College Kids May Abuse Painkillers to Ease Psychological Distress

Megan Brooks

June 18, 2012

June 18, 2012 — College students could be abusing opioid painkillers, sedatives, and other prescription drugs to inappropriately self-medicate for psychological distress, new research suggests.

Investigators Keith J. Zullig, PhD, MSPH, associate professor from West Virginia University School of Public Health, in Morgantown, and Amanda L. Divin, PhD, assistant professor from Western Illinois University Department of Health Sciences, in Macomb, Illinois, found that depressive symptoms and suicidality were significantly associated with a greater likelihood of using nonmedical prescription drugs, particularly painkillers in women.

"The complex and problematic relationship of depressive symptoms, suicidality, and NMPDU [nonmedical prescription drug use] on college campuses demands a multifaceted, collaborative, coordinated response, and cannot be left solely to campus healthcare providers, counselors, and mental health centers," the researchers write.

The study is published in the August issue of Addictive Behaviors.

Psychological Distress Rising

The investigators note that NMPDU among college students has been on the rise since the early 1990s and is now considered to be at epidemic proportions and a major public health threat. Psychological distress also appears to be increasing among college students.

To explore NMPDU and depressive symptoms in college students, the researchers analyzed data from the fall 2008 American College Health Association–National College Health Assessment (ACHA-NCHA), a national research survey that addresses 7 areas of health and behavior of college students. One of these areas is alcohol, tobacco, and other drug use.

Included in the sample were 22,783 randomly selected college students from 40 campuses across the United States. The students were asked about NMPDU (including painkillers, stimulants, sedatives and antidepressants) and mental health symptoms within the prior year.

Roughly 13% of the sample reported NMPDU. After adjusting for key behavioral and demographic covariates, those who reported feeling hopeless, sad, or depressed or who said that they had considered suicide were 1.22 to 1.31 times more likely to report NMPDU (P < .05).

Among the key findings:

  • Students who reported feeling hopeless, sad, or depressed were 1.18 to 1.43 times more likely to report using opioid painkillers.

  • Students who reported feeling sad or depressed or that they had considered suicide were 1.22 to 1.38 times more likely to report stimulant use.

  • Students who reported being depressed were 1.36 times more likely to report sedative use.

  • Students who reported feeling hopeless or depressed were, respectively, 1.44 and 1.91 times more likely to report using antidepressants.

"When the adjusted models were repeated separately by gender, results were more pronounced for females, especially for females who reported painkiller use," the researchers write.

"We were surprised by the strength of the associations with opioids, particularly for females. It looks like a lot of these findings were driven by women in the study," Dr. Zullig told Medscape Medical News.

"Curiously," he added, "from the literature search, women appear to be prescribed opioids at higher rates than men, and their physiology makes them more susceptible to have problems from opioids than men, so this could be 1 contributing factor among many."

Mental Health Outreach Critical

"As our study demonstrates, use of prescription drugs, particularly painkillers like Vicodin [acetaminophen and hydrocodone] and Oxycontin [oxycodone], is related to depressive symptoms and suicidal thoughts and behaviors in college students," Dr. Divin added in a statement. Therefore, "mental health outreach on college campuses is particularly important."

In their article, the researchers say it remains unclear whether drug use "causes psychological distress, psychological distress leads to drug use, or drug use and psychological distress are caused by other common risk factors."

Nonetheless, they say their findings "highlight the significance of examining any NMPDU as well as the individual categories of drugs when analyzing depressive symptoms and suicidality."

"Considering how common prescription sharing is on college campuses and the prevalence of mental health issues during the college years, more investigation in this area is definitely warranted," Dr. Divin said. "Our study is just 1 of the many first steps in exploring the relationship between nonmedical prescription drug use and mental health."

The authors have disclosed no relevant financial relationships.

Addict Behav. 2012;37:890-899. Abstract

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