College Students Involved in Greek Life are at Higher Risk for Nonmedical Use of Prescription Stimulants, Particularly via Non-oral Routes

College students are an at-risk population for prescription stimulant nonmedical use (NMU; use for any reason or in any way other than prescribed, including misuse/abuse). An online survey was used to study 3,011 respondents age 18-26 years: 1) college students involved in Greek life (fraternity/sorority)(n=157), 2) college students not involved in Greek life (n=1,199), and 3) controls (same age cohort not currently enrolled in college)(n=1,655). Prevalence of lifetime prescription stimulant NMU was significantly higher for Greek students (15.9%) than for non-Greek students (6.0%, p<0.0001) and controls (5.3%, p<0.001). Past-year prescription stimulant NMU for Greek students was 3.6-6.5 times higher than non-Greek students and controls, respectively (p<0.001). 48.0% of Greek students and 30.7% of controls reported NMU via non-oral routes, primarily snorting. Non-Greek students were significantly less likely to report non-oral use (15.3%, p<0.001; snorting 13.9%, p=0.002) than Greek students (snorting 44%). While all groups reported procuring prescription stimulants from their doctor and family/friends, Greek students were 3 times more likely to purchase from a dealer (24.0% v. 8.3% and 8.0%). Depression and anxiety diagnoses were common among all groups, however Greek students that reported prescription stimulant NMU were more likely to report history of ADHD, bipolar disorder, substance/alcohol use disorders, learning disability, oppositional defiant disorder, and conduct disorder. Greek life participation is associated with higher risk for prescription stimulant NMU and non-oral routes of administration compared to non-Greek students and same age cohorts. Differences in underlying comorbidities and procurement behaviors were also found which may inform prevention and intervention strategies.