Prescription Medication and Substance Use Among Graduate Nursing and Health Science Students: A Scoping Review of...

To synthesize evidence on the initiation of prescription medications, over-the-counter substances, illicit substances, and other coping mechanisms among graduate nursing and health science students, medical students, and medical residents during training. The review also sought to identify predisposing personal and academic factors, as well as school-related stressors, influencing substance use.

Scoping review conducted per Arksey and O'Malley framework and PRISMA-ScR guidelines.

Four databases (PubMed, EMBASE, CINAHL, and Cochrane) were searched for studies published between 2013 and 2024. Inclusion criteria were graduate nursing, health science, and medical students and residents; initiation of medications or substances during training; and reporting of contributing factors or stressors. All citations were exported to Covidence for systematic review management. Of 941 initial citations, 655 abstracts were screened, 80 full-text articles were reviewed, and 25 studies met inclusion criteria.

High levels of stress, anxiety, and depression were consistently reported across student populations. Initiation of substances-including prescription medications (notably stimulants and anxiolytics), alcohol, and other stimulants-emerged as common coping mechanisms. Predisposing factors included preexisting mental health conditions, academic pressure, and cultural normalization of substance use within healthcare education. School-related stressors such as workload intensity, prolonged training hours, and high-stakes performance expectations strongly influenced initiation.

Graduate health science students and residents are at risk for stress-related substance use. These findings underscore the need for targeted institutional strategies that simultaneously address mental health and substance use. Future research should investigate long-term consequences of initiation and evaluate sustainable interventions that strengthen support systems, reduce reliance on substances, and promote well-being among healthcare trainees.