Prescribing Practices, Motivations, and Behaviors Contributing to Prescription Stimulant Misuse Among Medical Students at an Allopathic Medical School: Cross-Sectional Survey Study.

Objective The rate of prescription stimulant misuse has steadily risen over the past few decades. Medical students are at significant risk; however, limited data exist surrounding misuse in this population. This cross-sectional survey aimed to investigate prescribing practices, behaviors, and motivations contributing to medical student prescription stimulant misuse. Methods An electronic survey was distributed via university email to all medical students enrolled at an allopathic medical school. Survey assessed prescribing practices, malingering, diversion, provider counseling, perceived medication safety, knowledge of adverse effects and consequences of diversion, pressure to use medication, and normality of peer misuse. Sample t-tests, chi-square tests, and Kendall's Tau-b tests were used for analysis. Results Of the approximately 600 students eligible for inclusion in the study, 290 (48.3%) completed the survey. 256 (88.3%) respondents reported no prescription stimulant use, 29 (10.0%) reported use with a prescription, and 5 (1.7%) reported use without a prescription. 12 (41.4%) of the 29 respondents with a prescription received their first prescription while in medical school, 3 (10.3%) were prescribed without a complete evaluation for attention deficit hyperactivity disorder (ADHD), and 2 (7.4%) engaged in malingering. A total of 16 users (55.2%) received medication counseling, and 15 users (51.7%) received legal counseling at the time of prescription. Receiving legal and medication counseling was associated with a significantly higher average understanding of consequences of diversion (p = 0.012) and medication side effects (p = 0.017), respectively. There were no significant differences in motivations for use or behaviors of use between users with and without a prescription. The year of medical school was significantly associated with stimulant use behavior (p = 0.03). Students experiencing greater pressure to use medication to compete academically were significantly more likely to indicate an interest in matching into psychiatry (p = 0.036), obstetrics & gynecology (p = 0.025), interventional radiology (p = 0.044), urology (p < .0001), and physical medicine & rehabilitation (p = 0.050) residencies. Among non-users, there was a statistically significant positive correlation between pressure to use medication and both the frequency of witnessing peers use medication without a prescription (+0.336, p < 0.0001) and the likelihood of malingering (+0.422, p < 0.0001). Conclusions The prevalence of non-prescription stimulant use was lower than what has been reported in previous studies; however, cases of malingering and potentially inappropriate prescribing of stimulants were observed among students with prescriptions. Efforts should be taken to increase provider counseling on the medical risks of use and the implications of diversion. Mitigating the perceived normalcy of stimulant misuse may be an effective strategy for reducing misuse among medical students.