Exploring prescription opioid misuse among college students: a secondary analysis of ACHA National College Health Assessment data (2019–2022)

<i>Background:</i> Prescription opioid misuse (POM) remains a significant public health concern among college students, yet few studies have examined POM prevalence, misuse behaviors among those with prescriptions, and how students access opioids in college settings.<i>Objectives:</i> Assessing the prevalence of POM, patterns of opioid sourcing (i.e. prescribed vs. illicit), and the trends of misuse of one's own prescription (i.e. higher dosage and/or frequency) among college students.<i>Methods:</i> Data from the 2019-2022 American College Health Association-National College Health Assessment III survey, including responses from 331,156 students (64.4% cisgender female), were analyzed. Descriptive analyses assessed POM prevalence and misuse patterns, while multivariable logistic regression identified factors linked to illicit opioid sourcing and prescribed opioid misuse (higher dosage and/or increased frequency).<i>Results:</i> Lifetime POM was reported among 3.9% (<i>n</i> = 12,983) of students and past three-month POM was reported among 0.7% of all students (<i>n</i> = 2,327). Of participants with recent misuse, 55.5% used opioids that were not prescribed to them, and 44.5% used their own prescriptions. Among those with prescriptions, 26.0% exceeded the recommended dosage, and 22.7% shortened the dosing interval. Illicit sourcing was more common among gender-diverse students (aOR: 2.72, 95% CI: 1.62-4.71, <i>p</i> < .0001) and those with severe psychological distress (aOR: 1.42, 95% CI: 1.11-1.82, <i>p</i> = .0053). Misuse of higher dosages (aOR: 2.92, 95% CI: 2.07-4.32, <i>p</i> < .0001) and increased use frequency (aOR: 1.79, 95% CI: 1.23-2.63, <i>p</i> = .0026) was linked to suicidal risk.<i>Conclusion:</i> Prescription monitoring, substance use education, and harm reduction strategies to mitigate misuse risks are needed.