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Opioid Use Disorder on College Campuses

April 20, 2022

Table of Contents

How Much of a Problem is Opioid Use on College Campuses?  

2018 Survey (“Monitoring the Future College Students and Young Adults”) found that self-reported misuse of prescription opioids in the past year was 2.7% among college students in 2013. It warns that use of illicit opioids — like heroin, fentanyl, and other derivations — remains a significant problem.[1] 

Where Do Students Get Opioids?

The Addictive Behaviors journal found that students obtain opioids primarily from either friends or parents. The drugs are either shared from a misguided sense of wanting to help (i.e. a loved one having experienced the benefit of opioids and offering to share them) or for pure recreation, where the opioids are purchased or  exchanged with the intent to experience a high.[2] 

Prescription Opioid Use on College Campuses 

Many college students have serious misconceptions about the dangers of using opioids without a prescription. Some may believe that, because prescription opioids are  legal, they cannot be as harmful as other injectable forms of opioids such as heroin or fentanyl. .This assumption may be furthered if the drugs are obtained from a friend or family member, especially in cases where the person was prescribed the opioids for a legitimate medical issue. 

But without proper medical supervision, prescription opioids can quickly become a drug of abuse just like any other form of opioids.[3] Their strong narcotic effects can lead to both addiction and/or overdose. 

Who Uses Opioids on Campus?

All college students can potentially be involved in opioid misuse. However, some studies suggest that risk factors include white race, living in a fraternity or a sorority house, and having lower grade point averages.[4] Researchers have not been able to agree if there are gender differences in the rates of opioid misuse on college campuses. Some have conducted studies that have found men were more likely than women to report having misused (prescription) opioids, but others have not shown higher use among one gender or another..[14, 15]Nonetheless, epidemiologists believe that it is necessary to research the gender differences between opioid users on college campuses because those differences are important when determining addiction treatment plans. Men, women, and non-binary people may require individualized treatment based on their gender identity.

Risk Factors for Opioid Misuse on College Campuses

College is a time of transition and subsequently a time for potential stress. Many mental health and substance use disorders may present in this age group for the first time, either as an inevitable result of genetic predisposition or environmental factors. 

College students are highly influenced by their social circles. Students that associate with e with social groups where opioids are consumed recreationally (fraternity or sororities, sports teams, etc.) are more likely to use themselves.This also extends to having easy access to opioids — someone’s medicine cabinet, for example, or knowing someone who sells these drugs on campus. 

A big risk factor is age itself. People who are in their teen or young adult years, i.e. college age students, are more likely to start misusing prescription medications[7] 

New lack of parental supervision also lends to development of opioid misuse. For many college students, their time on campus is a chance to find themselves, to push their boundaries, and to live outside their family homes for the first time. The Journal of Drug Education notes that this is considered a standard rite of passage for many American young adults, so much so that some college administrators are reluctant to crack down down too hard on students’ desire to “have fun” and “break rules” as part of that experience.[8,9]

However this new freedom comes with new risks: anything from late-night video game marathons, to increased sexual activity, to binge drinking and substance misuse.

Academic and social stresses of college can also prompt development of opioid use disorder [10] Natural academic stress — of the expectation of good grades and competition for jobs and internships, etc. There is also the social stress of finding a new community, a new group of friends, romantic partners, etc.. Stress, says U.S. News & World Report, is an innate part of life on campus, and this can compel students to seek out unhealthy ways of alleviating their mental burdens, including opioid misuse.[11] 

American Public Media referred to this as “the college mental health crisis,” where students — away from home for the first time, struggling to keep up with the cultural idea that they were supposed to be having the best years of their lives — were instead feeling suffocated, trapped, and lost.[12] Some may get prescribed opioids to help with their stress and sleep. Others may buy opioids (prescription or illicit) to self-medicate and then become hooked on the temporary relief they experience. 

Signs of Opioid Use on Campus

What are some of the signs of opioid use disorder among college students? Look for symptoms like these:

  • Unexpected and unhealthy weight loss or weight gain
  • Unusual sleeping patterns, especially sleeping for long periods of time
  • Prolonged depression, presenting as a lack of interest in activities and showing no interest or energy
  • Poor muscle coordination
  • Sudden decline in academic performance (poor grades or missed classes) 
  • Decline in social engagement
  • Associating with people who can obtain opioids or other substances 

Treatment Options  on Campus 

Fortunately, most schools realize the importance of addressing and treating opioid use disorder on campus.[16] 

Almost all schools offer on-campus counseling and wellness programs. [17] Part of the work of these programs is to offer education about opioids and opioid misuse — that opioids are legitimate medications, but they should only be obtained via a prescription and taken under a doctor’s supervision. While these programs can sometimes take the form of traditional counseling and therapy, different colleges offer different programs, including one on one therapy, group counseling, wellness activities, medication management by college-health providers, among others. 

Medication for Addiction Treatment

Medication for Addiction Treatment (MAT) is where prescribed medication (primarily Methadone or Suboxone) are used to help students control opioid use disorders. 

MAT gives people a chance of reaching their goal of ending their use of opioids while controlling the withdrawal symptoms of reducing use. With Medication for Addiction Treatment, people are given a controlled prescription of a longer-acting opioid in order to wean off the stronger opioids on which they had developed dependence. In 2019, the Journal of Substance Abuse Treatment noted that MAT, especially when used in conjunction with behavioral/psychological interventions,  was very effective in helping patients overcome OUD .[18] 

Just as n the general population, MAT is used to help college students  resume normal life after Students can continue their studies while still receiving psychological and medication-assisted treatment.[19] 

Will I Have to Leave School?

Not necessarily. While taking a leave of medical absence in order to recover from OUD may be recommended or even necessary, some students may be able to continue their studies while simultaneously pursuing treatment. Talk to your school counselors or advisors about taking a leave of absence if necessary versus continuing education while in treatment. This decision should be a shared one between the school, the student, and family, and should prioritize the recovery needs of the student above all else. 

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Drug and Alcohol Use in College-Age Adults in 2018. National Institute on Drug Abuse. https://nida.nih.gov/drug-topics/trends-statistics/infographics/drug-alcohol-use-in-college-age-adults-in-2018. 2019. Accessed March 2022.
  2. Motives, Diversion and Routes of Administration Associated With Nonmedical Use of Prescription Opioids. Addictive Behaviors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1766373/. 2007. Accessed March 2022.
  3. Prescription Opioids: What You Need to Know. American Hospital Association. https://www.aha.org/factsheet/2018-02-20-prescription-opioids-what-you-need-know. Accessed March 2022.
  4. Nonmedical Use of Prescription Opioids Among U.S. College Students: Prevalence and Correlates From a National Survey. Addictive Behaviors. https://doi.org/10.1016/j.addbeh.2004.08.024. 2005. Accessed March 2022.
  5. Risk Factors for Opioid Use Disorder and Overdose. Anesthesia & Analgesiahttps://journals.lww.com/anesthesia-analgesia/fulltext/2017/11000/risk_factors_for_opioid_use_disorder_and_overdose.41.aspx. November 2017. Accessed March 2022.
  6. Substance-Use Disorders and Poverty as Prospective Predictors of First-Time Homelessness in the United States. American Journal of  Public Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865876/. 2013. Accessed March 2022.
  7. Prescription Opioid Use and Misuse Among Adolescents and Young Adults in the United States: A National Survey Study. PLOS Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6830740/. November 2019. Accessed March 2022.
  8. Alcohol Abuse as a Rite of Passage: The Effect of Beliefs About Alcohol and the College Experience on Undergraduates' Drinking Behaviors. Journal of Drug Education. https://pubmed.ncbi.nlm.nih.gov/17345914/. 2006. Accessed March 2022.
  9. Heavy Drinking and Polydrug Use Among College Students. Journal of Drug Issues. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2567115/. January 2009. Accessed March 2022.
  10. Risk Factors for Addiction Potential Among College Students. International Journal of Preventive Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843961/. February 2018. Accessed March 2022.
  11. Stress in College Students: What to Know. U.S. News & World Report. https://www.usnews.com/education/best-colleges/articles/stress-in-college-students-what-to-know. October 2020. Accessed March 2022.
  12. Under Pressure: Inside the College Mental Health Crisis. American Public Media Reports. https://www.apmreports.org/episode/2021/08/19/under-pressure-the-college-mental-health-crisis. August 2021. Accessed March 2022.
  13. What's Behind the Unexpected Gender Gap on College Campuses? AOL. https://www.aol.com/news/whats-behind-the-unexpected-gender-gap-on-colleges-campuses-204548329.html. September 2021. Accessed March 2022.
  14. Gender and Prescription Opioids: Findings From the National Survey on Drug Use and Health. Addictive Behaviors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2919630/. November 2010. Accessed March 2022.
  15. Gender Differences in a Clinical Trial for Prescription Opioid Dependence. Journal of Substance Abuse Treatment. https://pubmed.ncbi.nlm.nih.gov/23313145/. January 2013. Accessed March 2022.
  16. Record Numbers of College Students Are Seeking Treatment for Depression and Anxiety — But Schools Can't Keep Up. TIME. https://time.com/5190291/anxiety-depression-college-university-students/. March 2018. Accessed March 2022.
  17. Five Ways to Combat Stress During Finals. University of New Hampshire Today. https://www.unh.edu/unhtoday/2019/12/five-ways-combat-stress-during-finals. December 2019. Accessed March 2022.
  18. Effectiveness of Medication Assisted Treatment for Opioid Use in Prison and Jail Settings: A Meta-Analysis and Systematic Review. Journal of Substance Abuse Treatment. https://pubmed.ncbi.nlm.nih.gov/30797392/. December 2018. Accessed March 2022.
  19. How Effective Is Medication-Assisted Treatment For Addiction? Here’s the Science. STAT News. https://www.statnews.com/2017/05/15/medication-assisted-treatment-what-we-know/. May 2017. Accessed March 2022.

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