Medical and non-medical use of prescription stimulants: Association with cannabis, alcohol and tobacco use among university and college students in Israel

Background: Non-medical use of prescription stimulants (NPS) by college students has been increasing in recent years. Studies of NPS users addressed multidrug use. Limited research attention has been paid to the medical use of prescription stimulants (MPS) and their association with the use of other substances. The present study examines the use of medical and non-medical prescription stimulants (MNPS) by students, and its association with cannabis, alcohol and tobacco use. Methods: Self-report questionnaires were collected from 814 social science undergraduates from three universities and one college in Israel (27.1% male and 72.4% female), average age 28.1 (SD= 0.79). Results: 19.3% (N=155) of students were MNPS users: 66.8% MPS (12.2% of the entire sample) and 33.1% NPS (7.1% of the entre sample). No differences were found between NPS and MPS with regard to the use of cannabis, alcohol and tobacco, but significant differences were found between MNPS users compared to abstainers (those who used neither medical nor non-medical prescription stimulants), with MNPS using more substances than abstainers (46.5% of MNPS smoked cigarettes, compared with 27.7% of abstainers (χ2=28.55, df=4, p<0.001); 80% of MNPS drank alcohol, compared with 70% of abstainers (χ2=10.10, df=4, p<0.05); and 25.8% of MNPS used cannabis (χ2=8.44, df=4, p<0.001), compared with 15.9% of abstainers. Conclusions: Users of medical and non-medical prescription stimulants are both at risk of using other substances, such as cannabis, alcohol and tobacco. Interventions and prevention programs must focus on all students who use MNPS, not only on NPS users.