Alcohol use and consequences in matriculating US college students by prescription stimulant/opioid nonmedical misuse status

US college students have elevated prescription opioid and stimulant misuse rates, with frequent alcohol use and alcohol-related consequences (ARCs). To date, though, no research has examined relationships between opioid and/or stimulant misuse and alcohol quantity/frequency or ARC variables in college students.

The 2016-17 AlcoholEDU for College™, a web-based alcohol prevention program, provided data (n = 491,849). Participants were grouped into past 14-day: (1) no misuse; (2) opioid misuse only; (3) stimulant misuse only; and (4) combined misuse. Using multilevel logistic regressions, groups were compared on 14-day alcohol use odds, and among those with use, odds of any ARCs and specific ARCs (e.g., hangover). Multilevel negative binomial regressions compared group members with alcohol use on 14-day total drinks, maximum 24-h drinks and drinking days.

Alcohol use and any ARCs odds were highest in the stimulant (odds ratios [OR] = 3.47 and 2.97, respectively) or opioid misuse only groups (ORs = 3.31 and 2.43, respectively), with the combined misuse group intermediate (ORs = 1.63 and 1.29; reference: no misuse). Mean 14-day drinks decreased from those with combined misuse, to those with stimulant misuse only, opioid misuse only and no misuse (8.22, 7.1, 6.67, and 4.71, respectively).

College students engaged in 14-day stimulant and/or opioid misuse had higher odds of 14-day alcohol use, higher levels of alcohol use, and a greater likelihood of ARCs, versus students without misuse. These findings suggest that college students with any prescription misuse need alcohol screening, although those with poly-prescription misuse may not need more intensive alcohol interventions.