Misuse of stimulant medication is pervasive among college students. In this study, we surveyed undergraduate college students (N = 3,038) at a large-sized Southwestern university. We examined unique characteristics of students misusing stimulant medication with a prescription (n = 74) and those misusing without a prescription (n = 356). Both groups reported being motivated to use for study enhancement purposes and increased alertness. They identified sleeplessness, racing heart, and racing thoughts as the most common side effects, and often used concurrently with alcohol and marijuana.