Academic journal article South African Journal of Psychiatry

Prevalence and Correlates of Non-Medical Stimulants and Related Drug Use in a Sample of South African Undergraduate Medical Students

Academic journal article South African Journal of Psychiatry

Prevalence and Correlates of Non-Medical Stimulants and Related Drug Use in a Sample of South African Undergraduate Medical Students

Article excerpt

Introduction

The non-medical use of prescription psychostimulants or cognitive-enhancing substances among healthy college students is a growing concern. Stimulant drugs are generally prescribed for the treatment of Attention Deficit/Hyperactivity Disorder (ADHD), narcolepsy and some cases of depression. (1) Yet, reports show that 5%-35% of college students use prescription psychostimulants for non-medical purposes. (2) These drugs are normally prescribed to increase motivation, mood, energy and wakefulness, and include methylphenidate, dextroamphetamine, pemoline and modafinil. (1)

Abuse of stimulant drugs can lead to psychological and physiological tolerance and dependence. Common side effects include gastrointestinal discomfort, anxiety, irritability, insomnia, tachycardia, cardiac arrhythmias and dysphoria. Less common adverse effects include induction of movement disorders, Tourette's disorder and other tics. In addition, high doses of sympathomimetics (which might be the case if stimulants are used non-medically or recreationally) can lead to dry mouth, bruxism, formication, emotional liability, psychosis and seizures. (1) Besides the above concerns, there are multiple ethical considerations involved. In the broader context, these include justifying treatment to healthy or subsyndromal individuals (referring to individuals displaying some symptoms of an illness but not severe enough for diagnosis as a clinically recognised syndrome), as well as offering pharmacological neuroenhancement for doctors working long shifts and other occupations requiring prolonged attention such as long-distance truck drivers or pilots. Lastly, the possible need for the development of protocols on the use of psychostimulants by academic institutions is another area of possible ethical debate. (3,4)

In 2001, a nationwide survey in the United States on the non-medical use of stimulants among a group of 10 000 undergraduate university students revealed a lifetime prevalence of 6.9%, a past year prevalence of 4.1% and a past month prevalence of 2.1%. (5) This cohort comprised of randomly selected students attending various 4-year courses at 119 American colleges and universities. A cross-sectional assessment was done with the help of a 20-page survey. In 2005, Teter et al. (6) reported 8.1% lifetime prevalence and a 5.4% past-year prevalence of illicit prescription stimulant use from an Internet survey of 9161 randomly sampled college students. These students were all from a single large public university and were invited via email to complete the Student Life Survey (SLS), developed by the Michigan Substance Abuse Research Centre. Furthermore, reports show that medical students appear to be at higher risk for stimulant use: in 2010, Tuttle et al. reported that 10.0% of medical students used stimulants during their lifetime. (7) Another report showed that 20.0% of medical students used stimulants during their lifetime and 15.0% used during medical school. (8) It should, however, be noted that 9.0% of participants in the aforementioned study were diagnosed with ADHD. (8) In 2013, Emanuel et al. (2) conducted a multi-institutional census on 2732 medical students and reported a lifetime psychostimulant use of 18.0%, with 11.0% reporting use during medical school and 63.0% of those using stimulants non-medically. This was an online, anonymous, cross-sectional survey about cognitive enhancement drug use and associated factors to all enrolled students at four Chicago-area medical schools, one public and three private institutions, across class year one through to six.

These above-mentioned studies found that the reasons for non-medical use of stimulants are diverse, including coping with the pressure of an academic environment, improving school performance, staying awake to study or complete projects, as well as recreationally to achieve euphoria or lose weight. (2) Other factors associated with higher rates of use included being male, white, members of fraternities and/or sororities and lower average grades. …

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