participate in the national online survey. Respondents were asked to report use of any prescription drugs not specifically prescribed to them during the fall of 2007.

Reasons for Abuse

A total of 10,083 students responded to the survey, including 1662 students aged 18 to 29 years who reported nonmedical prescription drug use. Of the 1043 respondents who reported stimulant and/or opioid use, 523 used both, 298 used only stimulants, and 222 used only opioids. Females were more likely than males to use only opioids (64% vs 36%).

The most commonly used stimulants were amphetamines and methylphenidate, with rates of 68% and 38%, respectively. The most commonly used opioids were hydrocodone (57.31%), oxycodone (31.68%), and morphine (14.5%). Other opioids included buprenorphine, fentanyl, hydromorphone, methadone, and tramadol.

Students took stimulants or opioids for similar reasons, mainly to obtain a specific feeling. Strikingly, 29% used the drugs to treat withdrawal symptoms.

Table 1: Reasons for Stimulant and Opioid Use

Reason Stimulant Users, % Opioid Users, %
For the specific feeling or high it caused 65 70
Out of curiosity to see what the drug is like 52 49
To reduce social anxiety or to fit in 50 48
To treatwithdrawal symptoms 29 29

Prescriptions a Common Source

Although most students swallowed the drugs, up to 20% inhaled them and up to 10% injected them.

The most commonly inhaled drugs were buprenorphine, methadone, and methylphenidate, with about a quarter of users reporting this mode of administration.

The most commonly injected drugs were morphine (37%), fentanyl (15%), and oxymorphone (13%).

Table 2: Routes of Administration for Stimulants and Opioids

Route of Administration Stimulant Users, % Opioid Users, %
Ingestion 92 82
Inhalation 20 16
Injection 5 10

Legitimate prescriptions appear to be a common source. Stimulants were most commonly obtained from friends (59%) or physicians (45%). Similarly, opioids were mainly obtained from friends (46%) and physicians (47%).

Family members or other people were the source of 30% of drugs, less than 8% of the medications were stolen, and less than 5% were purchased over the Internet.

Stimulants were used more frequently for performance enhancement (eg, to help students stay awake when studying for exams), whereas opioids are used more to "party," said Dr. Dart.

"The study sampled a particular group of students who were willing to reply to a survey, and it was not designed to estimate prevalence," he cautioned. However, he added, it does shed light on the characteristics of this population and identifies that a significant proportion of students report abusing drugs by intravenous injection.

Dr. Dart and Ms. Montoya report being employed by the RADARS system.

American Academy of Addiction Psychiatry 19th Annual Meeting and Symposium: Paper Presentation Session 2. Presented December 6, 2008.

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