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The students participated by filling out an anonymous questionnaire on drug use lifetime, previous 12 months and previous 30 days. The influence that gender and academic year have on drug use was also analyzed. RESULTS: During the study period, there was an increase in the use of illicit drugs, especially inhalants and amphetamines, among the medical students evaluated. Drug use except that of marijuana and inhalants was comparable between the genders, and academic year was an important influencing factor. This is suggestive of a specific behavioral pattern among medical students. Our findings corroborate those of previous studies. Because of the negative health effects of illicit drug use, further studies are needed in order to deepen the understanding of this phenomenon and to facilitate the development of preventive measures. Descriptors: Students, medical; Street drugs; Sex distribution; Epidemiology; Administration, inhalation. Among illicit drugs, marijuana is the most widely used, with a prevalence of 3. Young adults deserve special attention, especially those who are university students. Considering the positions that university students will attain in society and the development that they represent as a whole, determining their opinions and attitudes toward alcohol and drugs, as well as the prevalence of the use of these substances among students, can provide information that increases the overall understanding of student behavior. In the United States, the importance of this issue has been demonstrated through the planning and development of the 'Monitoring the Future Surveys' project. For 27 years, these prospective studies have analyzed the prevalence of alcohol and other drug use among students, from junior high school to adulthood, focusing on university life. In addition, the authors of the 'Harvard School of Public Health College Alcohol Study', who surveyed a nationally representative sample of students enrolled in four-year university courses in the United States four times between and , reported that heavy drinking continues to be a problem among university students and recommended that preventive measures be implemented. Illicit drug use is also prevalent in Latin America, where the prevalence rates of alcohol, tobacco and other drug use lifetime use and use in the previous 12 months are highest among young adults aged 18 to 24 years, university students in particular. In those countries, the annual prevalence of cocaine use is twice as high among young adults as in the general population. From to , this gender-related difference increased for the consumption of tobacco, marijuana, hallucinogens, amphetamines, anticholinergics, tranquilizers and inhalants. Drug consumption among medical students is of special interest, since their behavior, attitudes and beliefs do not reflect their greater access to scientific information, especially in comparison with other populations in the same age range. In reality, medical students have revealed significant vulnerability with regard to engaging in health risk behavior, 21 a paradoxical situation that has been a matter for concern worldwide and in Brazil. A cross-sectional study on drug use among medical students at FMUSP, carried out in , and , found that alcohol, tobacco, marijuana, inhalants and tranquilizers were the drugs most commonly consumed. Among the risk factors for drug consumption attributed to medical courses, the relevance of the academic year has recently been identified as a relevant factor. This deficit in clinical practice seems to have a direct association with alcohol consumption among students, since heavy drinkers are more prone to discount the importance of counseling than are moderate drinkers or abstainers. Drug consumption in the medical profession is not limited to the university years; it touches the lives of many established physicians and causes a broad spectrum of problems. The evolution of drug consumption among medical students is an issue that deserves attention. Characterizing and monitoring that consumption is an important objective. Since substance use could have an impact on the conduct, reliability and efficiency of future physicians, understanding such use will contribute to developing early detection and intervention strategies to prevent drug use and abuse, thereby avoiding the related personal and social problems. Two independent cross-sectional studies were carried out in and to identify drug use lifetime, previous 12 months and previous 30 days among students enrolled at FMUSP. Based on the results of those surveys, we compared drug consumption among medical students in with that reported for medical students in Effects relating to gender and academic year were also analyzed. The sample was stratified by subject area Humanities, Exact Sciences and Biological Sciences , current term and student gender. Students were selected through systematic random sampling. Their participation was voluntary and they were only included in the study after all of its aims had been properly explained. All participating students gave written informed consent. To ensure anonymity, student names were not disclosed. According to the USP Statistical Yearbook, there were 29, enrolled students in and 32, enrolled students in In order to determine the number of students to be interviewed within each subject area, it was established that the sampling error between a given percentage obtained for the sample and its corresponding value in the target population should not exceed 0. Therefore, drug consumption at USP was investigated through analysis of 5, valid questionnaires: 2, from and 2, from For the current study, we evaluated data related to FMUSP students: in and in , distributed according to gender men; women and academic year. In Brazil, the medical course lasts for six years. To identify the influence of academic year on drug consumption measurements, the samples were divided into two groups: the early-years group first, second and third academic years consisting of students in and in and the later-years group fourth, fifth and sixth academic years consisting of students 97 in and 74 in This division was made because a survey conducted earlier in the period had demonstrated that the consumption of alcohol, tobacco and illicit drugs was more prevalent among students in the third, fourth, fifth and sixth academic years. The students were asked to complete an anonymous self-report questionnaire regarding legal and illicit drug use within their lifetime, within the previous 12 months and within the previous 30 days. In both surveys and , the questionnaire was identical except for the inclusion of ecstasy among the substances studied in These assistants went to classrooms and invited the selected students to participate. First, they explained the study objectives, gave assurance that the information would remain confidential and asked participants to read and sign the informed consent statement. Finally, those who agreed to participate deposited the completed questionnaire in a box placed at the front of the classroom. Since both survey samples in and in were independent, the possibility of response overlaps was not considered in the statistical analyses. The drug consumption measurements were analyzed separately for the general population at FMUSP , between genders and according to academic year early years: first to third years; later years: fourth to sixth years. For this analysis, the population weights attributed to the different strata the subject area in the USP sample in and 10,11,13 were reconsidered, and were recalculated for the entire USP student population, minus the FMUSP students. Thus, the new weights for and , respectively, were as follows: 0. The student sample was similar to the student sample in many ways. Regarding gender distribution, males accounted for There were no statistical differences between men and women, in either year, regarding sociodemographic data Table 1. Marital status and family income were similar for the two groups and in both surveys. This same USP student sample has been examined in greater detail in previous studies. Although the prevalence of alcohol consumption lifetime, previous 12 months and previous 30 days among the medical students was high in both surveys, no statistical difference was observed between and Table 4. Therefore, alcohol consumption remained stable over the period analyzed. The same was observed for tobacco consumption. Among the medical students, lifetime use of illicit drugs rose from However, it is of note that approximately 4 out of 10 medical students reported having tried drugs at least once in their lives. In both surveys, considering only illicit substance use, marijuana and inhalants were the substances most commonly consumed. Over the period from to , there were significant increases in the lifetime use of inhalants from Regarding the previous 12 months, there were also increases in the use of inhalants from Therefore, inhalants and amphetamines were the substances that showed the greatest increases in consumption between and Finally, the consumption of ecstasy was measured only in and was relatively low among medical students at that time lifetime: 2. Table 5 shows the consumption of alcohol, tobacco and other drugs among medical students at FMUSP, by gender. Lifetime use of marijuana was significantly higher among men than among women in In , lifetime use of inhalants was significantly higher among men There was also a gender-related effect regarding alcohol use in the previous 30 days, although this difference was significant only in No other gender-related differences were observed. Alcohol, tobacco, marijuana and inhalants were the four drugs most consumed, by both genders and in both surveys. In , cocaine and hallucinogens were the fifth and sixth most commonly used drugs among men for lifetime, previous 12 months and previous 30 days use , but this pattern of use changed in , when cocaine was replaced by amphetamines in fifth place and hallucinogens maintained the sixth position. Surprisingly, there was no change in the drug use profile among women from one survey to the other, with the fifth and sixth positions still occupied by amphetamines and tranquilizers. It is noteworthy that, in , hallucinogens took an important place in the history of drug consumption among women, as the seventh most commonly consumed drug, just below tranquilizers. Table 6 shows the consumption of alcohol, tobacco and other drugs among medical students at FMUSP, by academic year. In , illicit drug use in the previous 12 months was higher among the medical students in the early-years group than among those in the later-years group Also in , there were intergroup differences in inhalant use, in the previous 12 months early-years: This suggests that inhalant consumption was more prevalent among early-year medical students. In , the prevalence of lifetime tobacco use was statistically higher among the medical students in the early-years group than among those in the later-years group However, a different pattern of use was identified for anticholinergics and ecstasy. In , lifetime use of anticholinergics was marginally higher among the students in the later-years group 3. Finally, concerning lifetime use of ecstasy in , it was also higher among medical students in the later academic years early-years: 0. In , there were very few differences between medical students and other undergraduates. In , these differences were extended to other drugs. Certain drugs were more commonly consumed by non-medical students, especially in the second survey Alcohol, tobacco and illicit drug use among FMUSP medical students was similar to that reported in other studies conducted in Brazil. In addition, there was a marked change in the drug use profile among medical students. Inhalant use rose to reach the position of second most consumed drug, overtaking marijuana and even tobacco consumption. According to Lemos et al. Marked differences can be seen when comparing the results of the current study with those of nationwide surveys. When compared with young adults in the same age range years in the general population reference year: , 12 the difference regarding the prevalences of lifetime use of illicit drugs general , alcohol, tobacco, inhalants, amphetamines, hallucinogens and tranquilizers is notable. Nevertheless, regardless of how remarkable the differences in alcohol and tobacco use are, it can be seen that overall illicit drug use was 2. Even greater differences can be seen regarding the use of inhalants, amphetamines and hallucinogens. For instance, hallucinogen use was almost 10 times greater among medical students than in the general population 6. Even after a four-year interval from to , the level of drug use reported for young adults aged 18 to 24 years in the general population was lower than that observed among medical students, for overall illicit drug use and for the specific use of inhalants, amphetamines and hallucinogens. Therefore, the comparisons suggested here are only exploratory. The increase in illicit drug use among medical students although not statistically significant was paralleled by an increase among other students at USP, over the same time period. Although there was a significant increase in inhalant use among other undergraduates at USP, 11 the increase was significantly greater among medical students. This corroborates the findings of other Brazilian studies ,40,45 and suggests that, despite some regional differences, inhalant consumption is usual among medical students. The use of illicit drugs especially inhalants was more prevalent among students in the early academic years, whereas recreational use of anticholinergics and ecstasy was more common among students in the later academic years. Taken together, the data indicate a major change in the drug use situation at FMUSP, 10 years after the first survey was conducted At the time of the first survey, the use of alcohol, tobacco, drugs marijuana and inhalants and tranquilizers was greater among students in the later academic years third to sixth years. Paduani et al. However, neither these previous studies nor the present study was longitudinal, and it therefore cannot be assumed that the observed increase occurred over the course of the medical training. Hence, the findings that have been reported are still under debate. One hypothesis to explain the higher illicit drug use in the early academic years is that basic-cycle medical students, especially those living away from home, usually present higher levels of clinical stress symptoms, particularly when trying to manage their lifestyle academic stress. Thus, trying drugs and using them on a regular basis might be understood as a way of alleviating psychological stress among students in the early academic years. Although drug use is more prevalent among medical students in the early academic years, the risk factors for drug use among students in the later years should not be disregarded. As identified in previous studies, drug use among students in the later academic years is especially due to the ease of access to drugs and contact with other professionals who are already recreational users. In addition, drug use is seen as a way to achieve better academic and work performance, a common motivation for drug use among health professionals. It is also of note that, in trying to alleviate psychological and physical stress, along with work overload, medical students and physicians have practiced self-medication. This leads to significant health impairment 24,47 and delays the recognition and treatment of drug abuse or dependence, thereby affecting their professional lives and consequently the well-being of their patients. Such convergence, especially regarding alcohol consumption, has also been identified in international studies. Amphetamine and tranquilizer consumption, previously exclusive to females, also became prevalent among men, a result that differs slightly from those of other studies. Among FMUSP students, inhalant consumption has risen, ranking second and third in terms of prevalence of use lifetime and previous 12 months in , thus surpassing tobacco and marijuana consumption. Since medical students in Brazil generally come from high-income families 15 and still live with their parents, 16 inhalant use among such students depicts a paradoxical situation, considering that solvent inhalation is one of the most peculiar behavioral patterns among children and adolescents living on the streets 61 and among adolescents in juvenile detention centers. Solvent inhalation also has a negative influence on preexisting psychiatric illnesses. Overall, inhalant use might have a negative impact on academic performance and on the quality of the future health professional, jeopardizing their lives and the lives of their patients. Although the findings of the present study must still be regarded as preliminary, they indicate that, over a five-year period from comparison between two independent cross-sectional studies conducted in and , there was an increase in drug use among medical students at FMUSP. The effects that gender and academic year have on drug consumption must be considered in planning interventions aimed at influencing the behavior of medical students. Since drug use among medical students has increased despite the information to which they have access, the data suggest that there is a need allocate resources for the treatment, recovery and rehabilitation of students who already abuse or are dependent on drugs. In addition, there need to be strategies aiming toward early recognition of such individuals, in order to avoid the onset or progression of drug use-related implications. Furthermore, inhalant use merits special attention, and further studies should investigate this. Finally, additional studies are needed in order to increase understanding of the reasons for drug use among medical students, focusing also on the dimension that inhalant use has acquired among them and its implications for the university environment. The present study had certain limitations. Students who were absent when the questionnaire was applied were not contacted again, and, therefore, nothing could be concluded about their behavior. It could be argued that, had they answered the questionnaire, the prevalence of drug use would have been greater than what was determined. Since these surveys are cross-sectional studies, conclusions relating to the influence that academic year has on drug use among medical students cannot be precisely defined. Open menu Brazil. Brazilian Journal of Psychiatry. Open menu. Abstract Resumo English Resumo Portuguese. Text EN Text English. Students; medical; Street drugs; Sex distribution; Epidemiology; Administration; inhalation. Method Two independent cross-sectional studies were carried out in and to identify drug use lifetime, previous 12 months and previous 30 days among students enrolled at FMUSP. Main outcome measures The students were asked to complete an anonymous self-report questionnaire regarding legal and illicit drug use within their lifetime, within the previous 12 months and within the previous 30 days. Statistical procedures Since both survey samples in and in were independent, the possibility of response overlaps was not considered in the statistical analyses. Results 1. World drug report Wechsler H, Nelson TF. What we have learned from the Harvard School Of Public Health College Alcohol Study: focusing attention on college student alcohol consumption and the environmental conditions that promote it. J Stud Alcohol Drugs. Rev Bras Psiquiatr. Alcohol and drug use among university students: gender differences. Rev Bras Psiquiatr ;29 2 Use of alcohol and drugs by medical students of Unesp. Rev Bras Psiquiatr ;21 2 Prevalence of psychoactive drug use among medical students in Rio de Janeiro. Soc Psychiatry Psychiatr Epidemiol ;41 12 Factors associated with the use of solvents and cannabis by medical students. Addict Behav ;32 8 The use of psychoactive substances among medical students in southern Brazil. Drug Alcohol Rev ;26 3 Evolutional pattern of drug use by medical students. Addict Behav ;33 3 The relationship between stress and life-style of students at the Faculty of Medicine of Porto. Acta Med Port ;21 3 Dug consumption by medical students in Tegucigalpa, Honduras. Use of and attitudes toward cleub drugs by medical students. J Addict Dis ;27 4 Influence of medical training on self-medication by students. Int J Clin Pharmacol Ther ;46 1 Multiple health risk behaviors in German first year university students. Prev Med. Depression, anxiety and substance use in medical students in the Republic of Macedonia. Bratisl Lek Listy. Substance use among medical students: time to reignite the debate? Nat Med J India ;21 2 Students' attitudes and practices towards drug and alcohol use at Tabriz University of Medical Sciences. East Mediterr Health J. Alcohol use among college students: an international perspective. Curr Opin Psychiatry. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ. Perceptions of Pakistani medical students about drugs and alcohol: a questionnaire-based survey. Subst Abuse Treat Prev Policy ; Trends in medical student use of tobacco, alcohol and drugs in an Irish university, Drug Alcohol Depend. Addiciones ;16 1 Use of psychoactive substances among Zagreb University medical students: follow-up study. Croat Med J. Substance abuse by medical students and doctors. J Indian Med Assoc ;98 8 Factors influencing alcohol and illicit drug use amongst medical students. Alcohol and drug use in second-year medical students at the University of Leeds. Med Educ. Medical students: abuse of psychoactive substances and sexuality aspects. Int J Adolesc Med Health ;20 3 Recreational use of PDES inhibitors by young healthy men: recognizing this issue among medical students. J Sex Med ;5 10 Rev Bras Educ Med. J Bras Psiquiatr ;57 3 Alcohol consumton and alcohol counselling behaviour among US medical students: cohort study BMJ ;a Clinical and demographical aspects of alcohol and drug dependent physicians. Rev Assoc Med Bras. Epidemiology of substance use in adolescence: prevalence, trends and policy implications. Risk factors for alcohol and other drug use by healthcare professionals. Subst Abuse Treat Prev Policy. Improving physician and medical student education in substance use disorders. J Stud Alcohol Drugs ;68 1 Epidemiology of alcohol use in Brazil. Rev Bras Psiquiatr ;26 Suppl 1 Rev Latino-Am Enfermagem ;13 Esp Use of alcohol among the inhabitants of the largest cities in Brazil Braz J Med Biol Res ;40 3 Is gender relevant only for problem alcohol behaviors? An examination of correlates of alcohol use among college students. Addict Behav ;33 2 Evidence for a closing gender gap in alcohol use, abuse and dependence in the United States population. Drug Alcohol Depend ;93 Inhalant use among incarcerated adolescents in the United States: prevalence, characteristics, and correlates of use. History Accepted 19 May Received 24 Dec Tables 7. Stay informed of issues for this journal through your RSS reader. PDF English. Google Google Scholar.

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