Understanding Illicit Prescription Painkiller Use: A Multivariable Exploration of Mental Health and Other Predictors Among Canadian University Students: Comprendre la consommation illicite d’analgésiques sur ordonnance : une analyse multivariée de la

Background and Objectives Illicit prescription painkiller use among university students is a growing concern, influenced by a range of demographic, mental and physical health, academic, and co-substance use factors contributing to the elevated risk. However, Canadian evidence specific to university students remains limited. This study examined correlates of self-reported illicit prescription painkiller use among Canadian university students. Method A secondary analysis of data from the American College Health Association National College Health Assessment II Canadian university edition was conducted. The dependent variable was past-year illicit prescription painkiller use, defined as a yes or no response to self-reported use of prescription painkillers without a prescription from a healthcare provider in the past 12 months. Descriptive statistics and binary logistic regression were used to examine associated demographic, academic, physical health, mental health, and co-substance use factors. Results Among the analytical sample of 44,508, 5.8% ( n = 2,585) reported illicit prescription painkiller use in the past 12 months. Significant predictors included race, sex, sexual identity, international student status, mental health factors, chronic illness, academic factors, and co-substance use. Higher odds of use were observed among West Asian and Black students, international students, students with chronic illness, students reporting hopelessness, feeling overwhelmed, depression with functional impairment, or suicidal ideation, and students reporting tobacco, alcohol, e-cigarette, or cocaine use. Conclusions Illicit prescription painkiller use among Canadian university students was associated with demographic, mental health, physical health, academic, and co-substance use factors. Findings support campus-based prevention and support strategies that integrate substance use education, mental health services, and equitable access to care.