Opioid Misuse in College Student Populations

Among young adults enrolled in higher education, transitioning to college life often coincides with significant developmental changes. These changes are frequently accompanied by heightened vulnerability to substance use behaviours, particularly opioid misuse, and its intersection with mental health challenges. Recent national studies highlight the concerning prevalence of these behaviours and underline their potential impact on student well-being and academic performance.

Young adults aged 18–25 are disproportionately prone to substance misuse compared to older populations. College campuses, serving approximately 20 million young adults in the United States, have become a focal point for assessments of such behaviours. Substance misuse, including binge drinking (67%), cannabis use (38% in the past year), and nicotine vaping (28% in the last 30 days), is broadly documented. However, opioid misuse, despite its serious health implications, remains underexplored in college populations compared to other substances.

Prevalence and Demographic Characteristics

A large-scale study sourced from the Healthy Minds Study encompassing data from 2017 to 2020 revealed key insights:

Out of 176,191 students, 782 (0.44%) reported opioid misuse within the past month.
Lifetime opioid misuse estimates among university populations range from 4% to 19.7%.
50% of students by their sophomore year reported being offered illicit opioids for nonmedical purposes.

Notably, opioid misuse among adolescents and young adults aligns with the broader trends of rising adolescent overdose deaths. Since 2019, overdoses involving fentanyl, a potent synthetic opioid, have tripled, with 5.2 deaths per 100,000 adolescents reported in 2022. Fentanyl is increasingly found in non-opioid substances such as stimulants and counterfeit pills, amplifying its reach beyond students deliberately misusing opioids.

Mental Health Correlations

The study identified a profound correlation between opioid misuse and mental health disorders:

Students reporting opioid misuse were 24.1% more likely to exhibit symptoms of anxiety or depression.
64.3% of opioid-misusing students screened positive for depression or anxiety, with 57.9% receiving formal diagnoses.
Among these, less than half received mental health treatment within the past year.

Help-Seeking Behaviours and Barriers

A concerning gap exists in mental health service utilisation:

82.8% of students who misused opioids expressed a perceived need for help, yet only 48% sought professional intervention.
Barriers included fear of stigma (over 50%) and apprehension about being judged or penalised (47%).

Additional disparities in treatment accessibility were observed within minority groups:

African American students exhibited a 73% lower likelihood of receiving mental health diagnoses, while Asian students were 51% less likely to access therapy compared to their white peers.
Sexual minority students, including transgender and LGB students, reported higher rates of mental health disorders yet faced similar obstacles in obtaining care.

Academic Performance

The effect of opioid misuse extends beyond physical and mental health, significantly impacting academic outcomes. For instance:

Students prioritising substance-seeking behaviours over academics represented 70% of those entering opioid treatment programmes.
Academic difficulties such as missed classes and reduced effort were reported among opioid users.
Recent studies further demonstrate the adverse academic effects of co-occurring substance use and mental health symptoms.

Findings from Related Research

Oregon State University Study

A 2021 study conducted at Oregon State University provides complementary insights. It highlights the broader spectrum of outcomes linked to prescription stimulant and opioid misuse among college students:

Misusing these substances doubled the likelihood of reporting mental health issues including anxiety and depression.
Academic struggles were notably severe among stimulant users, often exacerbated by the misconception that such substances improve performance.
Chronic pain was cited more frequently among opioid-misusing students compared to those using illicit drugs.

The study underscored the need for targeted drug education to address misconceptions about self-medication and academic enhancements through drug use. It also urged healthcare providers to caution patients against sharing prescriptions.

Policy Implications

The Andersen Behavioural Model of Health Services Utilisation offers a framework to understand barriers hindering mental health and substance use treatment uptake. Predisposing factors (age, gender, ethnicity), enabling conditions (insurance, resource awareness), and perceived need all influence healthcare access and, by extension, academic retention.

Efforts to address these disparities include: