Exploring prescription opioid misuse among college students: a secondary analysis of ACHA National College Health Assessment data (2019-2022).

Background

Prescription opioid misuse (POM) remains a significant public health concern among college students, yet few studies have examined POM prevalence, misuse behaviors among those with prescriptions, and how students access opioids in college settings.

Objectives

Assessing the prevalence of POM, patterns of opioid sourcing (i.e. prescribed vs. illicit), and the trends of misuse of one's own prescription (i.e. higher dosage and/or frequency) among college students.

Methods

Data from the 2019-2022 American College Health Association-National College Health Assessment III survey, including responses from 331,156 students (64.4% cisgender female), were analyzed. Descriptive analyses assessed POM prevalence and misuse patterns, while multivariable logistic regression identified factors linked to illicit opioid sourcing and prescribed opioid misuse (higher dosage and/or increased frequency).

Results

Lifetime POM was reported among 3.9% (n = 12,983) of students and past three-month POM was reported among 0.7% of all students (n = 2,327). Of participants with recent misuse, 55.5% used opioids that were not prescribed to them, and 44.5% used their own prescriptions. Among those with prescriptions, 26.0% exceeded the recommended dosage, and 22.7% shortened the dosing interval. Illicit sourcing was more common among gender-diverse students (aOR: 2.72, 95% CI: 1.62-4.71, p < .0001) and those with severe psychological distress (aOR: 1.42, 95% CI: 1.11-1.82, p = .0053). Misuse of higher dosages (aOR: 2.92, 95% CI: 2.07-4.32, p < .0001) and increased use frequency (aOR: 1.79, 95% CI: 1.23-2.63, p = .0026) was linked to suicidal risk.

Conclusion

Prescription monitoring, substance use education, and harm reduction strategies to mitigate misuse risks are needed.