OUT OUT OF OF
SIGHT IGHT
uncovering prescription drugs on campus The U.S. makes up 5 percent of the world’s population, yet it consumes 75 percent of the world’s prescription drugs. About one in four college students has illegally used prescription drugs such as Adderall, Ritalin and Vyvanse, and many more have been offered these medications while on campus. Out of Sight is a six day exhibition that will include multiple works of data visualization to represent the statistic of prescription drug use and abuse on school campus.
contents contents 01
Introduction
02
05
Background
Prevention
03
The Study: Interviews
04
Type of Misuse
05
introduction introduction Although prescription drug misuse by young adults has generated a great deal of concern among public health practitioners, clinicians, law enforcement authorities, collegiate officials, and those engaged in drug abuse prevention, there is a dearth of research focused on the socio-cultural factors underlying these consumption patterns. The analysis presented here adds to our existing knowledge by describing several socio-cultural factors related to prescription drug misuse among a group of college students in the United States. This paper briefly describes the types of prescription drugs misused in a collegiate setting, the sources of these drugs, and the types of venues where use takes place. It goes on to describe in more detail several different types of misuse— self-medication of physiological conditions and states of affect, socio-recreational applications, and uses organized around academic demands.
Finally, these patterns of use are further situated within the collegiate sociocultural context by examining several factors that may be contributing to increases in prescription drug misuse among college students. These factors include student perceptions of the social acceptability of prescription drug misuse, attitudes that regard prescription drugs as attractive alternatives to other drugs, ideals concerning culturally sanctioned “time-out� periods characterized by experimentation with drug use, and available sources of knowledge regarding the use of prescription drugs.
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For the first time, our national study finds that today’s teens are more likely to have abused a prescription painkiller to get high than they are to have experimented with a variety of illegal drugs. In other words, Generation Rx has arrived.
”
Roy Bostock (PATS, 2005)
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background background Prescription drug misuse, the use of medications without a prescription or contrary to a doctor’s direction, is not a new phenomenon but recently emerging trends and incidents have brought heightened attention to this health, medical, and legal issue (Wilford, Finch, Czechowicz, & Warren, 1994). In the 1990s, surveillance data in the United States began to indicate a substantial rise in prescription drug misuse. Between 1990 and 1998, it is estimated that the misuse of pain relievers, tranquilizers, and sedatives rose by 181%, 132%, and 90%, respectively, and in one year alone (1999) approximately four million people were thought to have used prescription drugs nonmedically (National Institute on Drug Abuse [NIDA], 2001, p. 4).
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These trends have been particularly pronounced among young people. Data fromthe 2002 National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration [SAMHSA], 2003) indicate that the nonmedical use of psychotherapeutics, pain relievers, tranquilizers, stimulants, and sedatives has grown steadily in recent years in this population. The lifetime nonmedical pain reliever prevalence rate among youths aged 12 to 17, for instance, increased from 1% in 1989 to 11% in 2002, while among young adults aged 18 to 25 the rate grew from 7% to 22% over roughly the same time period. College life provides a culturally sanctioned environment within which this time-out period may take place (Côté & Allahar, 1996). In fact, institutions of higher learning in the United States were intentionally developed to guide young adults through a stage where they were expected to undergo a “protracted period of adjustment to responsibility” and allow them a “time to reflect on life’s possibilities and choices” (Kett, 1977, pp. 296-297).
In sum, there has been a concerning rise in prescription drug misuse on college campuses in recent years. While the research literature suggests that a number of socio-cultural factors may be influencing these patterns, there have been few studies that specifically describe and analyze these trends.
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52 interviews conducted 52 interviews conducted 52 interviews conducted 52 interviews conducted 52 interviews conducted 52 interviews conducted 52 interviews conducted 52 interviews conducted 52 interviews conducted 52 interviews conducted 52 interviews conducted
the the study study The analyses presented here derive from an exploratory study funded by the National Institute on Drug Abuse and include consideration of data collected across two stages of research. These data consist of a total of 52 interviews conducted with college students at a public university in the southwestern United States. All interviews required approximately one and a half hours to complete, and participants were compensated with $20. All recruitment and research procedures were reviewed and approved by an Institutional Review Board, and all participants gave their informed consent to be interviewed for this project. The first phase consisted of formative interviews meant to explore the domain of prescription drug misuse in order to develop a more structured guide for the indepth interviews to follow in the second stage of
data collection. These first phase interviews predominately consisted of semi structured questions that focused on a variety of aspects of drug use, including types of pharmaceuticals misused, the college drug scene, recent experiences, social settings, and outcomes. A more structured free listing activity was also conducted during this stage of data collection. This included the following two questions: “What are all the drugs that college students use?” and “What prescription drugs have you ever used to get high (or used in a way not directed by a doctor)?” A total of 33 individuals participated in this stage of the investigation.
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A 23-year-old woman noted:
Another 25-year-old male shared his thoughts regarding the factors influencing his Ritalin misuse:
Sentiments exemplified in the following passage from a 25-yearold male:
myself starving for ener- “ I did it to relax and blow off “ Most people in college aren’t “ Igyfound steam. I guess I’ve really gotten and just needing to be there to do drugs. They have to work hard and focus. The hard drugs will really mess you up. The people who do the hard drugs are probably not able to stay in school; they end up living for their drugs.
”
focused and I tried it and it actually helped me concentrate and be alert for an extended amount of time. And I found that I could study more efficiently with it than I could without it.
”
to where I enjoyed how I felt and I enjoy a carefree attitude and I’m kind of like that anyway. I’m pretty happy and laid back and doing drugs just increased that in me. And so not really to escape from anything or to get ready for anything, just to have a good time, and work and school cannot be a good time, sometimes, so it was a way to have a good time in a not such a good time atmosphere.
”
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One informant, a 19-year-old female, discussed her use of hydrocodone for pain relief:
In a similar way, a 25-year-old female described her use of alprazolam (Xanax) to treat stress and facilitate sleeping:
In the following passage a 25-year-old female discusses the use of phentermine to control her weight:
“ I didn’t really abuse it. I mean, “ It was just a really stressful time “ Originally I got it because I was it wasn’t prescribed to me, but I used it because my hand was broken and Ibuprofen didn’t really work.
”
in my life and my job was really stressful on top of that, so my boss just gave it to me, really with just the intention of helping me sleep.
”
working in a gym. The receptionist there had gone to this doctor to get a diet pill, and she said that she had lost weight. I was overweight at the time and I went and I started taking it and I liked the results.
”
“ When you’re pulling like 16 hour days and
you’re not eating and you’re stumbling into walls it’s a lot easier, instead of going to a final all tense, you’re just mellowed out. So it helped me deal with it [final exams].
”
23-year-old male regarding his use of a muscle relaxer
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types types of of misuse misuse As indicated in Table 1, study participants reported a total of 238 lifetime episodes of misuse of 56 different prescription drugs for an average of approximately five episodes of prescription drug misuse per respondent (4.58). It is noteworthy that not all the items included by informants actually require a prescription. This may indicate some degree of cultural variability and ambiguity regarding what truly constitutes a prescription medication. In line with population based research (McCabe, Teter, Boyd, Knight, & Wechsler, 2005; SAMHSA, 2003), two broad classes of drugs are the most commonly misused—narcotic analgesics (e.g., hydrocodone, oxycodone) and benzodiazepines (e.g., diazepam, alprazolam). Stimulants (e.g., methylphenidate) are also misused widely. Informants reported securing prescription drugs from a number of sources, most notably from their own stockpiles of leftover prescriptions or those available from friends or family. Other sources included pharmacies in Mexico (less than a day’s drive from the field site), the Internet, and individual “dealers.” Prescription drugs were most commonly misused in social settings—at parties, bars and clubs, or simply when “hanging out” with friends. At other times, particularly in situations where stimulants were taken in order to facilitate studying or when individuals wanted to relax alone, prescription drugs were used in less social environments. 31
Generic Name (Brand Name)
* Total
%
Hydrocodone + Acetaminophen (Vicodin)
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65.4
Oxycodone + Acetaminophen (Percocet, Roxicet)
32
61.5
Diazepam (Valium)
19
36.5
Alprazolam (Xanax)
15
28.8
Oxycodone (OxyContin)
14
26.9
Methylphenidate (Ritalin, Concerta)
13
25.0
Acetaminophen + Codeine (Tylenol w/ Codeine)
12
23.1
Dextroamphetamine + Amphetamine (Adderall)
9
17.3
Propoxyphene (Darvon)
6
11.5
Clonazepam (Klonopin)
6
11.5
Ketamine (Ketalar)
5
9.6
Carisoprodol (Soma)
5
9.6
Ibuprofen 800 (Motrin 800)
5
9.6
* Based on study participants that reported a total of 238 lifetime episodes of misuse of 56 different prescription drugs
Generic Name (Brand Name)
Total
%
Meperidine (Demerol)
4
7.7
Caffeine (Vivarin)
3
5.8
Tramadol (Ultram)
3
5.8
Sildenafil (Viagra)
3
5.8
Bupropion (Wellbutrin)
3
5.8
Fexofenadine (Allegra)
2
3.8
Zolpidem (Ambien)
2
3.8
Amitriptyline (Elavil, Endep)
2
3.8
Lorazepam (Ativan)
2
3.8
Phenobarbital (Barbita or Luminol)
2
3.8
Trazodone HC1 (Desyrel)
2
3.8
Phentermine (Fastin, Adipex)
2
3.8
Gabapentin (Neurontin)
2
3.8
Fluoxetine (Prozac or Sarafem)
2
3.8
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prevention prevention There are many traditional methods of prevention that might be used to tackle prescription drug misuse among university students. These include leafleting and information campaigns, classroom-based educational programmes, and campus support services. However, some of the most recent and innovative prevention programmes have been based on developments in computers and technology. The aim of the following section is to review some of these more recent methods for tackling prescription drug misuse. The review was based on a systematic search of five online bibliographic databases: ASSIA, Web of Science, PubMed, Medline and the Journal of American College Health, which specialises in research on health matters relating to university students.
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Web-based surveillance of drug use trends
Online monitoring of inappropriate prescribing
One of the problems of responding to drug misuse (including prescription drug misuse) is that information relating to current trends and fashions can be out of date by the time it is available to practitioners. The aim of web-based surveillance of drug use trends is to obtain ‘real time’ data on types of drugs misused and methods of using them (Nielson and Barratt 2009). The aim of the project was to provide professionals with easily accessible and reliable information on current drug misuse trends.
Another option for prevention is to reduce the supply of prescription drugs available for misuse. Many states in North America have implemented computerised prescription monitoring programmes that track the prescription and sale of controlled substances. The state of Florida, for example, currently operates the E-FORCSE (Electronic-Florida Online Reporting of Controlled Substances Evaluation) prescription drug misuse monitoring programme.
Online monitoring of current prescription drug misuse practices by users
Web-based methods for detection and prosecution of internet pharmacies
On-line information about current methods of obtaining and using prescription drugs is also available on the internet for drug users. It is possible that this information might be harmful and might exacerbate or increase prescription drug misuse. A recent survey of drug-related internet sites found that members sometimes used harmreduction websites to increase their knowledge about drugs and how to minimise the risks of negative consequences. These sites were also used to discover new ways of using drugs and drug combinations (Cone 2006).
There is some evidence that the number of online pharmacies supplying prescription only drugs without requiring a prescription has increased over the last 10 years (Forman 2006). While research on prescription drug misuse shows that the main sources of prescription medications are friends and family (McCabe and Boyd 2005), there is a small proportion of users who purchase their drugs from illegal pharmacies on the internet (Forman 2006). There have been some attempts to control the number of illegal internet sites through international internet enforcement operations.
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bibliography bibliography Quintero, Gilbert, Jeffery Peterson, and Bonnie Young.
“An Exploratory Study Of Socio-Cultural Factors Contributing
To Prescription Drug Misuse Among College Students.� Journal
Of Drug Issues 36.4 (2006): 903-931. Academic Search Premier.
Web. 19 Nov. 2015.
Holloway, K., Bennett, T., Parry, O., & Gorden, C. (2013). Misuse of
prescription drugs on university campuses: options for prevention.
International Review Of Law, Computers & Technology, 27(3), 324-
334. doi:10.1080/13600869.2013.796707
Red skull made of prescription drugs. Digital image. Pittsburg Post-Gazette.
PG Publishing Co., Inc, 23 Jan. 2014. Web. 10 Nov. 2015. <http://
www.post-gazette.com/local/south/2014/01/23/Over dose-deaths-from-
prescription-drug-abuse-skyrocketing-in-southwestern-Pennsylvania/sto ries/201401230018>.
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â&#x20AC;&#x153; An over-indulgence of anything, even something as pure as water, can intoxicate. â&#x20AC;?
Criss Jami
F F O O T T U U O O SIGHT SIGHT Saadia Kardar 2489326 OCAD University 2015 Professor Frederick Jon Burbach