College students who mixed prescription stimulants with alcohol or marijuana had the heaviest substance use patterns

Among 1,108 college students, those who simultaneously used nonmedical prescription stimulants with alcohol or marijuana showed the heaviest drinking, most marijuana use, most consequences, and used marijuana to alter the effects of other substances.

Fossos-Wong, Nicole et al.·Substance use & misuse·2021·Moderate EvidenceCross-Sectional
RTHC-03137Cross SectionalModerate Evidence2021RETHINKTHC RESEARCH DATABASErethinkthc.com/research

Quick Facts

Study Type
Cross-Sectional
Evidence
Moderate Evidence
Sample
N=1,108

What This Study Found

32.8% reported lifetime nonmedical prescription stimulant use; 12.5% used in the past 3 months. Of recent users, 51.1% simultaneously combined stimulants with alcohol and 40.2% with marijuana. The simultaneous use group had the heaviest drinking and marijuana use, the most consequences, and specifically used marijuana to alter effects of other substances.

Key Numbers

1,108 students from 3 universities; 32.8% lifetime NPS use; 12.5% past-3-month use; 51.1% of recent users combined with alcohol; 40.2% combined with marijuana; simultaneous users had heaviest substance use and most consequences

How They Did This

Cross-sectional survey of 1,108 college students from three universities who reported past-year marijuana and alcohol use. Compared three groups: no nonmedical prescription stimulant history, nonmedical use without simultaneous combination, and simultaneous use with alcohol and/or marijuana.

Why This Research Matters

Simultaneous use of multiple substances creates compounded health risks. Identifying that simultaneous prescription stimulant-cannabis-alcohol users represent a distinct high-risk group enables more targeted campus prevention.

The Bigger Picture

The finding that marijuana was used specifically to alter the effects of other substances suggests intentional polydrug management among college students, a pattern that existing single-substance prevention programs may not adequately address.

What This Study Doesn't Tell Us

Cross-sectional survey cannot determine causal ordering. Three universities may not represent all campuses. Self-reported data. Only students reporting past-year alcohol and marijuana use were included, excluding abstainers.

Questions This Raises

  • ?Are students using marijuana to "come down" from stimulant effects or to enhance them?
  • ?Would polydrug-specific prevention messaging be more effective than single-substance approaches?

Trust & Context

Key Stat:
51% of recent prescription stimulant users combined them with alcohol simultaneously
Evidence Grade:
Multi-site cross-sectional survey with adequate sample size, though limited by self-report and cross-sectional design.
Study Age:
Published in 2021.
Original Title:
Patterns, Consequences, and Motives in Simultaneous Use of Prescription Stimulant Medication with Alcohol and Marijuana.
Published In:
Substance use & misuse, 56(13), 1972-1981 (2021)
Database ID:
RTHC-03137

Evidence Hierarchy

Meta-Analysis / Systematic Review
Randomized Controlled Trial
Cohort / Case-Control
Cross-Sectional / ObservationalSnapshot without intervening
This study
Case Report / Animal Study

A snapshot of a population at one point in time.

What do these levels mean? →

Frequently Asked Questions

How common is mixing prescription stimulants with cannabis?

Among the 12.5% of students who used nonmedical prescription stimulants in the past 3 months, 40.2% reported simultaneously combining them with marijuana, and 51.1% combined them with alcohol.

Why do students combine these substances?

The simultaneous use group reported greater motives for using marijuana to alter the effects of other substances, suggesting intentional pharmacological management. This polydrug pattern was associated with the heaviest overall substance use and most negative consequences.

Read More on RethinkTHC

Cite This Study

RTHC-03137·https://rethinkthc.com/research/RTHC-03137

APA

Fossos-Wong, Nicole; Kilmer, Jason R; W Sokolovsky, Alexander; Lee, Ha-Yoon; Jackson, Kristina M; White, Helene R. (2021). Patterns, Consequences, and Motives in Simultaneous Use of Prescription Stimulant Medication with Alcohol and Marijuana.. Substance use & misuse, 56(13), 1972-1981. https://doi.org/10.1080/10826084.2021.1963983

MLA

Fossos-Wong, Nicole, et al. "Patterns, Consequences, and Motives in Simultaneous Use of Prescription Stimulant Medication with Alcohol and Marijuana.." Substance use & misuse, 2021. https://doi.org/10.1080/10826084.2021.1963983

RethinkTHC

RethinkTHC Research Database. "Patterns, Consequences, and Motives in Simultaneous Use of P..." RTHC-03137. Retrieved from https://rethinkthc.com/research/fossos-wong-2021-patterns-consequences-and-motives

Access the Original Study

Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.

This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.