The use of drugs and medical students: a literature review

Candido, Fernando José; Souza, Rodrigo; Stumpf, Matheo Augusto; Fernandes, Luiz Gustavo; Veiga, Rafael; Santin, Matheus; Kluthcovsky, Ana

doi:10.1590/1806-9282.64.05.462

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REVIEW ARTICLE • Rev. Assoc. Med. Bras. 64 (5) • May 2018 • https://doi.org/10.1590/1806-9282.64.05.462 copy

The use of drugs and medical students: a literature review

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

INTRODUCTION

The consumption and abuse of alcohol and other drugs are increasingly present in the lives of university students and may already be considered a public health problem because of the direct impacts on the physical and mental health of these individuals. The requirements of the medical program play a vital role in the increasing rate of drug users.

OBJECTIVES

To carry out a systematic review of the literature on the use of drugs, licit or not, in Brazilian medical students.

METHODS

A descriptive-exploratory study, in which the SciELO and MEDLINE databases were used. A total of 99 articles were found, of which 16 were selected for this review.

RESULTS

Alcohol and tobacco were the most frequently used licit drugs among medical students. The most consumed illicit drugs were marijuana, solvents, “lança-perfume” (ether spray), and anxiolytics. The male genre presented a tendency of consuming more significant amounts of all kinds of drugs, with the exception of tranquilizers. It was found an increasing prevalence of drug consumption in medical students, as the program progressed, which may result from the intrinsic stress from medical school activities. Students who do not use psychoactive drugs are more likely to live with their parents, to disapprove drugs consumption, to practice religious beliefs and to be employed.

Conclusion

The prevalence of licit and illicit drug use among medical students is high, even though they understand the injuries it may cause.

Substance-related disorders; Students, medical; Street drugs; Alcoholism

Year of publication	Sample and type of study	Objectives	Data collection methods	Main achievements
Mesquita et al., 19988	796 of 1,080 students of the Faculty of Medicine of the University of São Paulo (retrospective)	Seek the association between marijuana use and ether sprays (lança perfume).	World Health Organization multiple choice questionnaire.	Male students use ether sprays 1.9x more than female students. Medical students with a history of marijuana use were estimated to use ether sprays 6-7 times more than students who did not use marijuana.
Kerr-Correa et al., 19999	3,725 of 5,225 students enrolled in nine medical programs in the state of São Paulo (retrospective)	Evaluate the use of alcohol and drugs among students from nine different medical programs in the state of São Paulo find the profile of the drugs that are used most often.	Self-administered questionnaire proposed by the World Health Organization.	Alcoholism was considered a health problem by 90% of the students. In descending order, the most commonly used drugs were alcohol, tobacco, solvents, marijuana, tranquilizers, and cocaine, with consumption increasing in the last years of the program. Greater tendency of benzodiazepine use in the final years of the program, due to the ease of access to prescriptions and medication in the hospital, stress at the end of the program and residency exams.
Passos et al., 200610	1,054 medical students from four medical programs in Rio de Janeiro (retrospective)	To estimate the prevalence of psychoactive drug use in four medical programs in Rio de Janeiro and its associated sociodemographic conditions.	Questionnaire used by the World Health Organization.	Alcohol was the most widely used drug (96.4%), followed by tobacco (54.3%), tranquilizers (24.2%), marijuana (20.9%), inhalants (18.4), cocaine (3.4%), LSD (3.3%), amphetamines (1.1%), weight loss drugs (0.9%), and ecstasy (0.4%). A total of 45% of the students know where to get drugs and 62% believe that it is easy to get them.
Boniatti et al., 200711	183 of 318 medical students from the University of Caxias do Sul (retrospective)	Investigate the patterns of psychoactive substance use in medical students.	Questionnaires sent by email. Upon return to class, the questionnaires were returned in an urn.	The most commonly used drugs were alcohol (97.3%), tobacco (54.6%), and marijuana (31.1%). There was no increase in the use of illicit drugs during the course of the program. Living with parents, a harmonious home, disapproval of drug use, and religious practices are variables related to lower drug use.
Di Pietro et al., 200712	456 of 650 students of the medical program of the Faculty of Medicine of the Federal University of São Paulo (retrospective)	Evaluate the use of drugs among medical students and look for associated factors.	A self-administered questionnaire was distributed in classrooms, individually.	The most commonly used drugs were alcohol (76.9%), tobacco (20.4%), and marijuana (16.2%). The consumption of all drugs - with the exception of tranquilizers - was more prevalent in men.
Lemos et al., 200713	404 of 432 students from two medical programs in Salvador (retrospective)	To analyze the local pattern of psychoactive substance use in the academic medical population and contribute to the creation of prevention activities.	Standard self-administered questionnaire proposed by the World Health Organization.	Alcohol (92.8%) and ether spray (46.2%) were the most commonly used drugs. The use of tobacco, ether spray, and tranquilizers increased significantly from the first to the sixth year of the program. The main reason found for drug use was entertainment (57.8%).
Carvalho et al., 200814	465 of 600 medical students of the Faculty of Medical Sciences of Santa Casa de São Paulo (prospective)	To identify risk factors related to sexuality and psychoactive substance use by medical students, in order to organize preventive strategies.	An anonymous, semi-structured questionnaire was used.	The most commonly used drug was alcohol (76.2%), with 46.5% using it at least once a week, 33.5% once a month and 2% daily; 11.1% used tobacco, with an average of 6.4 cigarettes a day. Ether spray was used by 22.6%, 98% at least once a month. Greater use of illicit drugs by men. Increased use of alcohol and tobacco throughout the program. Alcohol consumption is greater to alleviate tension, to share a behavior with colleagues and due to ease of access.
Mesquita et al., 200815	557 of 1,080 students of the Faculty of Medicine of the University of São Paulo (prospective)	To analyze medical students’ behavior when faced with drug abuse by colleagues from the academic universe.	Three self-administered questionnaires, focusing on licit and illicit drugs and alcohol, separately.	Faced with cases of alcohol abuse, students tend to intervene in some way. The same is not true for illicit drug cases. Information about the risks of alcohol remains under sociocultural acceptability and this explains why it is the most commonly used drug.
Panduani et al., 200816	303 of 400 students from the Federal University of Uberlândia from the first to the fifth year (retrospective)	To determine the prevalence of alcoholic beverages and cigarettes among medical students.	A self-administered individual questionnaire was distributed in classrooms.	A total of 66.34% of the students interviewed consumed alcoholic beverages. The prevalence increases over the course of the program. Of the interviewed students, 65.17% occasionally drank, 27.86% one to two times a week, 5.97% three to four times a week, and 1% daily. Only 10 students smoked, out of which only 2 smoked from 11 to 20 cigarettes a day.
Tockus e Gonçalves, 200817	88 students of the medical program of the Positivo University (retrospective)	To establish the drugs most commonly used by medical students and the problems related to its use.	Adapted World Health Organization questionnaire, through the university portal.	Alcohol use was more prevalent (70.45%), followed by cigarette (27.3%) and marijuana (10.2%), in the last 3 months. Regarding the use throughout life, prevalence was 78.4% for alcohol, 38.6% for tobacco, 26.1% for marijuana, 21.6% for inhalants, 11.4% for stimulants, and 3.4% for cocaine/crack.
Da Silveira et al., 200818	456 medical students from the Federal University of São Paulo (retrospective)	To identify patterns of drug use among university students in years 1 through 6 of the program to chart prevention strategies.	Anonymous questionnaire, which gathered data on drug use in the past 30 days.	Frequency of drug use by men: alcohol (80.5%), marijuana (25.3%), solvents (25.2%), tobacco (25.2%), amphetamines (3.8%) and tranquillizers (2.9%).
Oliveira et al., 201019	457 students of the Faculty of Medicine of the University of São Paulo (retrospective)	To characterize drug use by medical students at different times.	To compare the pattern of drug use in 1996 and 2001.	Alcohol and tobacco consumption remained stable between 1996 and 2001, but the consumption of illicit drugs increased from 36.1% to 43.8%. Alcohol, tobacco, marijuana, and inhalants were the most commonly used drugs in both periods.
Petroianu et al., 201020	332 of 360 medical students of the Federal University of Minas Gerais (retrospective)	To estimate the prevalence of alcohol, tobacco and narcotic use among medical students.	World Health Organization self-administered multiple choice questionnaire, followed by an interview.	Alcohol use by 85.2% of the students, being 37.7% at least once a week and 0.6% daily, with no difference between genders. Tobacco consumption by 16.3% of students, with 1.5% at least once a week and 3.3% daily.
Rodriguez et al., 201221	2876 students from universities in Brazil and other Latin American countries (retrospective)	To observe patterns of drug consumption and multiple drug use and their associated factors.	We interviewed students of the 1st and 2nd years, using 58 questions with the possibility of clarifying doubts.	The use of psychoactive substances during the last year, according to the country: Colombia (66.5%); Brazil (65.1%); Chile (51.1%); Nicaragua (42.6%); Jamaica (29.2%) and El Salvador (18.8%). The most frequent drug associations were alcohol and tobacco, except in Jamaica where they were alcohol and marijuana.
Ribeiro et al., 201422	289 of 608 students. (retrospective)	To identify the use of antidepressants, adhesion and guidance on the medication.	Structured self-report technique. Objective questionnaire.	Of the total, 11.4% stated that they use or have used antidepressants, 72.7% of which reported having had medical follow-up. Anxiety and depression were the most commonly reported reasons.
Silveira et al., 201423	152 of 156 students from the Pontifical Catholic University of Rio Grande do Sul (retrospective)	To evaluate the prevalence of methylphenidate use in medical students.	Cross-sectional survey through a questionnaire.	Of the total, 34.2% of the students had already used methylphenidate, and 23.02% had used without medical indication. The majority (68.57%) of the students who used it without medical indication did so to improve focus and performance in the program.

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[1] CORRESPONDING AUTHOR: Fernando José Candido Av. Carlos Cavalcanti, 4748 Ponta Grossa – Paraná - Brasil – 84030-900. E-mail: fjcandido2006@hotmail.com, diego_souzasmd@yahoo.com.br, matheoaugusto@hotmail.com, gustavorachid9@gmail.com, rbulykveiga@hotmail.com, mssantin@hotmail.com, anafabio2009@gmail.com.