White Paper | Examining Polysubstance Use on College Campuses
Sean Howse, MD, Madeline Hilliard, BS, EMT, & Ryan Foreman, MS
What is Polysubstance Use?
Polysubstance Use is the concurrent use of two or more drugs within a short period of time, either intentionally or unintentionally (Centers for Disease Control and Prevention, 2022). At least half of overdose deaths in the United States are the result of Polysubstance Use (O’Donnel et al., 2020; Peppin et al. 2020).
While alcohol remains the substance that students self-report using most commonly (Patrick et al., 2023), more definitive data suggest that alcohol is not the sole driver of substance use deaths on college campuses. In 2019, there were 4x more deaths from Polysubstance Use of alcohol and another drug compared to deaths from alcohol alone among college-age Americans. By 2021, there were 7x more deaths from Polysubstance Use than from alcohol alone in the college age group (Centers for Disease Control and Prevention, 2024).
Examples of where students engage in Polysubstance Use:
After drinking alcohol at a party, a student is pressured by a peer to try cocaine. With their inhibitions lowered by the alcohol, they use cocaine.
Following an afternoon midterm, a student is nervous about their results. Their roomate offers them one of their own prescription anti-anxiety pills to calm down. They head to a friend’s apartment where the group celebrates the end of exam week with several drinks of alcohol.
A student is studying all day for finals and purchases a focus-enhancing stimulant pill from a non-pharmacy source on the internet. Without their knowledge, the pill contains fentanyl.
What are the risks of Polysubstance Use on college campuses?
Each of the above scenarios poses unique dangers to students’ health and safety, beyond the risks of any substance used independently. In the first scenario, we cannot overlook the well-known fact that alcohol impairs memory and increases suggestibility (van Oorsouw et al., 2019b). Without comprehensive and highly-engaging education about cocaine, peer-pressured students under the influence of alcohol are less likely to remember why they would want to say ‘no’ and more likely to engage in use of cocaine. This scenario should be a prioritized concern for college administrators, both because use of cocaine increases a student’s desire to use more alcohol (Pennings et al., 2002) and because combined use of cocaine and alcohol increases risk of sudden death 18- to 25-fold (Andrews, 1997).
The second scenario is particularly hazardous because, when neither substance is illicit, students do not perceive the dangers of combining two legal drugs: prescription benzodiazepines (such as Xanax) and alcohol. In Polysubstance Use where these two depressant drugs are involved, the effects of each one compound that of the other both because the combination overwhelms the liver’s ability to remove either from the bloodstream within the normal timeframe and because they have similar mechanisms of action in the brain (Tanaka, 2002). Both drugs impair judgment and decision making. In the common context of a student who drinks excessively, they risk vomiting as a way to offload the alcohol. This is especially concerning when combined with benzodiazepines, which cause drowsiness as well as suppression of the gag reflex (Yashimoro, 1995). If untrained friends leave this student to ‘sleep it off,’ the student may asphyxiate on vomit while unconscious.
The third scenario has become increasingly common in recent years. Since 2020, instances of unintentional Polysubstance Use - in the form of students consuming what they believe to be legitimate prescription medications but are truly counterfeit pills containing fentanyl - has skyrocketed. As of late 2023, 70% of counterfeit prescription pills now contain lethal amounts of fentanyl, up from 40% in 2021 (Drug Enforcement Administration, 2023). These fake pills are nearly impossible to distinguish from legitimate medications without laboratory testing, and the fatal toll they take is greater for young adults than any other age group (Centers for Disease Control and Prevention, 2024).
How much of a risk is Polysubstance Use on college campuses?
More than 60% of college students regularly drink alcohol - at least 28% reporting engaging in binge drinking within the last 2 weeks (Patrick et al., 2023). While these data may seem familiar, what is less often considered are the facts that 46% of college students try an illicit drug at least once during the school year, with 1 in 4 students reporting using an illicit drug within the past month (Schulenberg, 2021). These national datasets from students’ self reports confirm illicit drug use occurs about half as frequently as alcohol use does on college campuses.
Polysubstance use on college campuses is an immediate and foreseeable risk for students. The data show that sufficient Alcohol & Other Drug (AOD) programming needs to address the dangers associated with the combined use of illicit drugs and alcohol. Therefore, foundational substance use education does not exist without teaching students about the implications of participating in combined drug and alcohol use.
DopaGE directly and holistically addresses Polysubstance Use, ensuring students receive evidence-based education to help themselves and their peers avoid the significant risks of Polysubstance Use.
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