Does Drug Use Among Medical Students Indicate Suffering?

According to the United Nations Office on Drugs and Crime, the use of alcohol and other substances has been increasing globally. The rate among those aged 15-64 years who consume such substances increased from 4.8% of the global population in 2009 to 5.3% in 2018. The numbers are even higher when speaking of university students, especially those in medical programs. According to a study conducted with students at the University of São Paulo School of Medicine (FMUSP) in Brazil and published in September in the São Paulo Medical Journal, the most commonly consumed substances in the previous year were alcohol (82.9%), illicit drugs (44.7%), marijuana (42.5%), and tobacco (36%).

The cross‑sectional study was conducted on 275 medical students at the FMUSP in August 2020. All medical students enrolled in the FMUSP from the first to the sixth year were contacted through institutional email to answer an online questionnaire.

In addition to collecting socioeconomic data, the form included questions related to the use of alcohol and other drugs during the respondent’s lifetime and in the previous 12 months. The study also assessed symptoms of depression and the impact of the COVID‑19 pandemic on drug consumption among the respondents.

The sample comprised 159 (57.8%) males, 113 (41.1%) females, and 3 (1.1%) nonbinary students. Seventy‑eight (28.4%) students were in the basic cycle (first and second years), 111 (40.4%) were in the clinical cycle (third and fourth years), and 86 (31.3%) were in internship (fifth and sixth years). The mean age was 23 years, and most students were single, with no religious affiliations, and from affluent classes.

Regarding lifetime use, alcohol was the most consumed substance (95.6%, n = 263), followed by marijuana (60%, n = 165), and tobacco (57.5%, n = 158). Additionally, 168 (61.1%) students reported consuming illicit drugs.

Substances that were most consumed in the past year were alcohol (82.9%, n = 228), marijuana (42.5%, n = 117), and tobacco (36%, n = 99). Moreover, 123 (44.7%) students reported using illicit drugs in the past year.

Substance use increased when the students passed from the basic cycle to the clinical cycle of the program. It was also observed that the COVID‑19 pandemic primarily affected substance use among infrequent users.

The Pandemic’s Role

Consumption patterns before and after the COVID‑19 outbreak were categorized as (1) less than once per week, so‑called “sporadic users,” or (2) once per week or more, so‑called “frequent users.” There was a decreasing trend in the prevalence of most substances used after the COVID‑19 pandemic among sporadic users. However, frequent users maintained their drug use patterns.

For André Malbergier, MD, PhD, professor of psychiatry at FMUSP and one of the study authors, this is an important point that highlights how substance users are not often affected by their environment. “Once recreational activities decreased with the pandemic, those using [drugs] recreationally decreased their use because [this use] was associated with social situations. Nevertheless, those who are dependent — and who often state they only use [substances] with friends — are the ones who, even without parties, even without these social events, seek the drug and continue to use it,” said Malbergier.

Medical Program Demands

Malbergier, who also coordinates the FMUSP Clinical Hospital’s Perdizes Institute Interdisciplinary Program of Drug and Alcohol Studies, stated that common sense would suggest that the high demands of the medical program should contribute to lower drug use among the students. However, he explained, the opposite is true. “The demands end up being a risk factor for substance use,” he told Medscape Portuguese Edition.

In focus and discussion groups with students regarding the motivations or context behind substance use, young adults cited the program’s pressure, stress, and high demands more often than partying rituals or get‑togethers with friends. He also emphasized, “This catches our attention, because it indicates a certain mental suffering of the medical students during the course.”

Malbergier also believes that other factors contribute to the high prevalence of substance use among medical school students, such as feelings of omnipotence after passing a highly competitive entrance exam; easy access to licit drugs, including benzodiazepines, amphetamines, and opioids; and immersion into a culture that favors substance use.

The study also shows that tobacco use, for example, almost doubled, when compared with that observed in a study conducted with FMUSP students in 2001. Although there has been no qualitative analysis detailing the factors behind this increase in tobacco use, Malbergier explained that they did identify that the students who were less able to deal with stress and who had more symptoms of anxiety and depression smoked more. “So, as we now know, although cigarettes do not necessarily cause depression or anxiety, they can be a marker for students who are experiencing some kind of mental suffering,” he stated.

Changing Use Patterns

Malbergier believes that the social demands for doctors to be “superheroes” and the expectation that they can handle anything contribute to students’ and professionals’ reluctance to express when they are suffering. “This is why people suffer in silence, often self‑medicate with drugs, use alcohol and tobacco, and do not feel able to seek help,” he stated.

The path to improving this scenario, said Malbergier, is working on humanizing the medical profession from day one of the program. “I believe this is the point that needs to be discussed in universities and among doctors. It is essential to recognize that we are allowed to find things difficult and that we can seek help,” he affirmed.

The data are a warning to the existence of a problem and the need to tackle it. “We need to take care of our students because soon they will be doctors, and we know this only tends to exacerbate the situation. We have seen that the rate of drug use among qualified professionals is high. Doctors [also] have a greater tendency to get divorced and have a higher risk of suicide, when compared with other professionals of similar socioeconomic status. Therefore, we have, in fact, contributed to training people based on suffering,” said Malbergier.

This article was translated from the Medscape Portuguese edition.

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