Dr. Erica Phillips, Associate Director in the Center for the Study of Student Life at the Ohio State University, is this episode's guest. During the interview, Erica discusses key findings from the College Prescription Drug Study (which she helps to coordinate), talks about where college students are getting prescription drugs to misuse, some of the top reasons students misuse medication, plus much more.
Rich Lucey: Hi, this is Rich Lucey in the Drug Enforcement Administration’s Community Outreach and Prevention Support Section and welcome to this edition of "Prevention Profiles: Take 5," our podcast series that we feature on our website, www.campusdrugprevention.gov.
I welcome you to the podcast and especially welcome today’s guest, Dr. Erica Phillips from the Ohio State University, so before we get to say hello to Erica, let me tell you a little bit about her.
Dr. Erica Phillips is an Associate Director in the Center for the Study of Student Life at the Ohio State University.
She conducts and coordinates multi-institutional research projects, including the study on collegiate financial wellness and the college prescription drug study.
She also works on assessments with student life departments in the areas of health and wellness.
Erica earned her Masters and Doctorate degrees in sociology from Ohio State.
Her research interests include higher education, student health and wellness, student finances and inequality.
She recently published her research in the Journal of Student Affairs Research and Practice and the Journal of Family and Economic Issues.
And with that, Erica, welcome to the podcast.
Erica Phillips: Great, thanks, Rich and thanks so much for having me today; I’m delighted to be here talking about the College Prescription Drug Study.
And it’s such an important issue and we’re going to get right into some of the findings and what their implications are, but before we get into the five questions proper, tell our listeners a little bit about the college prescription drug studies purpose and who the respondents are.
Phillips: Sure, most definitely.
So the college prescription drug study, which I’ll also refer to as CPDS, that’s sort of its acronym, it’s a multi-intuitional study of undergraduate, graduate and professional students.
So our student respondents are students who are at all levels of post-secondary education, whether that’s undergraduate or beyond.
We intentionally include graduate and professional students in addition to undergraduates, because prescription drug use non-medically is an issue that potentially affects all of these students, not just undergraduates.
The study itself examines the non-medical use of prescription drugs, including usage patterns of these drugs, reasons for and consequences of use, access to prescription drugs and perceptions of use among students.
We especially focus on three types of drugs, which are pain medications, sedatives and stimulants.
Our goal is to understand more about use among college students particularly, because there’s not a lot of information out there really specific to trends in use among college students.
So through my office, the Center for the Study of Student Life, as you said, we administer the CPDS every three years.
So it was first administered in 2014-2015 and then the most recent administration, which is the one I’ll be talking about today, was administered in 2018.
In 2018, we had 26 higher education institutions participate.
Mostly these were four-year institutions, a lot of four-year public institutions, but some four-year private institutions.
And then we also had one two-year institution participate.
So in the future, we’ll be, you know, hoping for more two-year institutions as we move forward with this.
But any institution can participate in the study, so we didn’t necessarily choose the institutions, it was whatever institutions, you know, wanted to participate.
We were like, great, let’s have you participate.
So as these 26 participating institutions, we have information for over 19,000 respondents, about their patterns of use or for the most part, non-use of prescription drugs, be that pain medications, sedatives or stimulants.
Is there anything else about the study you might want to know?
So, so actually, how does a school become a participant?
Is there a solicitation that goes out or how do they find out about it?
So schools find out about the study through a variety of channels.
We send emails to health and promotion officers or alcohol and other drug prevention specialists at colleges and sort of recruit them to potentially participate in the study, you know, to be the champion of this study on their campus potentially.
So institutions can participate in that way, if they get an email from us, but any institution that wants to participate can email us at, you know, its firstname.lastname@example.org.
And they can email us and we will, you know, sign them up to participate in the next iteration of the study.
So that’s kind of how, how this study works.
The study is free for institutions to participate in, in 2018.
We’re hoping to keep that same in 2021, so you know, we really want this to be information that practitioners can really be using to inform what’s going on, on their campuses.
Lucey: That’s really great to hear and just, you know, spontaneously, I’m making a note to myself.
So when it comes time to solicit for the next administration of the survey, I think I can say with relative assurance, we’d be happy to help you promote that on the website, campusdrugprevention.gov if you want to pursue that avenue.
You know, it’s something we would put on like the homepage and the carousel, if you will, that you know, gets highlighted for anywhere from two to four weeks usually.
And it would just drive traffic to you if schools are interested.
Phillips: Yeah, that would be great, thanks.
Lucey: OK, yeah.
So now that we know a little bit about the study and what it encompasses, thank you for that overview, because the questions I’ve prepared really drill down into not only the types of classes of drugs, if you will, but the reasons and the consequences, all that good meaty stuff about, about the connections and all the different issues related to prescription drug misuse among college students.
So I’m going to dive right in here and our first question.
One of the key findings from the study focuses on the frequency with which students are misusing prescription drugs, especially stimulants.
What did the study find in terms of the rates at which college students have ever used a prescription medication for non-medical reasons and when did these students typically begin to misuse prescription drugs?
Phillips: Yeah, these are great questions.
So as I said earlier, the CPDS really focuses specifically on the pain medications, sedatives and stimulants.
And so as you kind of alluded to, about 16% of student respondents shared that they had used stimulant medications non-medically and additionally, about 9% of students reported using sedatives or pain medications non-medically.
Now what’s key here is that they, that is, had they ever used those.
So not “have you used them in the past 30 days, have you used them in the past 12 months”?
It’s just have you ever used those?
And then the way the study is constructed is that anyone who says they’ve ever used those, then we drill down a little bit more and ask them a little bit more about how often they’ve used them and also thinking about sort of when they start using them.
So for students who had sort of ever used these prescription drugs non-medically, about 37% of students who reported using stimulants non-medically said that they had not used stimulants in the past 12 months.
So we feel pretty excited about this, that about a third of students relay yes, I’ve used stimulants non-medically in the past, about a third of them are then saying, but I haven’t used them in the past 12 months.
This also, of course, means that 63% of stimulant misusers had used stimulants non-medically in the past year.
So again, it’s how you want to sort of look at the, look at the answer to the question in terms of where you want your focus to be.
But there’s definitely, once you kind of drill down a little bit more into it, you kind of can understand even more about what are the most recent patterns of use, in addition to just general trends and having ever used stimulant medications non-medically.
It’s the same kind of situation for sedatives and for pain medications.
So among non-medical users, sedatives, 42% had not used sedatives non-medically in the past 12 months and among pain medication users, 45% had not used them non-medically in the past 12 months.
So you know, that’s positive in terms of knowing that a piece of the population who is using these substances non-medically, they’re not necessarily using them with a high regularity in terms of how they’re reporting it.
And the CPDS is able to get at kind of those different pieces of information, which can be, you know, helpful.
The other piece in terms of some of the things that we’ve looked at is looking at trends of use among students in terms of class rank.
And one of the things that’s sort of interesting here is that there’s a bit of an upward trend in the likelihood to say that you had ever misused as your class rank increases.
And this is pretty much the case across the board for the three kind of classes of prescription drugs.
So for example, with stimulants; 10.1% of first year students reported that they had ever used stimulants and this is ever used.
So 10.1% of first year students reported they had ever used stimulants, compared to 25% of students in their fifth year or beyond as undergraduates.
So we’re going from, you know, 10.1% to 25% who are saying they had ever used.
And this really gets to a little bit of your second question here, which is when do they start using, because students are more likely to start using during college.
I mean, this is really important in terms of campus prevention efforts and thinking about the work that you all are doing, because we really do know from this study that a lot of students are starting to misuse these substances during their time in college.
So that’s kind of important, too.
Or I think it’s important, I guess the researcher.
Lucey: Are you seeing that a significant as opposed … a significant number are starting in college as opposed to having started, say in high school?
So there are some differences here.
So we asked students, you know, kind of when did they start and we went as far back as did you start in elementary school, in middle school, in high school, in college?
So about half of students who reported using sedatives non-medically said that they started in college.
And about 65% of students who reported ever using stimulants non-medically said that they started doing them in college.
So about two-thirds of students who are saying yes, I used stimulants non-medically are saying that they started using them in college.
The second most sort of reported option, though, is high school.
So it really hones in on the fact that students are starting to use these substances in high school or college.
College is more likely for the stimulants significantly but also for the sedatives.
For pain medications, though, about 48% of students who had ever used pain medications non-medically said that they started using in high school, compared to 39% of students saying they started to use pain medications non-medically in college.
So something different is going on with pain medications in terms of when students were reporting their use.
So we’ll keep an eye on this in the next administration, to kind of see are these patterns were the same as we take cross-sections of data or are there, you know, shifts in sort of how students are reporting that and what that might mean.
Phillips: But overall, students are using and are more likely to start using prescription medications non-medically in college and if they’re not starting in college, then they’re usually starting in high school.
Lucey: This is all really interesting and we’ll get into a little bit more when we talk about some of the consequences and reasons, so I’m glad we’re able to start to set the groundwork, if you will, for some of the frequency rates and when students have used.
So let me move onto our second question.
According to the 2017 National Survey on Drug Use and Health, which is administered by SAMHSA, the Substance Abuse and Mental Health Services Administration, we know that, and this has been reported, you know, yearly and this has pretty much been constant for the last several years, that, that more half of people who misused pain relievers in the past year got those pain relievers the last time they misused from a friend or a relative.
Now according to the CD, CPDS, where are college students getting the prescription drugs that they’re using for non-medical reasons?
So similar to the National Survey on Drug Use and Health from SAMHSA, the college prescription drug study is also finding and did find that more than half of college students who reported sort of non-medical use pain medications were getting them from a friend or relative.
So the number from our study is 51%, saying that they got the medication from a friend and about 19% reporting that they obtained it from a relative.
And additionally, in over two-thirds of the cases where students were saying, you know, yes, I got my pain medication from a friend, a peer or a relative, they’re also saying that that friend, peer or relative gave them the medication.
So it’s sort of interesting in terms of pain medications and across all of these, because usually the students are reporting that they were given the medication, rather than that they sold it.
So you know, it’s two-thirds, so about 66% or so saying, you know, my that friend, peer or relative gave me the medication; 18% of students are saying that they paid their friend or relative for the medication.
And these patterns are the same for sedatives and stimulants.
The one interesting sort of piece that’s different with stimulants is that students were much more likely to get them from a friend, rather than a relative.
So you know, about 80% of students said they got them from a friend and only 7% said they got them from a relative.
And that’s pretty different than the 19% of students who are saying they got a pain medication from a relative.
Lucey: So, so let me just ask you about that and perhaps this might just be a complete presumption and I admit that right up front, so, but is it possible that the preponderance of obtaining prescription stimulants for non-medical use coming from friends really connects somewhat to the fact that stimulants are being much more misused among the college student population than say sedatives?
I think that certainly is possible.
I think there are also different narratives that exist, which you know, maybe we’ll get into a little bit later, but narratives around sort of the danger of these different substances or the consequences of use for these different substances.
And also just the availability of these substances.
You know, many students have actual prescriptions for stimulant medication that they actually use and you know, on a college campus it’s potentially, there are potentially more opportunities.
So it might also have to do with our study being really focused around college students, rather than sort of the general young adult population.
So now I want to move onto our next question and we’ll start now to dig into some of these reasons.
Based on what you found in the study, what are the, some of the top reasons that college students, using prescription drugs for non-medical reasons?
So the CPDS found that students’ reasons for using prescription drugs non-medically varies a bit by the type of drug.
So for example, students who reported misusing stimulants overwhelmingly reported that they were doing so to study or improve their grades.
It was about 80% of students who said I’m using stimulants non-medically to study or to improve my grades.
For pain medications, though, students reported that they were wanting to get high, to relieve pain or to see what it was like as kind of their top three reasons for use.
Similarly, with sedatives, top reasons for use were to sleep, to relieve anxiety or to get high.
So we see kind of some connections in pain medications and sedatives, they’re rather different than sort of reasons for use for stimulants.
But while you can see that, you know, experimentation with new substances perhaps plays a role with students for saying their reasoning is to get high or to see what it was like, you can also kind of see that there’s potentially some self-medication happening with students saying they’re using non-medically to sleep or relieve anxiety or pain.
So there still are some pieces there that I think will require additional research and require more teasing out in terms of really understanding why students are using these prescription drugs non-medically.
Lucey: So my very first interview for the podcast series, now going back, you know, a good year plus, was with Dr. Nora Volkow, the Director of the National Institute on Drug Abuse.
And we talked about this very issue and she talked about some of the research that exists around the whole issue of why students are misusing prescription stimulants.
In the, you know, I’ll say misguided belief that it’s going to help them improve their grades.
And, and so, my follow up question to you on, you know, why students are misusing and I’m going to just zero in on prescription stimulants, because we know that’s the class of prescription drugs that college students are misusing most.
If a significant number of students are misusing prescription stimulants, because they think it’s going to help them improve their grades, from your perspective, what is some of the messaging that should be promoted to help, you know, prevent this misuse from happening?
Phillips: Yeah, that’s a great question.
Messaging to students is vital in my view, in terms of helping them to understand kind of three pieces.
So one, most, I think yes, sorry.
So three pieces.
So the first being that most students are not misusing prescription drugs.
So while our study finds that 15.9% of students do report ever misusing stimulants, that’s not the, most students.
I think the second piece is exactly what you said in terms of the connection between stimulant use and improved grades or improved academics.
It is not distinctly or supported in the research in medical literature on this topic.
So there is not sort of support for that assumption and so messaging is really important in terms of dissuading students from making that assumption.
And then third, you know, really getting the messaging out to students that there are real dangers associated with using these substances non-medically, you know, beyond the scope and not under the care of a doctor or pharmacist.
So I think that messaging is really important in that way.
And one of the exciting things about this CPDS in terms of how it connects to that messaging is that, you know, I work with colleagues here at Ohio State and also you know, at the participating institutions when, you know, desired or asked for, to kind of work on social norming campaigns, for example.
So our Student Life/Student Wellness Center here is using the CPDS results to develop a social norming campaign with the goal of helping students to understand that the vast majority of their peers are not misusing prescription drugs, especially when it comes to stimulants.
And our colleagues in the College of Pharmacy who we partner with as well are doing similar messaging and education around for safe use and misuse through their Generation Rx initiative, which has kind of a college focus for part of it.
So in this way it’s really exciting to, you know, have a chance for some of these numbers to potentially be used to educate students about, you know, what use and misuse really look like and what are some of the, the difficulties around making assumptions of your perceptions of use.
So thank you so much for three concrete, you know, actually these three guidance points for prevention practitioners, both on college campuses and in the surrounding communities who are working with colleges and universities, you know, I’ll just reiterate what I heard is that one, and we know this even of many other substances, is that the majority of students, most students are not misusing and so there is that mentality that, you know, everybody uses and so like, I know there’s enormous perception correction that can happen there, right?
That we certainly can be, to be doing.
Second is again, stressing that this perceived connection between non-medical use of prescription stimulants and an improvement of grades is just not supported.
I know that other studies certainly, Dr. Amelia Aria has done plenty of studies on this with others as well, that it just does not support this.
And Dr. Volkow talked this, talked about this very issue, that there is no research to support this, this thinking that if I misuse or take a prescription stimulant I’m not supposed to, I’m not, you know, I don’t have a prescription to take it, but I’m going to take it, because I’m going to get a C to an A or a B to an A, that’s just not supported.
And so I think it’s important that you brought that up and then thirdly, stressing the real dangers of misusing, that you know, a lot of times people don’t truly know what they’re putting inside their bodies.
And especially if you’re not prescribed to take a medication, you really need to be thinking about that.
Phillips: Yep, I’m nodding along over here.
Lucey: Yeah, so I really appreciate that.
I just wanted to … I like the whole idea of the list of just these three things.
So, so, thank you for that.
I’m going to move onto a fourth question now.
So we talked a little bit about the reasons that college students are misusing prescription drugs, but your study also touches on the consequences of misuse and having read the study, I was, you know, interested in these different things.
Again, I think it might depend on the class of drug, but what are some of the most frequently reported consequences among students?
So the most frequently reported consequences of their use of both sedatives and pain medications were that students reported they had experienced memory loss, they’d been depressed or they’d done things they wished they hadn’t.
The story with stimulants was a little bit different, though, because for stimulants, 60% of students who had ever misused stimulants said that the consequence was a positive effect on their academics.
So again, we’re getting back to kind of that messaging discussion around perceptions a little bit.
But some non-medical users of stimulants also said that the consequences of their use had been emotional problems or depression.
So again, across all three of these classes of, for the drugs, depression came up as, you know, one of the top three consequences, which I think is something we want to continue to think about in terms of some of these side effects or consequences of non-medical use as well.
Lucey: So you just actually just touched on it and I wanted to use that as a follow-up question for you.
So I was, this struck me when I read the study and the results that one of the consequences reported by students who misused prescription stimulants was, is a positive effect on grades.
So that struck me, because of what we just discussed.
So do you know if that’s a true positive effect on grades or is that what we were talking about earlier, that’s from the student’s perspective, a perceived positive effect on grades.
Phillips: So it’s a perceived effect in that students are self-selecting and self-support, self-reporting, pardon me, in terms of these consequences.
So students are self-reporting that one of the consequences of their stimulant non-medical use was a positive effect on their academics.
So it’s not objectively known and I think, you know, if you think back to the messaging piece, this is where other research, that sort of has an experimental design or that, you know, can have like a pre-post design is more able to get at was there actually any kind of effect, whereas our research is more about what are students’ attitudes towards their use, in terms of reasons for and consequences.
So just knowing that the perceived effect is positive, I think is really important in terms of helping students to understand and to potentially change behaviors around whether or not they want to be using stimulants non-medically.
Lucey: I’ll harken back to again my interview that I had with Dr. Volkow on this very issue.
And I don’t remember the study authors and I actually don’t even remember if it was a U.S.- based study.
Something in my mind tells me it might have been based in Canada.
You might even know, because you’ve looked at this issue before, but she had talked at the time that, you know, this was and this was January of 2018 that we had the first interview in the podcast series, that it was research where students believed, going into a test-taking period that if they misused or you know, it wasn’t called that, but if they took a prescription stimulant, that it was definitely going to improve their grade.
And then when they were surveyed post-taking the test, they still had that belief, that yeah, it helped my grades and yet when it was examined against what their grades actually were, it just was totally not born out at all.
And so it was this perception going into the test-taking period and then coming out of the test-taking period that yeah, my taking of a prescription stimulant definitely helped me get a better grade.
And then when the truth be told, when the grades were, you know, given, that just did not come true.
So I think it was this idea.
Again, it’s a really firmly held belief that it’s going to help or that it did help.
Phillips: Sure, most definitely.
And I think that’s why it’s good in terms of a study like the CPDS to really be asking students about their experiences with these substances and to be asking them, you know, in an anonymous survey setting where, you know, maybe they’ll actually tell us.
This is such good information and I’m already knowing that we’re going to be able to get some good content, I think out of this, for the website as well as it’s good content for the listeners.
So I’m going to segue to our final question for the interview.
So according to your study, the majority of students, if I read correctly, they know where to go for help, if they are concerned or worried about prescription drug misuse.
So, which is great.
I mean, that’s a real positive finding, that students know where to go.
So with that in mind, as a researcher and as someone who’s involved in this particular subject matter, what advice do you have for our listeners who either have developed or they are developing resources to prevent prescription drug misuse among college students, what advice do you have for them?
Well, I think first I’ll reiterate what you said, that we were very pleased that so many students reported that they knew where to go for help if they were concerned or worried about their non-medical use of prescription drugs.
Because it was about 77% of students who said they knew where to go, either on or off campus if they had concerns.
So you know, that seems really positive on the whole.
If you’re developing resources, I think I would highly recommend working to understand initiatives and projects that are already doing this work across the country, like your campus prevention efforts or like, you know, the Generation Rx initiative that I mentioned earlier, because there’s a really strong community around these efforts, at least in terms of, you know, my interactions with it.
And people who work in this area want to share resources and share best practices to help one another.
So I think it’s really important to leverage that to your advantage.
I’d also share that our research suggests that the messaging, you know, that all of these sort of programs and practitioners are developing, is potentially getting through to students.
You know, if 77% are saying they know where to go if they’re concerned about misuse, something’s getting through somewhere.
And so keep up that work, you know, that’s really important.
I think the other thing, you know, that I would note, that I think is sort of interesting is that we also asked students about if they’ve ever taken an actual training or a workshop about safe use of prescription drugs.
And the majority, about 89% said that they had not, but 56% of students said that they were aware of a resource on campus or off campus to help with prescription drug safety.
And so that was, the questions about the workshop and prescription drug safety were asked of all students who took the survey, so we’re talking about 19,000 students or so here, who are saying no, I haven’t gotten specific training, but I definitely know of a resource on or off campus to help with prescription drug safety.
So it’s not only students who are non-medically using who know where to go, but it’s sort of students generally who seem aware of safe use of prescription drugs, at least a little bit.
So even if they’re not taking an official training, they’re still aware of the resources, they still might know where to go and so somehow the messaging is getting through, even if it’s not really tangible in terms of a training or something like that.
So generally, I kind of consider this pretty promising overall, that awareness is building, even while the majority of students are not using prescription drugs non-medically.
So most students aren’t using them, but awareness around how to use them safely is still pretty high.
Lucey: That is such a positive note on which to end the podcast interview, that Erica, you have just encapsulated.
There are four different pieces here of advice and I’ve actually combined a couple of them.
I think it’s really important, one, as you said that a good majority of students not only know where to go for help, but students also know of resources that exist around prescription drug safety.
You know, we’re just coming, you know, DEA has twice a year its prescription drug Take Back Days.
We have a publication that’s available on our website on how to dispose of prescription medications safely.
I think that’s it really important to continue to promote those messages and those efforts, not only for students, obviously, but for the immediate campus community as well as the surrounding community.
So the other thing that I heard you say is, you know, whether you are just getting involved in this work or if you’ve been at it for a while, it really does pay to get to know what other efforts are taking place.
This is, you know, we’ve been talking about this prescription drug misuse crisis for more than five years now.
And you know, as a result, there are a lot of good efforts that are going on out there as you mentioned, Gen Rx there.
You know, we’ve got Campus Drug Prevention, NIDA has efforts that they have going on out there.
I think all the different federal agencies have a piece in this, certainly at SAMHSA.
They do, the Department of Ed is doing what they can and then of course, all the non-federal sources.
So that is really important to get to know the landscape of efforts, so you can learn from them and even potentially collaborate.
And then the third piece I came away with, which is just true about prevention in general, which is to keep at it.
You know, we’re not going to see changes overnight; we have known this about prevention science for the longest time.
It is never an overnight success type of field.
And I think I really like the way that you said it.
The messaging is getting through.
I mean, it’s students who have misused at least once or more times in their lifetime, your study has shown out, yeah, that may be true, but in the past year, I have not.
And we don’t know why that is, but you know, we could maybe draw a dotted line to the fact that educational efforts around the dangers of misusing prescription drugs is getting through.
So you have really, you know, done us a good service by ending, you know, we’ve talked about the consequences and the reasons why, but ending the podcast on such a positive note is really, really important.
So I thank you for that.
I’m glad that this is useful and yeah, I hope that’ll be helpful.
So with that, let me loop back to what we had said just prior to getting into the five questions, that you know, our offer stands.
That when it comes time for you to administer the next iteration of the survey, if you want help from us, to help promote it on our website, campusdrugprevention.gov, we’re more than happy to do that, to help solicit more schools.
I think it’s, that’s great if we can get more schools involved and you know, increase that response rate and just the more we can learn about this issue, I think helps all of us.
So you know, with that again, Erica, thank you for your efforts and the rest of the folks involved in the CPDS and thank you again for being part of the podcast today.
Phillips: Great, thank you and yes, if there’s any, you know, additional questions you have or additional things you’re wondering about, please don’t hesitate to reach out or you know, ask to talk more.
Lucey: We will definitely do that and your information will be available, that we can make available to podcast listeners if they contact us directly, we can put them in touch with you.
So we’ll definitely do that.
So with that, I’m going to close out the podcast and to all of our listeners, thank you again for tuning into this episode of "Prevention Profiles: Take Five."
And with that, I’ll say take care and have a great day.