Patient Presentation
A 17-year-old female with attention deficit disorder with hyperactivity was being seen for her health maintenance examination. She was going to college in the fall and wanted to know what was the best way to keep her methylphenidate prescriptions safe in her dorm room. The past medical history showed she had been diagnosed after having school difficulties when she was in the 5th grade. She had been taking a long-acting medication with good response and some minor weight loss occasionally for the past 7 years.

The pertinent physical exam showed a healthy female with normal vital signs and her weight was at the 10% as it had been for the past 2 years. Her examination showed a Tanner V female without abnormalities. The diagnosis of a healthy female was made. The pediatrician discussed several issues about transitioning to college. “Discretion is important. Don’t go around telling everyone you have the medicine and just take it discretely in your room. Roommates may end up being your lifetime friends or may be someone you cannot trust. Remember they have to earn your trust before you tell them. Keep the medicine locked up. Either you buy a small safe and keep it hidden or there may be one in your room that you can use. Always keep your door locked. That is the first rule,” the pediatrician advised.

Discussion
Going away to college presents new and exciting opportunities for young adults. It also is an important time for transitioning many adult responsibilities to the young adult too. Keeping safe is important and safety tips for college can be reviewed here.

Any medication can be abused. Prescription stimulants are no different. Normally prescription stimulants are used for treatment of attention deficit disorder, narcolepsy and treatment resistant depression. They can help increase alertness, attention, and energy, cognition, learning and memory. However for these reasons and because they are easy to obtain and relatively inexpensive, prescription stimulants are commonly abused on college campuses. Side effects of prescription stimulant abuse includes addiction, cardiovascular side effects, withdrawal symptoms (fatigue, sleep problems or depression) and even hostility, paranoia or psychosis.

Learning Point
While some of the recommendations for safe use of prescription medications in college are specific for controlled substances like stimulants, they are generally true for any medication. Students and their families should consider the following questions:

• Who will prescribe the medication? Regular hometown physician, student health center, local physician in the college location, or a combination.
• How often will the student need to followup with the prescriber?
  • The regular physician is often very willing to continue to prescribe medications with followup arranged during scheduled college breaks such as Thanksgiving, Spring Break, etc.
  • However it is important to at least have a local physician who can assist the student if a problem arises. Dosing adjustments are not uncommon nor are side effects because of the changes in student’s lifestyle.
    Also other mental health problems may arise such as increased anxiety or depression that also needs to be addressed.

  • Similarly, it is often helpful to have a relationship with a local pharmacy before a potential problem arises.
• What pharmacy will be used? Regular pharmacy, local pharmacy, combination
  • Pre-dated paper prescriptions for controlled substances could be taken to college by the student and then taken to the local pharmacy to be filled.
    This is often the safest and most direct way to obtain the medication.

  • Paper prescriptions could also be sent by the regular physician through the postal service to the student at college or the local pharmacy.
  • The problem is that the paper prescription could be lost or even potentially stolen.
    Another option would be to use the regular pharmacy to fill the prescription which might work well if the student is routinely going back to their home from college.

  • A third option is for the regular pharmacy to fill the prescription and mail the medication to the student. This can be done but requires the student to sign for the medication and there are some other restrictions for using this option.
    Parents cannot fill the prescription and then send the medication to their student through the postal service.
• Where and how should the student store their medication?
  • Dorm rooms (and even apartments) are easy to gain access to. People often leave the door open “just for a minute” while they talk with someone or go down the hallway. This invites problems including theft of medications.
    Roommates can go through the student’s belongings or invite other people into the room who may also do this.

  • Medications like all valuables should be kept locked up in a safe place. Dorms may provide a room or drawer safe, but students often need to buy a small safe that they can discretely place in their room or even attach to some of the heavy furniture in the room.
    There are many different styles of safes.

  • Students should use discretion and not talk about or advertise that they are taking the medications.
  • When medications are hidden and locked up, it can also be a challenge for the student to remember to take their medication.
    • Students will have to balance remembering to take their medication. Some students may opt to use a weekly pill sorter that is placed somewhere they will see it daily, but keep the rest of the medication locked up.
      Some students who use this option also put a multivitamin with the medication so if asked, they can honestly say they are taking a vitamin and not arouse suspicion. A pill sorter may also be more easily remembered if traveling on weekend trips.
      If college is close to home, only having a small amount of medication in the dorm room (1-2 weeks for example) may be another option.
• How can students remember to take their medication?
  • Taking medication the same time every day as it builds the habit is one of the most common methods.
  • Using an alarm on a phone or watch is another idea.
  • Visual reminders on a calendar or note on a desk/mirror may also be helpful. Visual reminders should be discrete though.
• What happens if the student runs out of medication or it is lost or stolen?
  • This is one reason to have a local physician involved as problems do arise. A local physician may be willing to prescribe a small amount until the student can obtain a full prescription.
  • Theft of medication should be reported to Campus Security. Security could potentially find the medication but more likely it will help them to monitor criminal activity on campus for prevention or apprehension.
    Also a student who honestly would lose their medication later is more likely to be believed by a health care provider who is now being asked to prescribe additional medication, i.e. the student is less likely to be selling the medication if they reported to security.

Questions for Further Discussion
1. What other advice do you offer your college students and families about prescription medication in a dorm room?
2. What college safety tips do you offer your college students?

Related Cases

Disease: Attention Deficit Disorder with Hyperactivity | Prescription Drug Abuse | Drugs and Young People

Symptom/Presentation: Health Maintenance and Disease Prevention

Specialty: General Pediatrics | Pharmacology / Toxicology | School

Age: Teenager

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Prescription Drug Abuse and Drugs and Young People.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

National Institute on Drug Abuse. Commonly Abused Drugs Charts.
Available from the Internet at https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts#prescription-stimulants (rev. 1/2016, cited 3/28/2017).

National Institute on Drug Abuse. Misuse of Prescription Drugs.
Available from the Internet at https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/which-classes-prescription-drugs-are-commonly-misused
(rev. 8/2016, cited 3/28/17).

Federal Drug Administration. Is it legal for me to personally import drugs?
Available from the Internet at https://www.fda.gov/AboutFDA/Transparency/Basics/ucm194904.htm (rev. 3/20/17, cited 3/28/17).

United States Postal Service. 453 Controlled Substances and Drugs, Publication 52. Hazardous, Restricted and Perishable Mail.
Available from the Internet at http://pe.usps.com/text/pub52/pub52c4_019.htm
(cited 3/28/17).

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital