Psychoactive substance use for academic performance enhancement among pharmacy students in two universities in southeastern Nigeria: a cross-sectional study

The non-medical use of psychoactive substances to enhance academic performance is an increasingly recognised public health concern among university students, yet evidence among pharmacy students in Nigeria remains scarce. This study sought to determine the prevalence, patterns, motivations, perceived academic benefits, adverse effects and sociodemographic correlates of psychoactive substance use for enhanced academic performance among undergraduate pharmacy students in two universities in southeastern Nigeria. This multi-institutional, cross-sectional study surveyed 752 undergraduate pharmacy students at the University of Nigeria, Nsukka and Enugu State University of Science and Technology ( n = 702 and n = 50, respectively) using a structured, anonymous online questionnaire. Prevalence estimates are reported with 95% confidence intervals (CIs), and associations were examined using Pearson’s chi-square test or Fisher’s exact test, as appropriate. Overall, 550 of the 752 respondents (73.1%; 95% CI 69.9–76.2) reported using at least one psychoactive substance to enhance academic performance during examinations. Legal, non-prescription stimulants predominated, namely energy drinks (62.1%) and caffeine products (caffeine tablets or caffeinated beverages; 43.8%). Non-medical use of controlled or prescription-only medicines (cough syrup 1.7%, tramadol 1.5%, codeine-containing tablets 0.7%) and use of illicit substances or tobacco (marijuana 3.2%, cigarettes 1.5%) were uncommon. Among users, the principal motivations were staying awake to study (74.7%), feeling energetic (49.5%), extending study duration (44.7%) and improving concentration (20.4%). Self-rated academic performance changed little before and after use. Headache (43.5%), insomnia (28.5%) and confusion (13.6%) were the adverse effects most commonly reported by users, and 14.0% of users reported withdrawal symptoms. Male students were more likely than females to report marijuana (5.7% vs. 1.0%, P < 0.001), cigarette (2.9% vs. 0.2%, P = 0.004) and tramadol use (2.6% vs. 0.5%, P = 0.029). From the findings, it was concluded that psychoactive substance use for perceived academic performance enhancement is common among Nigerian pharmacy students and is driven predominantly by legal stimulants. Recommendations were made which include that targeted health education addressing sleep hygiene, study skills and emphasis on responsible stimulant use is warranted within pharmacy curricula. This study highlights the need for educational leaders and institutions to embed structured student-support systems within the governance of professional health-science programmes, using behavioural evidence to inform policy. The evidence supports a shift from reactive to proactive academic support and wellbeing strategies for pharmacy and other health-science students. Adopting this approach will enhance student management, improve educational outcomes, and support sustained academic performance. Use of psychoactive substances for perceived academic performance enhancement was common among pharmacy students in the two participating universities and involved predominantly legal stimulants, whereas non-medical use of controlled or illicit substances was uncommon. Because academic performance was self-rated and the design was cross-sectional, no inference can be drawn about whether these substances improve actual academic achievement. The adverse effects reported by users suggest that health education on sleep hygiene, effective study strategies and the risks of excessive stimulant intake merits consideration within pharmacy curricula and student-support services.