Illicit Drug Use In University Students In The UK And Ireland: A Prisma-guided Scoping Review

Subst Abuse Treat Prev Policy. 2023; 18: 18.

Published online 2023 Mar 14. doi: 10.1186/s13011-023-00526-1

Abstract

Background

Interest in the health and well-being of university students has increased in the UK and Ireland in the past two decades as their numbers have grown. Recent high-profile deaths of students after using illicit drugs have highlighted the importance of the topic for policy makers. This scoping review maps the state of the existing literature evaluating use of illicit drugs in university students in the UK and Ireland. It aims to highlight research gaps and inform policy.

Method

We conducted a systematic search of papers related to psychoactive drug use in university students in the UK and Ireland published before August 2021. The 18 extracted study characteristics included author(s); year of publication; journal; location of data collection; study design; delivery method (e.g., online survey, in-person, postal survey); number of participants; response rate; participant course of study, year of study, degree level (i.e., undergraduate, postgraduate), gender and age; time-period assessed (e.g., lifetime, current use, past 12 months); primary aim; primary outcome; ethical approval; and funding source.

Results

The PRISMA-guided search strategy identified 1583 papers for abstract review; of 110 papers retained for full-text review, 54 studies met criteria for inclusion for this paper. Primary outcomes were coded into five groups: prevalence and patterns of drug use; factors associated with drug use; attitudes and knowledge about, and motivation for, drug use; supply of drugs; consequences of drug use. The results show that there is no coherent body of research in this area. The prevalence of reported drug use has crept up and the range of substances reported has broadened over time, and attitudes to drugs on average have normalised. However, there are significant methodological limitations that limit the utility of these findings. There was little evidence of published work on prevention of, or intervention to reduce, drug-related harms.

Conclusion

The domains identified offer a framework for university administrators, researchers and policy makers to understand the potential response to drug use in university students in the UK and Ireland. Recommendations are made to fill the gaps in the research evidence base.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-023-00526-1.

Keywords: Psychoactive drugs, Students, University, Scoping review

Background

Illicit drugs are psychoactive substances whose non-medical use has been banned by international drug control treaties as they are believed to pose an unacceptable risk to the health of people that use them [1]. Prospective cohort studies in high-income countries consistently show that adolescence is the peak period for first illicit drug use, and levels and frequency of use begin to increase in mid-adolescence and peak in early adulthood before slowly declining with age [2, 3]. This is consistent with the latest figures available for England and Wales, which relate to trends in drug use for the year ending March 2020 [4]. Approximately 1 in 5 (21%) young adults aged 16–24 years had taken an illicit drug in the last year (1.3 million people) compared with 1 in 11 (9.4%) adults aged 16–59 years. Furthermore, twice as many young adults had taken a drug more than once a month in the last year. Cannabis was the most common drug used by 16–24 year olds (18.7%).

Illicit drug use in young adults tends to be more experimental and opportunistic than in older age groups, but some young adults start to use drugs more frequently and a small number progress to regular use and dependence. Degenhardt and colleagues have described the epidemiology of illicit drug use in young people (defined as 10–24 years old) around the world, the harms that they cause, and the potential responses available to reduce these harms [2, 5, 6]. Variations in patterns of drug use initiation between countries and cultures suggests that a young person’s entry into illicit drug use may reflect their personal characteristics, illicit drug availability, and social settings that facilitate or deter drug use [2].

Illicit drug use appears to be a common but infrequent activity amongst university students. In the UK most students start university at the age of 18 or 19, and it was reported in 2017/18 that a record 50.2% of English 17- to 30-year-olds had participated in higher education. This coincides with a period often known as ‘emerging adulthood’, commonly defined as the period between the end of compulsory schooling and the onset of adult commitments such as employment, long-term sexual relationships and parenthood [7].

During this period most students live away from home for the first time and so become more financially independent and self-reliant as a consequence. New friends are made and old friends from school are left behind, as the individual begins to forge a new adult identity away from parental influence. Peer and romantic interactions become more important, and there is a need to be more self-directed in terms of time management. The university can therefore be seen as a specific ‘risk environment’ [8], where cultural and environmental factors including distance from parents and the interconnected nature of student life can accelerate trajectories from drug experimentation to more involved drug use [9]. In this transitional phase, experimentation with drugs may be seen as a normative behaviour by students that helps them to develop new social relationships, enhance new experiences or to boost academic or recreational performance [7, 10].

A national survey of 2810 students in the UK in 2018 reported that 56% of respondents had used drugs, and 39% currently used them [11]. Cannabis was the most frequently taken drug (94% of respondents who said that they had used drugs) and was the most likely to have been used regularly. However, ecstasy, nitrous oxide and cocaine had all been used by most of the drug-using population at some point. Large scale North American surveys show that the annual prevalence of illicit substance use in university student populations has grown gradually from 34% in 2006, to 43% in 2018 [12]. The US national Monitoring the Future follow-up study reported that the annual prevalence in cannabis use in university students was at a historic high level, with a 5-year trend from 2014–2019 showing a significant 8.6% increase [12].

The 2017 Government Drug Strategy in England emphasised that Colleges and Universities had an important role to play in supporting the health and welfare of their students [13] (p9). Likewise, when the Irish Government convened a Rapid Response Group in September 2019 to address illicit drug use in higher education institutions (HEIs) it noted that HEIs “can assist in addressing the hazards of illicit drug use by implementing actions that have the potential to reduce the number of students who decide to use drugs in the first place, or to reduce the harm experienced by those students who have chosen to use drugs” [14]. However, there has been relatively little research on the incidence and prevalence of drug use in UK or Irish university student populations. Previous reviewers have noted methodological shortcomings, including small sample sizes and/or a narrow focus on students from a single university or even a single department [15, 16]. It is not clear whether student attitudes to drugs differ from their non-student peers, or whether they have changed over time. There is also a lack of consensus on the extent of drug-related harms and the most effective strategies to reduce them if necessary. In early 2022 Universities UK (UUK) announced that it wished to set out a common approach to reduce harms from drug use and to better tackle supply [17]. They noted that some universities had the stated aim of a ‘drug-free campus’ whereas others had implemented harm reduction and treatment services.

A coherent body of research into illicit drug use by university students might be expected to explore the epidemiology of use, potential mechanisms of initiation, escalation and reduction in use, prevailing attitudes towards and beliefs about drugs, any potential benefits or harms resulting from use, and methods for detecting, preventing and treating problematic use. The existing evidence base in this area is built on research in North American university populations [18, 19], but there are considerable differences between the USA and Europe in terms of the structure and funding of higher education, social and criminal justice systems, and the availability of treatment for substance use disorders. We therefore conducted a PRISMA-guided scoping review of the literature to answer the question ‘what is known from the existing literature about the use of illicit drugs by university students in the UK and Ireland?’. Scoping reviews aim to be comprehensive but with a focus on identifying gaps in the literature to inform policy. As such, they provide an overview of the research in an area of study but without an in-depth consideration of research quality [20]. The process involves identifying an initial research question, searching for and selecting relevant studies, and collating, charting, summarizing, and reporting the data [21]. This review is the first attempt to identify gaps in the evidence base to guide future research, policy and practice in identifying and reducing the potential harm of illicit psychoactive drug use in university students in the UK and Ireland.

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Methods

In line with scoping review guidance, we first considered the concept (what is known about illicit drug use), target population (university students in the UK or Ireland), and.outcomes of interest (including epidemiology, mechanisms of initiation, escalation and reduction in use, attitudes and beliefs about drugs, benefits or harms of use, and methods for detecting, preventing and treating problematic use) to clarify the focus of the scoping study [20, 22]. A search strategy was developed in line with our overarching question, and three electronic databases were searched in July 2021 to identify published papers: MEDLINE, PsycINFO and Web of Science. Search terms including ‘United Kingdom’, ‘Ireland’, ‘student’, ‘university’ and drug use’ were used (see Supplementary file 1 for a full list of search strings). The search terms were broad to be as comprehensive as possible. The reference lists of the included papers were searched and experts in the field contacted to identify any further evidence. The electronic databases EThOS and OpenGrey were used to search for unpublished evidence. Following the guidance for a systematic search created by the Canadian Agency for Drugs and Technology in Health [23], a general Google search was completed and the first 50 results were screened. There were no restrictions imposed on the date of publication, but due to time and cost restraints only English language papers were included.

Study selection

The search produced 1583 potential papers for inclusion. The inclusion and exclusion criteria were formulated as an iterative process once the breadth of the literature was understood. Systematic reviews and literature reviews were excluded but reference lists were searched. Primary studies were not excluded based on their design, and both quantitative and qualitative research was included. Theses and student dissertations were included, but other unpublished literature was assessed separately. Studies that also included non-student participants or non-UK/Ireland-based universities were only included if the results were separated by population and the relevant data could be extracted. Papers discussing drug education in the university curriculum of healthcare professionals were excluded. The full search included papers that focussed on the use of drugs prescribed by a healthcare professional (even if used illicitly e.g. those used as ‘cognitive enhancers’). However, this report focuses on illicit drugs only (see data supplement 2 for excluded papers on the latter topic). If more than one report used duplicate data, the most comprehensive or relevant paper was included.

Two independent reviewers (MB and ED) undertook the study selection process. The titles of the records found in the search were screened and the relevant abstracts independently assessed, with any disagreements between reviewers resolved through discussion. Full-text papers were then obtained and reviewed. The reviewers met frequently to discuss challenges surrounding study selection and to ensure the search strategy was suitable. Papers that assessed any aspect of the use of illicit drugs conducted in the UK or Ireland were included. Figure 1 shows the process of study selection using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework [24]. The excluded papers are listed in Supplementary file 2, along with the reasons for exclusion.