Safety, Generous Doctors, and Enabling Parents: A Perfect Recipe of Justifications for College Students’ Nonmedical Use of Prescription Painkillers

• Date: 01 October 2017
• Author: Joseph Kremer,Kristin Cutler
• DOI: 10.1177/0022042617710953
• Published date: 01 October 2017
• Subject Matter: Articles

https://doi.org/10.1177/0022042617710953

Journal of Drug Issues

2017, Vol. 47(4) 587 –605

© The Author(s) 2017

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DOI: 10.1177/0022042617710953

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Article

Safety, Generous Doctors, and

Enabling Parents: A Perfect

Recipe of Justifications for College

Students’ Nonmedical Use of

Prescription Painkillers

Kristin Cutler1 and Joseph Kremer2

Abstract

National data indicate that prescription painkillers are the second most commonly misused

prescription drug on college campuses. Although much research has focused on the motivations

given for the nonmedical use of these drugs, few studies explore justifications for use. This article

fills that gap by explicating the justifications college students incite to defend their nonmedical use

of these drugs. Drawing on semistructured interviews with students (N = 76) from a large public

northwestern university, inductive analysis uncovered social learning theories of crime, more

specifically Sykes and Matza’s neutralization theory, as helping to inform students’ justifications

for use. These justifications were combined to form two broad justification categories: “the safety

factor” and “authoritative enabling.” Given that justifications helped students to resolve any guilt,

shame, or stigma associated with their deviant use of prescription painkillers, it is important that

future research continue to explore and disentangle motivations from justifications.

Keywords

nonmedical prescription drug use, prescription painkillers, college students, neutralization

theory, social learning theory

Introduction

As of 2014, approximately 4.3 million Americans aged 12 and over engaged in the nonmedical

use of prescription painkillers (Substance Abuse and Mental Health Services Administration

[SAMHSA], 2015). Nonmedical prescription drug use (NMPDU) is generally defined as use

without a legitimate prescription or use for reasons or in ways that a doctor would not prescribe

(National Institute on Drug Abuse [NIDA], 2014; Quintero, Peterson, & Young, 2006). In addi-

tion, recent statistics compiled from a national sample of emergency room visits indicate that two

thirds of all visits involving overdose implicate prescription drugs (Yokell et al., 2014) with the

highest number of deaths resulting from overdose of prescription painkillers (Rudd, Aleshire,

1Washington State University, Pullman, WA, USA

2Luther College, Decorah, IA, USA

Corresponding Author:

Kristin Cutler, Washington State University, P.O. Box 644020 Pullman, WA 99164-4020, USA.

Email: kcutler@wsu.edu

710953JODXXX10.1177/0022042617710953Journal of Drug IssuesCutler and Kremer

research-article2017

588 Journal of Drug Issues 47(4)

Zibbell, & Gladden, 2016). In the United States, this equates to approximately 40 deaths per day

and 16,000 deaths per year that can be directly linked to this category of drugs (Centers for

Disease Control and Prevention [CDC], 2016), a number that has quadrupled since 1999. To

contextualize these figures, in 2014, the United States had the highest number of murders in the

industrialized world at 14,249 or approximately 39 murders per day (Barkan, 2015; Federal

Bureau of Investigation [FBI], 2014). Ultimately, the rising number of deaths resulting from

prescription painkillers is alarming and has led the CDC to declare prescription drug abuse (espe-

cially with respect to prescription painkillers) as the nation’s fastest growing drug problem.

Given this declaration by the CDC, it is only fitting to take a closer look at the 18 to 25 age

demographic who report the highest prevalence of NMPDU, with college students representing

some of the most vulnerable for misuse (McCabe, Boyd, & Teter, 2006; NIDA, 2014; Quintero

et al., 2006). In fact, recent National College Health Assessment data suggest that 16% of under-

graduate college students admit to using a prescription drug that was not prescribed to them in

the last 12 months (SAMHSA, 2015). Of these drugs, prescription painkillers such as Vicodin,

Percocet, and Oxycontin come in a close second to prescription stimulants that reside in the num-

ber one spot given their link to study/focus enhancement (American College Health Association,

2015; Cutler, 2014; McCabe & Boyd, 2005; McCabe, Teter, Boyd, Knight, & Wechsler, 2004).

We chose to focus in on prescription painkillers here given the lack of attention in the literature

and because students admit to being more aware of the dangers associated with the misuse and

abuse of these drugs, as opposed to prescription stimulants (see Cutler, 2014), yet still continue

to engage in their “deviant” use.

Although research in the fields of medicine, psychology, and sociology has predominantly

focused on the epidemiology (i.e., causes, distribution, and control of disease) of NMPDU, less

attention has been paid to the motivations (i.e., incentives and drives) for misuse and abuse, with

little to no attention being paid to justifications (i.e., rationalizations or neutralizations). In addi-

tion, though motivations and justifications are undeniably interrelated processes, motivations for

use have taken greater precedence in the literature because they are more easily ascertainable

through survey research that has been the primary method of inquiry used to study this topic to

date. How college students go about justifying why it is acceptable to engage in such behavior is,

however, a more complex process to uncover, and arguably best discerned through the use of

inductive, qualitative methods, whereby individuals are able to self-reflect and share their per-

sonal experiences using these drugs. Justifications for use are also arguably just as, if not more

important to expose than motivations for use given that they help individuals to resolve any guilt,

shame, or stigma associated with their NMPDU (Sykes & Matza, 1957).

Given all of this, the purpose of this article is twofold: (a) to use qualitative methods to pro-

vide a more in-depth look into the justifications that college students use to minimize their devi-

ant identities when engaging in the nonmedical use of prescription painkillers and (b) to better

explain and contextualize these findings using criminological theory, more specifically, Sykes

and Matza’s (1957) neutralization theory.

Literature Review

Theoretical Rationale

Social learning and subcultural theories have been used extensively to frame college students’

opportunities and motivations for the nonmedical use of commonly prescribed prescription drugs

(Akers, Krohn, Lanza-Kaduce, & Radosevich, 1979; Cutler, 2014, 2016; Durkin, Wolfe, & Clark,

2005; Ford, 2008b; Higgins, Mahoney, & Ricketts, 2009; Peralta & Steele, 2010; Schroeder &

Ford, 2012; Watkins, 2016a, 2016b). In general, social learning theory focuses on how signifi-

cant others such as friends and family affect the learning process and ultimately one’s decision to