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College Student’s Abuse of Prescription Pain Killers: Prevalence, Trends, and Risks
17 February 2011
Pain medications, commonly known as opioids, are prescription medications that reduce or relieve pain. When used safely and properly, opioids can manage pain effectively. However, the usage of painkillers can often lead to dependence and addiction. The abuse of painkillers is common, and there has been a rise in the United States of the non-medical use and abuse of prescription opioids. This paper will examine the growing trend of the misuse of painkillers by college students specifically, which has become an area of great concern.
What exactly are Opioids?
Opioids are a type of drug often prescribed for their analgesic effect. Commonly prescribed opioids are Percocet, Vicodin, Oxycontin, Demerol, and Percodan. They include substances like morphine, codeine, oxycodone, hydrocodone, and methadone. There are four types of classification for opioids – natural, semi-synthetic, fully synthetic, or endogenous. Natural opioids come from opiate alkaloids, which are found in the resin of the opium poppy, such as codeine and morphine. Semi-synthetic opioids, such as oxycodone, are generated by chemically altering the natural opioids. Fully synthetic opioids, such as methadone, are created form non-opioid substances in laboratories, and endogenous opioids like endorphins are produced naturally from the body. Opioids work to manage pain by binding to proteins in the brain, spinal cord, and gastrointestinal tract, called opioid receptors. Opioids then block the brain’s ability to perceive pain, and stimulate the pleasure centers of the brain instead. This creates a sense of euphoria within the individual, which is one reason that abuse is so common. Opioids do not in fact eliminate pain within the patient; they just decrease and modify the perception of pain (http://www.medicalnewstoday.com/info/oic/).
Common Effects of Opioid Use
In addition to producing a euphoric sensation, opioids have many other effects on the human body as well. Because opioids are such powerful drugs, it is important to understand all the possible side effects and symptoms. When taken, opioids can create a feeling of drowsiness, cause nausea, vomiting, constipation, dilated pupils, and even respiratory depression, which can lead to death. The effect the drug has on the individual depends on many different factors: the amount of the drug taken at once, the patient’s history with the drug, the administration of the drug, as well as the patient’s psychological and emotional state of mind. In addition, the combination of opioids and other drugs can have serious side effects. For example, combining opioids and alcohol together, a common mixture amongst college students, can be a deadly combination (http://www.spineuniverse.com/treatments/medication/drugs-used-treat-pain-opioids-narcotics).
With continual opioid use comes the possibility of an increased tolerance to the drug. This becomes problematic, because higher doses of the drug are needed for the original pain relieving effect. It is also possible to develop what is called a cross tolerance, meaning that the chronic use of one opioid causes heightened tolerance to all types of opioids. As the body becomes more tolerant to the drug, and adapts to it’s functioning, the possibility of withdrawal symptoms comes into play. When the intake of the drug is suddenly decreased or stopped all together, withdrawal symptoms can occur as quickly as a few hours after the dosage is lowered or stopped. Withdrawal symptoms appear in the form of intense cravings for the drug, restlessness, muscle and bone pain, moodiness, insomnia, abdominal cramps, diarrhea, goose bumps, and vomiting (http://www.spineuniverse.com/treatments/medication/drugs-used-treat-pain-opioids-narcotics).
Non-Medical Use and Abuse
To furthermore understand the issue at hand, it is necessary to define the terms, non-medical use and abuse. The National Household Survey on Drug Abuse defines non-medical use of a prescription drug as “using a psychotherapeutic drug even once, that was not prescribed for you, or that you took only for the experience or feeling it caused.” Drug abuse is defined by the DSM-IV as a “maladaptive pattern of substance use, leading to a clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period: recurrent substance use, resulting in a failure to fulfill major obligations at work, school or home; recurrent substance use in situations in which it is physically hazardous; recurrent substance-related legal problems; or continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance” (Zacny, Bigelow, Compton, Foley, Iguchi, Sannerud 2003).
Prevalence of the problem
Based on the 2004 National Survey on Drug Use and Health, young adults aged 18-25 have the highest prevalence of illicit use of prescription drugs. In addition, based on a study of 9161 randomly sampled college students in 2003, pain medications have the highest rate of misuse out of any prescription drug (McCabe, Boyd, Teter 2006). According to an online study of college students in 2007, the most commonly used opioids were hydrocodone, oxycodone, and morphine. Other popular opioids that were used were buprenorphine, fentanyl, hydromorphone, methadone, and tramadol (Busko 2008).Within the past few decades, the rates of non-medical use of opioids have increased steadily amongst college students in the US. For example, in 2001, 12.58 percent of all US college students reporting having illicitly used opioids at some point in time, whereas only 9.29 percent had used in 1999, and 8.4 percent in 1997. In addition to the increase of prevalence rates of college student’s misuse of opioids over time, there have been growing trends for opioid misuse (McCabe, West, Wechsler 2007).
The following graphs show data for trends of US College Student’s Non-medical Use of Opioids in 2001
Data from McCabe, West, Wechsler (2005) 1
This graph shows the correlation between geographical region of colleges and the percentage of students that have non-medically used opioids. The southern region of the country has the highest usage of non-medical opioid (11.32%), and the north-central region of the country has the lowest usage (8.2%).
Data from McCabe, West, Wechsler (2005) 2
This graph shows the correlation between admission criteria for colleges and the percentage of students that have used opioids at the colleges The competitive colleges have the highest rates of non-medical opioid use (10.74%), the less competitive colleges have the lowest rates of use (8.27%), and the most competitive colleges have the middle range of use (9.38%).
Data from McCabe, West, Wechsler (2005) 3
This graph shows the correlation between college enrollment size and the percentage of students that have non-medically used opioids. The smallest colleges, with enrollment under 1,000, have the highest rates of opioid use (12.18%), but the middle range of enrollment colleges had the lowest percentages.
Data from McCabe, West, Wechsler (2005) 4
This graph shows the correlation between the amounts of binge drinking present compared to the percentage of students that have non-medically used opioids. There is a direct relationship between the amount of binge drinking present at a school and the amount of students that have misused opioids. Where there are low amounts of binge drinking, the percentages of students who have tried opioids is 8.91%. Where there are high amounts of binge drinking, the percentage of opioid use reaches 10.84% of all students.
Data from McCabe, West, Wechsler (2005) 5
This graph shows the correlation between the amounts of marijuana used compared to the percentage of students that have non-medically used opioids on college campuses. Once again there is a direct relationship between marijuana use and non-medical opioid use. The colleges with the lowest rates of marijuana use have about 7.92% of opioid use, and the colleges with the highest rates of marijuana have 11.84% of opioid use.
Data from McCabe, West, Wechsler (2005) 6
This graph shows the correlation between the percentage of students on college campuses who have used other illicit drugs besides marijuana, and those who have used opioids non-medically. This is a direct relationship; the colleges with low rates of other illegal drug use have the lowest percentages of opioid use (7.93%), and the colleges with the highest rates have the highest percentages of opioid use, (11.8%).
These findings explain the popular trends in non-medical opioid abuse amongst US college students. There are many correlations between certain characteristics, and the prevalence of opioid use. It is common to misuse other drugs as well as alcohol in addition to opioids, which poses an even greater danger to the individual (McCabe, West, Wechsler, 2005).
Reasons for Abuse, Routes of Administration, and Source of Drug
In the 2007 online survey of 10,083 college students, students were questioned on their reasons for using opioids non-medically. The highest percentage of students, 70%, reported that they used opioids to reach the specific feeling or high it caused them. Curiosity was the reason that 49% of students used opioids, interested in seeing what the drug was like. 48% of students reported they used opioids to reduce social anxiety or to fit in, and 29% of students used opioids to treat withdrawal symptoms. Whereas other prescription drugs are commonly abused as performance enhancers, such as study aides, students cited that opioids were mostly used as “party drugs.” Students were also questioned on how they administered the drugs into their bodies. Most students swallowed the drugs, with 82% citing ingestion. However, 16% of students inhaled the drugs, and 10% injected them. The most commonly inhaled drugs were buprenorphine and methadone, whereas the most commonly injected drugs were morphine and fentanyl (Busko 2008). In a different online survey done on a random sample of undergraduate students in 2003, the sources of opioids to college students was investigated. 58% of student’s obtained pain medication from their peers (including friends, peers, roommates, boyfriends, girlfriends), 12.2% obtained the drugs from a family member, and 30% obtained the drugs from another source (including self, drug dealer, unspecified). This shows that opioids are easily accessible to college students, and readily available for misuse (McCabe, Boyd, 2005).
It is evident that the non-medical use of opioids in the college student population is a prevalent problem that is continuing to grow. Commonly known as pain medications, opioids are effective and safe when used properly. However, when used in a way other than what was intended, the misuse of opioids is a serious problem that carries many risks. There are many negative symptoms of opioid use, especially when used with other substances, which is common amongst college students. When taken with alcohol, antihistamines, or CNS depressants, opioids can cause death. In addition, there are often many variations of each drug, each containing different doses. It is common for college students to not truly know what or how much of a drug they are taking, which can be extremely dangerous. Because it is easy to become dependent on the feeling that the drugs create, one of the most dangerous aspects of opioid use among college students is the high risk of addiction
According to the 2005 National Survey on Drug Use and Health, about 2 million Americans are dependent on opioids. Showing that it is a serious problem the World Health Organization has recognized opioid dependence as a brain disease, explaining that it is a condition involving the physical, psychological, and behavioral need for an opioid. Unfortunately, opioid dependence affects every aspect of the individual’s life. The stigma surrounding opioid dependence is so negative that this often deters individuals from seeking help for their addiction. However, when an individual does seek treatment, the most common form of treatment is methadone, which is usually given in a clinical setting. In addition, psychosocial counseling is also an important treatment for opioid dependency. It is vital that individuals seek help as soon as possible, if there is any concern of dependency on opioids ( http://www.ioam.org/statistics.html).
Because the risks associated with the non-medical use of opioids are so serious, it is imperative that steps be taken to reduce the number of young people misusing these drugs. College students are at a very impressionable point in their development, and often experience independence and freedom for the first time. It is necessary to educate all teenagers, as well as college students, about the extreme dangers of misusing opioid drugs. In addition, it is essential to decrease the availability of such drugs to college students. This can be done by educating parents on the importance of keeping their prescription medications away from their children. This can also be achieved by the more meticulous monitoring of patients taking opioids by their physicians. Doctors should make sure the patient only receives the amount of medication necessary to treat their condition for the specific time period, being careful to not prescribe any excess opioids that can be sold or given away.
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