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Miami University is using an innovative approach to preventing prescription drug abuse among its students. Before prescribing medications for attention deficit hyperactivity disorder (ADHD), the university student counseling service requires students to participate in a workshop about time management, and another session about taking medication safely.
The school has developed similar prevention strategies for treating anxiety, sleep disorders and pain, according to Joshua Hersh, MD, Staff Psychiatrist at Miami University Student Counseling, located in Oxford, Ohio. “We are trying to minimize abuse by maximizing care,” said Dr. Hersh, who spoke about the university’s approach at the recent American Psychiatric Association annual meeting.
Abuse of stimulants such as Adderall and Ritalin is a major concern on college campuses around the country. A study conducted at the University of Maryland in 2010 found among students prescribed a medication, 35.8 percent diverted a medication at least once in their lifetime. The most commonly diverted medication classes were prescription ADHD medication, with a 61.7 percent diversion rate, and prescription painkillers, with a 35.1 percent diversion rate. Sharing was the most common method of diversion, with 33.6 percent of students sharing their medication(s) and 9.3 percent selling in their lifetime.
Nonmedical use of stimulant drugs has been linked to heart and blood vessel problems, as well as drug abuse or dependence. Dr. Hersh notes that combining alcohol and stimulants is particularly dangerous. “When they are combined, people get far more intoxicated than they normally would,” he said. “They are more likely to overdose or to drive while intoxicated.”
Students at Miami University who seek medication for ADHD must first go through an initial phone screen. They then attend a “brain booster” workshop, which lasts for 90 minutes. At the workshop, they receive a planner to help them organize their time, and are instructed in how to use it. They receive tips about time management, such as using their cell phone to keep track of appointments. Students are told how to improve their sleep, hygiene, minimize distractions, and improve their study skills and reduce procrastination.
“We tell them to treat college like a job,” Dr. Hersh said. “One of the main reasons people abuse stimulants is poor time management. They find they need to cram for an exam, and use stimulants to help them stay up all night. When we teach students time management skills, their attention and focus improves, and they are less likely to misuse stimulants.”
Several weeks after attending the workshop, students fill out a goal completion worksheet to demonstrate how well they have adopted the skills and behaviors they learned. If they decide to go ahead with an evaluation for ADHD, they attend another hour-long workshop, which is required even for students who have been prescribed ADHD medication in the past. They learn how to keep their medications safe in a college setting, and avoid misusing or diverting them. Only after they have attended both workshops can they see Dr. Hersh. “We slow down the process to screen out the people who just want a quick fix,” he explained.
Students seeking treatment for anxiety disorders attend an anxiety management workshop, sometimes along with individual therapy. “They are introduced to guided imagery, relaxation techniques and other behavioral techniques to control anxiety before they are evaluated for medication,” said Dr. Hersh.
If the doctor determines the student would benefit from medication, the student is first prescribed a non-addictive medication. If these medications aren’t effective, the student may be prescribed benzodiazepines, but the amount is limited, usually to 10 pills per month. The student is monitored frequently for signs of misuse and diversion.
For sleep disorders, students learn behavioral techniques, such as using a noise machine, before medication is prescribed. If medication is needed, students are first given non-controlled substances such as trazodone or melatonin. If the student is prescribed a controlled substance such as zolpidem (Ambien), they are given a limited amount. If needed, they are referred to a sleep disorders clinic for evaluation of conditions such as sleep apnea or narcolepsy.
Students being treated for pain are first given non-controlled medications such as non-steroidal anti-inflammatory medications (NSAIDs). If opiates are needed for severe, acute pain, students are given a limited supply, and are monitored for signs of misuse and diversion through urine screening.
By giving students tools to help manage their condition, evaluating them and following them closely, and prescribing potentially addictive medications only as a last resort, Dr. Hersh believes colleges across the country can have a big impact on reducing prescription drug abuse on campus.