Healthcare Prescription Drug Abuse On-Campus

Healthcare

Prescription Drug Abuse on-Campus and Off Introduction

Drug abuse has long been a major concern of policymakers, educators, and healthcare officials in the United States. The subject of innumerable media stories and government and medical reports, as well as many anecdotal accounts, drug abuse has typically meant the misuse, or recreational use, of illegal drugs. These illegal drugs include such dangerously addictive substances as heroin and crack cocaine, and also other drugs such as cocaine, marijuana, various barbiturates, amphetamines, and so forth.

However, it is only recently that many have begun to look at another related issue - the sizeable problem of the abuse of legal, prescription drugs. Abuse of prescription drugs - such as has gained notoriety in the widely publicized case of media pundit Rush Limbaugh, among others - is considered a large and growing problem in contemporary America. Abuse of prescription drugs is particularly acute among the country's youth. According to a National Household Survey on Drug Abuse conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), almost three million young people between the ages of twelve and seventeen, and almost seven million young men and women between the ages of eighteen and twenty-five reported using prescription medications non-medically at least one time in their lives. (Meadows, 2003, p. 36) Such figures equal out to a potentially enormous problem among today's student population. As can be seen by the age ranges given in the study, college and university students appear to be especially prone to experimenting with the recreational use of prescription medications. If so many millions of college age men and women have used prescription products non-medically at least one time, how many have used these same preparations on multiple occasions? In the foregoing study, the researcher will attempt to determine the extent to which a problem of prescription drug abuse does or does not exist in America's colleges and universities.

Literature Review

Nature of the Problem

Abuse of prescription medication in American colleges and universities is a complex issue that can only be understood by first examining the larger matter of prescription drug abuse in the general population. First, it is necessary to define the problem; to understand what amount of misuse constitutes abuse. The numbers themselves are often cited as proof that a major problem exists. According to the National Household Survey on Drug Abuse, there were fewer than half a million first-time users of prescription painkillers in the 1980's, as opposed to more than six million in 2002. (Barolat, 2005) Nonetheless, sheer numbers do not automatically equal a problem. As Barolat notes, there are indeed many people who are in genuine chronic physical pain, and who do require the aid of painkillers to maintain normal levels of day-today functionality. Definitions of "abuse" that are based solely, or largely, on the numbers of individuals who take prescription painkillers is the source of serious problems for those in genuine need:

For the estimated 50,000,000 chronic pain sufferers, it is becoming increasingly more difficult to obtain prescriptions for painkillers and access to medications. Even more worrisome is the absence of alternatives offered by Federal regulators to patients in need. Rather than promoting advanced treatments, such as spinal cord stimulation, the Drug Enforcement Agency has set its sights on curtailing the nation's supply of prescription medications. (Barolat, 2005)

The fact that the Drug Enforcement Agency has taken it upon itself to attempt to strictly limit the prescribing of painkillers, and other potentially addictive or physically dangerous drugs, because so many people are taking them sounds more like a knee-jerk reaction to numbers than any real attempt to understand, much less to define, a problem.

The administration of George W. Bush, in particular, has sought to impose rigorous controls on the sale and availability of prescription drugs. The Administration's outlook can be summed up by a March 1, 2004 pronouncement by John P. Walters, director of the White House Office of National Drug Control Policy (ONDCP), "The nonmedical use of prescription drags has become an increasingly wide-spread and serious problem in this country," (Meadows, 2004, p. 7).

Once again, the Federal Government's definition of the problem is a numbers game - if a lot of people do it, there must be a problem. National Drug Control Policy thinking is summed up by a further description of who uses what, with careful attention paid to linking prescription drugs with illicit drugs:

Narcotic pain relievers, tranquilizers, stimulants, and sedatives trailed only marijuana in the list of drags abused by Americans in 2002. While self-reported abuse of illicit drags, including cocaine and heroin, has fallen over the past years, prescription drug abuse has increased and is now more prevalent than abuse of all other drags except for marijuana. (Meadows, 2004, p. 7)

The authoritative nature of such statements is further born out by the additional information that these "conclusions" are supported by noted public health authorities and advocates:

Waiters [Sic - should read Walters] was joined by Surgeon General Richard H. Carmona, M.D., M.P.H., former FDA Commissioner Mark B. McClellan, M.D., Ph.D., Karen Tandy, administrator of the Drug Enforcement Agency (DEA), and U.S. Rep. Tom Davis, R-Va. (Meadows, 2004, p. 7)

However, the above political definition of prescription drug abuse neither distinguishes legitimate users from illegitimate users of those same drugs, nor does it provide any real and clear definition of why high incidences of usage should necessarily be considered a national health problem.

A more helpful definition of prescription drug abuse might be found in the words of Lynn E. O'Connor, Milena Esherick, and Cassandra Vieten who define the issue in terms of the actual effects of the misuse of these drugs. O'Connor, Esherick, and Vieten looked specifically at the problems of women and concluded that abuse of even prescription drugs such as Valium, and other sedating benzodiazepines and opiate-type pain relievers (O'Connor, Esherick & Vieten, 2002, p. 75) could lead to considerable problems in daily life. "Under the influence of drugs, women lose their spouses, their jobs, their children, and their lives. Women are being incarcerated at increasing rates for drug-related offenses." (O'Connor, Esherick & Vieten, 2002, p. 75)

In this case, a clear connection is being made between abuse of licit drugs and personal and familial difficulties, as well as problems at work, and with the law. They further connect the abuse of prescription drugs, as opposed to illegal drugs, to crises in later life.

Some women who are able to limit their adolescent drug experimentation may develop serious drug problems at middle or older ages, frequently in response to marital or family difficulties, illness, or other stressful life events. Often this later-onset drug abuse involves prescription drugs, legally obtained through physicians or psychiatrists. Iatrogenic addiction -- that is, addiction caused by medical practice -- is an enormous problem for women. (O'Connor, Esherick & Vieten, 2002, p. 76)

Richard N. Rosenthal, M.D. also observes that anxiety disorders are commonly associated with abuse of prescription drugs (Toneatto, 2003, p. 31) - and in further support of O'Connor, Esherick, and Vieten states that women are more frequently diagnosed with anxiety disorders than men - thus supporting the idea that abuse of prescription drugs is very often tied to life crises.

Pauline Rennie Payton even cites a case in which a woman who has been bullied at work admits to having resorted to abuse of prescription drugs in order to alleviate the emotional pain, anguish, and pressure.

Prescription Drug Abuse in Colleges and Universities

Based on the above information, a working definition of "prescription drug abuse" can be considered to entail the employment of prescription medications for the purposes of "self-medicating;" of easing personal traumas. These traumas consist particularly of life crises such as marital break-ups, other family problems, and problems with work, or at work. Most of these problems, especially in the case of women, seem to be associated with midlife. Nevertheless, they do involve the existence of what - to the individual concerned - comes across as something insurmountable, either an internal psychological difficulty, or an external threat that causes psychological difficulties. In determining whether there is a prescription drug problem in America's colleges and universities, one might look at whether the college experience can be considered broadly similar to other experiences that induce the kinds of psychological difficulties that frequently lead individuals to abuse prescription drugs. Susan D. Raeburn provides a connection as to modes of thought; what constitutes pressure in a college or young adult environment can be different from what constitutes pressure in midlife, but it is, nonetheless, a potent stimulus for psychological trauma:

Eating disorders were virtually unknown in undergraduate college classrooms of abnormal psychology in the early 1970s, with the exception of an occasional obscure reference to that mysterious starvation syndrome, anorexia. A frightening photograph of an emaciated girl was offered in the textbook with no seeming recognition that the disorder had any relationship to the crazy eating habits promulgated by weight-loss fads and fashion magazines of the time and already being practiced by countless college women. (Raeburn, 2002, p. 127)

Clearly, college life presents it sown situations that are conducive to the creation, or exaggeration, of psychological disorders in individuals.

College is a time of change, and change can produce stress; however, as it is to be noted that a certain amount of substance abuse appears to be a part of the regular college experience.

All forms of SUD are relatively prevalent in young adulthood, suggesting that perhaps substance involvement is more related to developmental and social factors associated with this stage of life as opposed to stable individual differences. (Sher, 2003, p. 167)

This not to say that individual problems with prescription drug abuse do not exist in the nation's colleges and universities, but that the root causes, and more importantly, the nature of the "prescription drug abuse problem" might be quite different from that which obtains among the adult population. David Degrazia (Degrazia, 2000, p. 34) recounts the story of a woman, nearly thirty-years-old, who personally requested a prescription for Prozac from her physician. The woman had always managed quite well in childhood, and even in college, and had appeared to have attained her career goals up to that point. Degrazia concludes that the woman had successfully dealt with the problems of college life through the medium of several close friendships (Degrazia, 2000, p. 34) - another point that underscores the significance of anxiety-producing factors in encouraging "abuse" of prescription drugs, in this case, the anti-depressant Prozac. This case is interesting, furthermore, because it illustrates a common feature of college life; the prevalence of close friendships, of support networks that would tend to mitigate against the need the feelings of isolation and alienation that so often produce anxiety disorders. The college environment, in this respect, is quite different from the later work environment. To a far greater degree than that found in college or university, the world of work is one of almost hyper-individualism, with one aspiring career-oriented man or woman competing against another. In addition, college students possess the advantage of a network of school counselors who can provide some level of professional help and support, much as drug counselors provide help to adults battling addiction (Freeman, 2001, p. 374).

In short, while drug abuse may be a problem in the context of college life, it does not tend to be a problem of prescription drugs. The college environment is, on the whole, quite different from the adult world of work. College students are subjected to a great deal of pressure - pressure to conform to particular images of body and self - but they also possess resources of community, close friends, and professional counselors, that are much more likely to be lacking in the adult world. College students are at considerable risk of substance abuse, but this, at this stage of social and personal development, is more commonly symptomatic of a general tendency among that particular age group. Prescription drugs, on the other hand, are typically abused by adults who have already made the transition into the much lonelier and far more isolated world that lies beyond the campus. Prescription medications can and will be abused on America's college campuses, but they are not likely to be the enormous problem that government figures may assert them to be. Indeed, figures themselves tell little of the reality of the situation. For if users are considered only in so far as they add "one more" to the statistical pile, the abuser is not separated form the user; those who genuinely require the assistance of medication are being lumped in with those who overuse, or make use for no legitimate medical reason, of potentially powerful medications.

Methods and Materials

Object of Study

The researcher will conduct a study the purpose of which will be to determine to what extent, if any, a problem exists with the abuse of prescription drugs at American colleges and universities.

Setting of Study

The study will be conducted at a mid-sized American university in a suburban campus setting. This setting has been chosen, not only because it is typical of so many American colleges and universities, but because the somewhat isolated, insular setting allows other variables to be eliminated, such as the influence of a nearby urban environment, or other sizeable community, which might result in many students' living a lifestyle that is not largely bounded by the campus itself.

Participants in the Study

Fifty college students will participate in this study. Participants will consist of males and females of various ages. Participants will be grouped according to five Age Categories:

A. 18-21

B. 22-25

C. 26-30

D. 31-40

E. 40 and up

Participants in the study will be chosen to reflect, as accurately as possible, the actual age breakdown of students at the participating university, in order to insure that results are not skewed by the disproportionate participation of any one age group, or gender.

Study Instrument

The study instrument (see Appendix a) will consist of a sixteen (16) question Survey that will be distributed to each participant. Participants' will be specifically questioned on the use of prescription sleeping pills - as opposed to any other kind of prescription medication - so as to focus the study on a single class of drugs, thereby eliminating possibly differences in response, and difficulties in analysis arising from the use of a wide variety of medications with an extreme range of possible effects. The sixteen questions will be preceded by two multiple choice questions. The first of these questions will assign to each participant to the appropriate age category, while the second will show the participant's gender.

Following this, the survey questions will endeavor to understand the nature of any prescription drug use on the part of the participant. The survey will include questions on frequency of use, circumstance of use, and emotional and other reactions both to use, and cessation of use. These questions will require only a "yes" or "no" answer.

Results

The survey reveals that a significant percentage of college students have, in fact, taken prescription sleeping pills at one time or another; the incidence of use having been greater among female students, and particularly among female students in the C, D, and E. Age Groups. Male students, too, showed an increase in sleeping pill takers as they aged. Frequent user of sleeping pills who stopped taking their medications showed a far higher level of symptoms of cessation of use than did those who rarely took such medications. Effects of cessation after frequent use consisted of various physical and emotional and psychological symptoms. Frequent usage was deduced from participants' responding in the affirmative to a question that asked if they had frequently used several different physicians to obtain the prescriptions. As well, frequency of use could be deduced from an affirmative answer to a question regarding whether the participant had continued to take the medication even though it was no longer medically necessary. Increased problems with the sleeping pill usage was also show in those participants' who answered in the affirmative to questions that asked whether they had taken pills along with alcohol, or in combination with other pills. Frequent users were also shown to require larger and more frequent dosages of the same medication. However, there did not appear to exist a direct correlation between frequency of use and any recourse to use the medication to "treat" other conditions such as anxiety, or feelings of being upset, or lonely. Participants who reported having these feelings were no more likely to take sleeping pills, or to take them excessively, than were those who did not report those feelings.

Conclusion

The results of this study show that, at this university, and among this population, there is no evident abuse of prescription sleeping pills. The various reasons given for abuse of prescription drugs, as cited in the literature, do not support any such conclusion in the case of this research. External evidence supports the idea that prescription drug abuse is primarily associated with older populations - a fact born out even in this study. However, the reasons for this abuse derive, most frequently, from conditions that do not normally predominate within the college environment. Adults in the workplace are typically placed in highly-individualized situations, situations that can cause them to develop anxiety disorders because of extreme pressures that are, in large measure, significantly different and much more highly personalized, than those psychological pressures found on a college campus. Additionally, the college student can usually avail himself or herself of a fairly sizeable support network consisting of close friends and school counselors, and so does not suffer the extreme isolation to which an adult may be subject. College or university is primarily a group world, where students face problems as a group. Drug abuse, such as it exists - and it does exist - is much more strongly associated with the generalities of college life as they are experience by the group as a whole, than with the individual anome of adult experience. The substance abuse that can be so common among college students is typically one of illegal drugs; the likely reason for this being their relative prevalence in the group environment of college. Post-collegiate adults likely turn to licit drugs out of reasons of easier availability; an initial attempt to seek an actual medical cure for a condition, and reasons of outward respectability in a world where illegal drug use is not generally accepted.

Summary and Recommendations

Prescription drug abuse is not a major problem in America's colleges and universities. It is not a major problem because college does not produce the kinds of conditions that generally lead to the abuse of prescription drugs. By creating and implementing campaigns, the aim of which is the curtailing of almost all use of prescription drugs, the American government is doing a disservice to those individuals who might truly benefit from the use of these medications. As well, such a campaign ignores the complexity and range of circumstances that can lead to abuse. It is also spreads the focus so broadly that large populations are swept unnecessarily into the net. Government need not waste its resources on rigidly controlling college students' access to prescription drugs because the conditions that tend toward their abuse are not at all common in this environment. Even among adults who have long been out of school, and who face life crises, strict curtailment of potentially helpful medications is not the answer. Officials and advocates must not harm the many who need the help of medications and treatment for the sake of those who abuse these medications and treatments. Mere numbers do not tell the complete story; rather it is the individual lives that lie behind these figures that are important.