Student Perceptions of Methylphenidate Abuse at a Public Liberal Arts College

Prescription drug misuse and abuse are escalating national wellness crises.^i,2 Misuse involves the intentional or unintentional utilise of medications without a prescription, for purposes for which it was not intended, or in a way dissimilar from how it was prescribed.³ Prescription drugs are the tertiary nigh misused substances behind marijuana and alcohol, and young adults aged 18 to 25 years have the highest prevalence of prescription drug misuse.ⁱⁱⁱ

The 2018 National Survey of Drug Use and Wellness reported that 16.9 million Americans aged ≥12 years misused a prescription drug in the past yr.^four Prescription hurting relievers were the virtually misused drug, and approximately one.9 million young adults aged eighteen to 25 years misused pain relievers in the year earlier the survey was conducted.⁴ The other prescription drug classes that were frequently misused included sedatives, tranquilizers, and stimulants.^ii,4,5

Young adults aged 18 to 25 years misuse prescription drugs more than any other historic period-grouping, and prescription drug misuse has become a major business organization among higher students.^4,6 More than twoscore% of young adults in college study having misused some type of prescription psychotherapeutic drug at to the lowest degree once in their lifetime.⁵ This rising tendency of prescription drug misuse is paralleled past an increase in adverse wellness consequences, including emergency section visits and hospital admissions.^vii,8

The misuse of stimulants is associated with cardiovascular problems, psychiatric issues, and drug abuse or dependence.⁹ When stimulants are consumed with alcohol, they increase the risks for booze poisoning and alcohol-related injuries.¹⁰ At that place has been a dramatic increment in emergency department visits related to attention-arrears/hyperactivity disorder medications, with an increment from 2131 visits in 2005 to 8148 visits in 2010 amongst persons aged 18 to 25 years.¹¹

Other negative outcomes that may event from prescription drug misuse include drug overdose, initiating injection drug utilize, and decease.¹² The Substance Abuse and Mental Wellness Services Administration reported that more 2 million hospital admissions for substance abuse handling were recorded in 2017 alone.¹³

Previous studies of prescription drug misuse among college students have examined the run a risk factors and motivations for prescription drug misuse.^2,xiv,15 Some of these studies reported that being male person, beingness white, living off campus, and being a member of a fraternity or a sorority are risk factors associated with misusing prescription opioids.^2,14,xv In add-on, many young people perceive prescription drugs to be safer than illegal drugs, because they are prescribed by a physician.⁵ These attitudes are amplified by the dramatic shift in independence and the influence of peers among higher students.^16,17

The overarching theme is that peer influence and injunctive and subjective norms pose the virtually significant risks for starting prescription drug misuse, because peers are the master source of misused prescription drugs.^18-23 Considering subjective norms and normative beliefs play a function in the initiation of substance use, nosotros explored the normative beliefs and perceptions of respondents toward their peers' prescription drug misuse.

Although previous studies take increased our knowledge of the prevalence of, risk factors for, and motives for prescription drug misuse among college students, several issues remain unexamined. First, the design of prescription drug misuse varies considerably between individual colleges, and there are only few studies that focus on college students in particular geographic areas,^20,21 such as West Virginia, the country with the highest drug abuse in the nation.²²

Second, in that location is scant information regarding how higher students perceive prescription drug misuse equally a problem among their peers. Such information is essential to evaluate the needs of interventions that reduce prescription drug misuse from the perspective of college students. Furthermore, despite continued efforts by academic institutions and organizations,^24,25 at that place is a lack of sufficient data to demonstrate the effectiveness of specific prevention and intervention efforts. Proposed interventions range from educating students on the dangers and consequences of prescription drug misuse,²⁵ correcting the social norm that "everyone is misusing or abusing" prescription drugs,²⁶ to managing the surround with local law enforcement.^27,28

A cognition gap exists with respect to how college students perceive the availability and effectiveness of such interventions. Such knowledge is valuable to reveal the extent of attain of these interventions. Therefore, this written report aimed to examine college students' beliefs about prescription drug misuse amid their peers, and to examine their beliefs nearly the available and potential intervention efforts to reduce prescription drug misuse.

Method

We conducted a cross-sectional online survey among students anile 18 to 30 years who were enrolled at Westward Virginia University (WVU), the largest university in West Virginia. All the study instruments and procedures were reviewed and approved by the WVU Institutional Review Lath. After that approval, nosotros used a convenience and snowball sampling strategy to recruit participants using listservs, social media, and printed posters.

The survey was adult using Qualtrics XM (2016 Qualtrics; Provo, UT). Responses were collected from March 2017 to February 2018. All survey respondents provided informed consent to participate in the study before starting the survey. Participation in the survey was anonymous and voluntary. No incentives were provided for participating in the study.

The online survey contained questions regarding ­demographic characteristics, beliefs about prescription drug misuse amongst college students and peers, and beliefs virtually interventions for reducing prescription drug misuse among higher students (see Appendix). The participants were asked to study variables, including appointment of nascency, sexual practice, state of permanent residence, race or ethnicity, level in college, area of study, annual income, housing, membership of a social fraternity or sorority, employment status, and marital status (married, widowed, divorced or separated, never married, member of an single couple).

The perceived prevalence of prescription drug misuse among peers was assessed past asking whether the students knew someone who misused prescription drugs in the past 12 months. The perceived prevalence of prescription drug misuse among peers and college students was measured by 5 percentile ranges (0%-20%, 21%-twoscore%, 41%-60%, 61%-lxxx%, and 81%-100%).

A total of 3 classes of prescription drugs were assessed, including stimulants (eg, methylphenidate, amphetamines), sedatives/tranquilizers (eg, diazepam, alprazo­lam, lorazepam, clonazepam, zolpidem), and opioid analgesics (eg, hydrocodone plus acetaminophen, oxycodone/oxycodone plus acetaminophen, methadone).²⁶ The participants were asked which prescription drug course they believe was the most misused past their peers.

A total of 6 frequently reported motivations (which were identified from a review of previously published articles) were assessed, which included improving academic performance, reducing stress, recreational use (eg, to feel expert or get high), reducing nervousness in a social scene or to political party, enhancing athletic performance, and losing weight.^26-30 The participants were asked to report all the motivations underlying prescription drug misuse among their peers.

The participants were asked to written report all the sources (ie, peers, family members, the Internet, prescribers, pharmacists/pharmacist assistants, and others) from which their peers obtained the prescription drug for misuse. The ease of obtaining prescription drugs from each source was evaluated by calculating the hateful score of a 4-indicate response gear up ranging from very difficult (1) to very easy (iv).

The perceived relevance of prescription drug misuse as a problem among higher students was measured by asking how concerned the participants were about prescription drug misuse amid college students and peers, as well as whether the participants perceived prescription drug misuse every bit a trouble (truthful, imitation, not certain) for themselves, their peers, and higher students in full general. The response set for business organisation ranged from not concerned at all (1) to very concerned (4).

The participants were asked whether interventions were needed to reduce prescription drug misuse among their peers. The responses ranged from strongly disagree (1) to strongly agree (4). The perceived need was represented by the hateful score of the responses. The participants were asked nigh their sensation of whatsoever prescription drug misuse intervention and a electric current program that provides consulting services for prescription drug misuse (Student Assistance Plan) at WVU. The perceived availability was measured dichotomously (yes or no), with "yes" being divers every bit both of the questions having a response of "yeah."

The perceived effectiveness of iv prescription drug misuse interventions—the Pupil Assistance Programme, education on the dangers and consequences, correcting the social norm, and environment management—were represented by the mean score of a 4-indicate response set ranging from strongly disagree (1) to strongly agree (4).

The behavior of constructive prescription drug misuse interventions were explored by the post-obit open-ended question: "What would exist an effective intervention to reduce prescription drug misuse amidst peers/college students?"

Statistical Analysis

Frequencies, means, and standard deviations (SDs) were used to describe the written report sample. Bivariate association betwixt the students' characteristics and the misuse of prescription drugs by peers was assessed using chi-square statistics for dichotomous and chiselled variables. One-way analyses of variance and post-hoc pairwise comparisons using Tukey's Honestly Significant Deviation tests were conducted for continuous variables.

A P value of <.05 was considered statistically pregnant. All the quantitative analyses were conducted with SAS version ix.4 (SAS Establish, Inc; Cary, NC). The ATLAS.ti qualitative analysis tool (Scientific Software Evolution GmbH; Berlin, Germany) was used to analyze the responses to the open-ended questions using word frequencies and word deject.

Results

A total of 359 participants responded to the survey; later on removing the incomplete responses, we had 341 complete responses. After excluding the respondents who did not meet the age and enrollment eligibility criteria, we had 312 eligible responses that were used for statistical analysis.

Table i shows select demographic data for the respondents. The mean age of the respondents was 21 years (SD, 2.85). Approximately 68% of the respondents were women, and more than xc% of the respondents were enrolled as full-time students. More than 68% of the students reported that they live off campus, and 55.6% said they were employed either function time or full time.

Of the respondents, 38% said they believed that between 21% and 40% of all higher students misuse prescription drugs, and 65% of the respondents said they perceived that less than 40% of college students misuse prescription drugs. A total of 62% of the respondents reported knowing someone who had misused prescription drugs in the by 12 months (Table 1).

The respondents who did and did not study having peers who are misusing prescription drugs were like in nigh demographic characteristics (Tabular array 2). The percentages of male and female students who reported peer prescription drug misuse were like. Freshmen, sophomores, and graduate or professional students all reported similar rates of peer prescription drug misuse.

Peer prescription drug misuse was highest (seventy%) in individuals with a family unit income of ≥$50,000, and although prescription drug misuse did not differ significantly by blazon of residence, individuals who lived in off-campus housing reported slightly higher peer prescription drug misuse compared with those who lived on campus (65% vs 56%; P = .120). Students who reported having peers who misuse prescription drugs consisted of a significantly college percent of fraternity and sorority members than the students who did not report peer prescription drug misuse (83% vs 60%, respectively; P = .017; Tabular array ii).

Table 3 shows the perceptions regarding prescription drug misuse and interventions among respondents who reported peer prescription drug misuse. Stimulants were the most prevalent prescription drug misused. The most common reasons reported for misuse were recreational use (66%) and improving academic operation (51%). Most (85%) respondents said that peers were the most common source of obtaining prescription drugs for misuse. The majority of respondents noted that prescription drug misuse is a problem for college students (73%) and agreed that interventions are needed to reduce prescription drug misuse (67%).

Perceptions about the need for interventions differed significantly by peer misuse (P <.001), level of concern about college students' prescription drug misuse (P <.001), twelvemonth in schoolhouse (P = .004), state of residence (P = .03), and sexual activity (P = .04). Approximately 67% of individuals with peer prescription drug misuse agreed or strongly agreed that interventions are needed, whereas ninety% of individuals without peer prescription drug misuse agreed or strongly agreed that interventions are needed.

Awareness of the available interventions was lower for individuals who reported peer prescription drug misuse (P = .04), and a significantly higher proportion of individuals who responded "no" to being aware of prescription drug misuse interventions had peers who misused prescription drugs (78%). More 20% of participants with peer prescription drug misuse did non know about any available interventions compared with 11% of those without peer prescription drug misuse.

The perceived effectiveness of the Pupil Assistance Programme differed significantly between the peer prescription drug misuse groups (P = .04). Approximately seventy% of individuals without peer prescription drug misuse agreed or strongly agreed that the Student Assistance Program could be constructive at reducing peer prescription drug misuse compared with simply 56% of those with peer prescription drug misuse. The perceived effectiveness of prevention education differed significantly between the peer prescription drug misuse groups (P = .03).

Approximately 80% of individuals without prescription drug misuse agreed or strongly agreed that prevention instruction can exist effective compared with 69% of those with peer prescription drug misuse. The perceived effectiveness of social norm correction was lower for students who had peer prescription drug misuse (P = .005), and more 70% of students without peer prescription drug misuse agreed or strongly agreed that social norm correction would be effective at reducing peer prescription drug misuse compared with 58% of those with peer prescription drug misuse.

The perceived effectiveness of environmental direction differed significantly for those who reported peer prescription drug misuse compared with those who did not (P <.001), and approximately 70% of respondents without peer prescription drug misuse agreed or strongly agreed that environmental direction would be effective at reducing prescription drug misuse at their higher compared with 40% of those with peer prescription drug misuse (Table 3).

The responses to the open-ended questions that asked what type of interventions should piece of work best to reduce peer prescription drug misuse (run across Appendix) were multifaceted. A total of 136 responses were nerveless. The respondents with peer prescription drug misuse were twice equally likely to provide a response to the open-concluded question than those without peer prescription drug misuse (67% vs 33%, respectively). We identified 12 common features from all the responses and classified them into iii primary themes—chief prevention, harm reduction, and no demand for intervention (Table iv).

A total of 21 (fifteen.4%) respondents perceived no demand for an intervention. For the primary prevention theme, 53 (53.five%) respondents proposed some grade of educational intervention, 20 (20.two%) proposed addressing reasons for prescription drug misuse, and 14 (14.1%) proposed policy or law enforcement. For harm reduction, xiv (43.8%) proposed removing barriers to intervention, ten (31.three%) proposed family or peer support, and 9 (28.1%) proposed professional handling for drug use disorders (Table 4). Some examples of the interventions suggested by the survey respondents to the open-concluded questions are shown in Table 5.

Discussion

The current study explores the perceptions and beliefs of college students regarding prescription drug misuse among their peers. The results of this study show that peer prescription drug misuse is prevalent among college students, and that students perceive that the current interventions used to address prescription drug misuse are not very effective or may not exist targeting the right population. Peer prescription drug misuse was very common among college students in our study and more l% of the respondents knew a peer who had misused prescription drugs in the past 12 months.

Approximately 62% of college students in our report reported having a peer with prescription drug misuse; this prevalence of peer prescription drug misuse was higher than those reported by previous studies.^31,32 Using a sample drawn from a large midwestern Usa academy, Hall and colleagues reported that the rate of peer prescription drug misuse was 44%,³¹ whereas Babcock and Byrne found that the prevalence of peer prescription drug misuse was 53.4% amidst respondents attending a northeastern Usa liberal arts college.³²

The greater prevalence of peer prescription drug misuse in this written report may reverberate an overall increase in prescription drug misuse over the past xv years,^33-35 or may be related to the increased opioid and other drug-related problems that West Virginia has faced within the by decade.^three,36,37 Furthermore, this may as well depict the regional variation in prescription drug misuse previously reported by Cicero and colleagues that showed a greater prevalence in rural, suburban, and small- to medium-sized urban areas.³⁸

This study'southward results show that the survey respondents underestimated the prevalence of prescription drug misuse among college students. Virtually 65% of the respondents thought that less than 40% of college students misused prescription drugs, which is lower than the prevalence reported in the literature.^31,32 Findings from previous studies prove that college students often overestimate the prevalence of drug misuse among their peers.^21,39

Consistent with previous studies,^nine,forty stimulants were the most often misused drug course, accounting for almost 75% of all reported peer prescription drug misuse in our study. These numbers point that prescription stimulant misuse is emerging as a significant problem amidst college students, predominantly for academic purposes to increase alacrity, ameliorate concentration, and aid in studying.⁴¹

This ascent tendency in stimulant misuse may be traced to easier access to these medications through peers and family members who receive prescription stimulants from their physicians. Approximately 60% of the college students in our written report reported that drugs that their friends misused were sourced from peers, which included friends, roommates, or classmates. This finding is similar to previous studies reporting that the most common sources of prescription drugs misused by college students are peers and family unit members.^{6,9,xvi,33,34}

In our report, students who were members of a fraternity or sorority perceived less demand for interventions than individuals who were not members of a fraternity or sorority. Individuals who had peers with prescription drug misuse were less likely to be aware of available interventions and to perceive a lower need for prescription drug misuse interventions. Nigh 90% of individuals who did not take peers with prescription drug misuse agreed that interventions were needed to address prescription drug misuse at their college, whereas but 66% of students who had peer prescription drug misuse agreed that in that location was a need for whatsoever intervention.

These differences may be explained past normative beliefs within friend groups of students with peer prescription drug misuse versus those without peer prescription drug misuse. Several studies have established the role of injunctive norms, which refers to the perceived approving of the behavior by their peers, in the initiation of drug use behavior.^21-23,35,36 Perceiving that their peers would corroborate of drug misuse beliefs may encourage or help maintain this behavior. This peer approval may manifest as complacency toward the need for, and effectiveness of, the available interventions.³⁷

This finding has significant implications for researchers who are designing interventions on higher campuses to address prescription drug misuse. Targeting students who misuse prescription drugs, equally well every bit their peers, may yield amend results than focusing solely on the students who are misusing. Interventions that are aimed at the peers of students with prescription drug misuse should focus on increasing their perceptions almost the need for interventions and the negative consequences of prescription drug misuse.

Among the three major themes identified from the participants' written responses regarding interventions, master prevention was the near prominent, with 72.8% of respondents recommending that interventions that implement main prevention approaches, such as pedagogy and addressing or removing the triggers for prescription drug misuse amid college students, would be constructive.

Didactics should focus on informing students most the possible short- and long-term effects of prescription drug misuse, changing misconceptions regarding stimulant use for academic reasons, and teaching coping techniques to deal with stress. A 19-twelvemonth-onetime female educatee suggested the following education strategy, stating "Students need to be presented with the facts. We, as a whole, need to finish acting like drug misuse isn't an extremely severe result in our current country. Students need to hear testimonies from other students, families, recovering addicts, people in general who lose someone to addiction. I personally have lost a significant other to an opioid overdose. I hate seeing young people all through my town, my state, and my country existence torn down past addiction. We need to exercise something, annihilation."

The second near prominent theme was harm reduction approaches for students who are already misusing prescription drugs, including removing barriers to intervention (eg, stigma, price, and access), peer and family unit support, and getting assistance from a professional. While proposing a harm reduction strategy, a 24-yr-onetime female person student stated, "I retrieve pedagogy on the dangers of overdosing. Also, people who demand help tin can get the assist they need without being punished. Information technology too needs to be affordable or gratuitous." Previous studies take explored various harm reduction strategies to help young people with drug misuse.^42-44

The third prominent theme was that interventions were non needed. The respondents who supported this theme had more positive attitudes toward prescription drug misuse amid higher students, and this was correlated with having peer prescription drug misuse. This suggests that having friends who misuse prescription drugs shapes the perceptions about the behavior and its acceptability and decreases the level of business organisation well-nigh the harms and negative outcomes of prescription drug misuse.

Limitations

This study has several limitations that need to be considered when interpreting the results of this study. First, the cross-exclusive design of the written report precludes whatsoever causal inferences; therefore, we cannot assume whatsoever temporality of events.

In add-on, the participants were asked near their peers prescription drug misuse, and this approach may overestimate the prevalence of prescription drug misuse on the campus; different individuals might have had mutual friends, and 2 respondents might have been referring to the same person when reporting peer prescription drug misuse.

Finally, we used a convenience sampling arroyo to recruit participants for this study; hence, the results may non be generalizable to the entire student population in the United states.

Conclusion

This is the showtime written report to explore the perceived needs for interventions among peers of college students who misuse prescription drugs and the perceived effectiveness of available interventions. The insights generated from this study may help to explain why many interventions practise not produce the expected outcomes on college campuses. The inclusion of open up-ended questions provides valuable insights from friends of students with prescription drug misuse nearly how to blueprint interventions that may piece of work for their peers. This insight is valuable for researchers and university officials to use when designing future interventions. Farther research is needed to empathize why students with peer prescription drug misuse perceive very little need for interventions and have fewer positive perceptions about the effectiveness of bachelor interventions. Futurity studies could focus on understanding the perceptions of impairment and consequences of peer prescription drug misuse amidst individuals with peer prescription drug misuse compared with those without peer prescription drug misuse.

Author Disclosure Statement

The authors have no conflicts of involvement to study.

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