Prescription Stimulant Misuse in the College Population: Examining the Influence of Policy Environments

Introduction: In response to the growing misuse of prescription stimulants among college students, campuses are re-examining their prescribing and dispensing policies.  The variation in policy environments, and the impact of these policy environments on misuse, is not yet fully understood.  Understanding policy environments and their influence on misuse is necessary when developing prevention efforts.   

Methods: Component 1: A random sample of 30 key contacts from the 843 ACHA-member schools was contacted to discuss their health center policies and practices.  Component 2: Three pilot studies were conducted at three different campuses. Each pilot study employed one-stage cluster sampling and utilized a paper-based, in-class methodology. Students completed a psychometrically validated survey developed using the Theory of Triadic Influence. Study #1 (Winter 2012, N = 520 students) was conducted at a Pacific Northwest university where the campus health center providers diagnose ADHD and prescribe stimulants, and the campus pharmacy dispenses the drugs. Study #2 (Spring 2013, N =554) was conducted at a northern California university that had recently passed a policy whereby health care providers and the pharmacy no longer diagnosed, prescribed or dispensed prescription stimulants, unless students entered the university prior to enactment of the policy. Study #3 (To be completed Spring 2016) will take place at a southern California university that has never diagnosed nor dispensed these drugs.  Descriptive statistics, nested logistic regression, and structural equation modeling were/will be conducted to understand the prevalence and correlates of the behavior.

Results:  Component 1: Sixteen of the 30 key contacts provided information on their policy environments. Two campuses offered diagnosing; five prescribed medical stimulants; and one campus pharmacy dispensed stimulants. Component 2: The prevalence of prescription stimulant misuse at campuses #1 and #2 were approximately 26% and 17%, respectively; the prevalence at campus #3 is to be determined. At campuses #1 and #2, similar behavioral correlates were identified. It is hypothesized that campus #3 will have the lowest prevalence of the three campuses, and its correlates will parallel correlates found at campuses #1 and #2.

Conclusions: To our knowledge, this is the first study to examine the variation in, and the prevalence of prescription stimulant misuse by, campus policy environments. Preliminary findings suggest policy variation exists, and “stricter” policy may be associated with lower prevalence. Further research is needed to verify these findings. Irrespective of policy, the behavior’s etiology is multi-faceted. Accordingly, prevention efforts will require a comprehensive approach.