College is often a period of growing independence. Students are managing academics, work, relationships, health care and daily responsibilities with less direct oversight from parents and caregivers than they may have had in high school.
That independence is an important part of becoming an adult, but it can also make substance misuse harder for families to recognize.
Prescription drug misuse remains a concern among college students, particularly when it comes to prescription stimulants. Understanding why students may misuse medications, what warning signs families can watch for and how to keep conversations open can help reduce risk.
What Is Prescription Drug Misuse?
Prescription drug misuse generally means using a prescription medication in a way other than directed by a health care provider. That can include:
- Taking medication prescribed to someone else
- Taking a higher dose than prescribed
- Taking medication more often than directed
- Using medication for a different purpose than intended
- Combining medications or other substances without medical guidance
Prescription medications have legitimate medical uses, but that does not mean they are safe to use without a prescription or outside the guidance of a qualified health care professional.
How Common Is Prescription Drug Misuse Among College Students?
Recent national data show that prescription drug misuse continues to affect a portion of the college population.
According to the 2024 Monitoring the Future study, about 6% of college students reported nonmedical use of a prescription drug during the previous year.
Prescription stimulants are an especially important part of the picture. In the same survey, 4.1% of college students reported using amphetamines without a doctor’s prescription during the previous year, compared with 1.5% of young adults of the same age who were not enrolled in college.
Broader national data show a similar concern among young adults. The 2024 National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration found that 5.8% of U.S. adults ages 18 to 25 reported misusing a prescription psychotherapeutic drug in the previous year.
These numbers do not mean prescription drug misuse is increasing across every category. In fact, national data show declines in several forms of prescription drug misuse among young adults in recent years. But misuse remains an important prevention issue, particularly on college campuses where prescription stimulants may be readily available.
Why Do College Students Misuse Prescription Drugs?
There is no single reason.
Students may misuse prescription medications for academic, emotional, social or recreational reasons. Some may be trying to manage symptoms they have not discussed with a health care provider. Others may believe prescription drugs are safer than illicit substances because they have legitimate medical uses.
Prescription stimulants illustrate this particularly well.
In a recent study of community college students, the most commonly reported reason for nonmedical prescription stimulant use was to improve concentration while studying or academic performance, followed by using stimulants to increase energy. Read the study through PubMed.
A student facing an exam or struggling to concentrate may therefore see taking a friend’s medication as a practical shortcut rather than as substance misuse.
That perception can be dangerous.
Medication prescribed for one person has been selected based on that individual’s health history, diagnosis, dosage needs and other medications. What is appropriate for one student may not be appropriate or safe for another.
Prescription Stimulants and College Campuses
Prescription stimulant medications are commonly used to treat conditions such as attention-deficit/hyperactivity disorder, or ADHD.
Students who use these medications as prescribed should not be stigmatized. They are legitimate treatments that can be important to a student’s health and academic success.
The prevention concern is nonmedical use and diversion, including sharing or selling medication to someone for whom it was not prescribed.
A large national study involving more than 224,000 undergraduate students at nearly 400 U.S. colleges and universities found a relationship between the prevalence of ADHD medication treatment on a campus and prescription stimulant misuse. The findings reinforce the importance of preventing medication sharing while supporting students who appropriately use prescribed treatments. Read the study in Addiction.
Families can help by making one distinction especially clear:
Having access to prescription medication is not the same thing as having medical permission to use it.
Jason Surks’ Story
For Wellspring Center for Prevention, prescription drug misuse also has a deeply personal connection.
Jason Surks was a 19-year-old Rutgers University student and the son of Linda Surks, who worked in substance misuse prevention with Wellspring.
Jason was studying pre-pharmacy, working at a pharmacy and maintaining strong relationships with his family and friends. After his death from a prescription drug overdose in December 2003, his family learned that he had been misusing prescription medications.
One of the warning signs appeared while Jason was in college.
His mother discovered an unlabeled bottle containing a generic form of Ritalin in his room. Jason explained that he had received the medication from a friend and wanted to see whether it would help him focus in school.
His family also later learned that Jason researched medications and drug interactions online. As a pre-pharmacy student, he may have believed his knowledge allowed him to manage the risks involved.
His experience illustrates an important prevention lesson that remains relevant today:
Knowing something about a medication does not make nonmedical use safe.
It also shows why prescription drug misuse can be difficult for families to recognize. Jason continued attending college, working and regularly coming home. His behavior did not consistently signal to his family that something was seriously wrong.
Linda shared Jason’s story in the hope that other families might recognize risks that her family could not see at the time. His legacy also continues through Wellspring Center for Prevention. The Jason Surks Memorial Resource Center provides prevention information, resources and access to Wellspring’s Certified Prevention Specialists, while the Jason Surks Memorial Fund supports prevention efforts in the communities Wellspring serves.
Continue Jason’s Legacy
Explore the Jason Surks Memorial Resource Center.
Support prevention in New Jersey through the Jason Surks Memorial Fund.
The Drug Environment Has Changed Since 2003
Jason’s story took place more than two decades ago. Many of the underlying prevention lessons remain relevant, but the drug environment facing today’s students has changed.
One major concern is the availability of counterfeit pills.
Medications obtained through a licensed pharmacy contain known ingredients and doses. Pills purchased through social media, illicit markets or other unregulated sources may be made to resemble legitimate prescription medications while containing fentanyl or other unexpected substances.
That creates an additional risk for today’s college students that families should understand.
A pill that looks like a prescription medication is not necessarily what it appears to be.
Why Prescription Drug Misuse Can Be Hard to Recognize
Substance misuse does not always produce immediate or dramatic changes in behavior.
College students may also be living away from home, meaning parents and caregivers see them much less frequently than they did during high school.
A student can continue earning good grades, maintaining friendships or working while still experiencing substance-related problems.
Families should therefore avoid relying on any single stereotype of what substance misuse “looks like.”
Possible warning signs can include:
- Taking medication that was prescribed to someone else
- Unexplained pills or medications
- Frequently running out of prescribed medication early
- Sudden changes in sleep patterns
- Noticeable changes in mood or behavior
- Increasing secrecy around medications or substance use
- Combining medications with alcohol or other substances
- Obtaining medication from friends, online sources or other nonmedical channels
No single sign necessarily means someone is misusing prescription drugs. Patterns of behavior and changes over time matter more than one isolated observation.
Mixing Prescription Drugs With Other Substances Can Increase Risk
Prescription drug misuse may also occur alongside alcohol, cannabis or other drug use.
Recent research examining college students’ daily behavior found that prescription drug misuse often occurred in combination with other substances. Read the study.
Combining substances can create unpredictable effects and increase the risk of serious harm.
Students should be encouraged to talk openly with a health care provider or pharmacist about possible interactions between medications, alcohol, cannabis, supplements and other substances they may use.
How Families Can Reduce the Risk of Prescription Drug Misuse
Parents and caregivers may have less day-to-day involvement once a child goes to college, but prevention conversations should not end when high school does.
Families can continue supporting young adults by:
Talk About Prescription Medications Directly
Discuss the difference between using medication as prescribed and taking someone else’s medication.
Be specific. Students may not necessarily think of taking a friend’s stimulant to study as “drug use.”
Avoid Fear-Based Conversations
Students are more likely to keep communicating when conversations are grounded in accurate information rather than assumptions, accusations or scare tactics.
Ask questions and listen to what they are experiencing.
Encourage Professional Help for Health Concerns
If a student is struggling with concentration, anxiety, sleep, pain or another health problem, encourage them to speak with a health care professional rather than trying someone else’s medication.
Store Medications Securely
Students who have legitimate prescriptions should keep medications secure and avoid sharing them.
Families should also regularly review medications kept at home and safely dispose of medications that are no longer needed.
Keep the Conversation Going
One conversation before a student leaves for college is not enough.
Academic pressure, relationships, mental health, living arrangements and social environments can change quickly during the college years. Regular conversations give families more opportunities to understand what their student is experiencing.
Prevention Does Not End When Students Leave Home
College students are learning to make increasingly independent decisions about their health, relationships and futures.
Families cannot eliminate every risk, nor can they monitor every decision their adult children make. But they can provide reliable information, communicate clear expectations and make it easier for young adults to ask for help.
Jason Surks’ story reminds us that prescription drug misuse may not always be obvious and that knowledge alone does not eliminate risk.
More than 20 years later, his family’s decision to share his experience continues to reinforce an important prevention message: conversations about prescription medications, substance misuse and healthy decision-making should continue well beyond adolescence.
If you or someone you know is struggling with substance use, reaching out to a health care professional, counselor, or trusted support resource can be an important first step.