Results revealed that the main patterns of drug misuse involved self-medication, recreation, and academics. Prescription drug misuse was widespread among participants due to the characteristics of prescription medications: known composition, dose dependent effects and predictability, and widespread availability. The overriding cultural belief among the participants was that pharmaceuticals were relatively safe to use when compared to other types of drugs. Many participants reported abusing prescription drugs as a replacement for other illicit drugs. Participants’ responses belied a surprisingly low level of awareness of the medical risks associated with unsupervised prescription drug use and of the dangers of mixing pharmaceuticals with alcohol. Results suggest that physicians working with college populations should discuss the issues related to the socio-recreational use of prescription drugs as well as the dangers and risks posed by unsupervised pharmaceutical use. Data were drawn from an exploratory study funded by the National Institute on Drug Abuse. Participants were 52 college students at a public university who were recruited through advertisements and snowball sampling. In the first phase of the study, participants completed semi-structured interviews that focused on a variety of aspects of drug use. In the second phase of the study, participants responded to more in-depth interviews that probed the major cultural themes, patterns, and knowledge related to collegiate drug use. Interviews were transcribed and coded using a descriptive coding scheme based on specific questions and broad domains from the interview. Descriptive statistical analyses were conducted in SPSS. Future research should examine the role of popular media and news outlets in generating and perpetuating the idea that prescription drug abuse is relatively safe. Tables, notes, references