Abstract: Background: Most drug users initiate illicit drug use during adolescence and young adulthood. Although in the general population a trend towards a decrease in drug use can be seen, patterns of drug use amongstudents are unclear.Objectives: The objective of the study was to look at drug use patterns among students in higher education in Belgium. Methods: A survey study in Antwerp (Belgium) was conducted on three occasions (2005, 2009, and 2013) at several institutes for higher education. Students (total sample size 24,478; 29,210, and 31,950, respectively) were asked if they had used legal or illicit drugs in the past year. To compare whether drug use differed between the separate years, ÷2- tests were performed on past-year drug use for all three time points. If significant, ÷2-tests between pairs were performed. Gender and age differences were also analyzed. Results: The use of nondistilled alcohol, spirits, and cannabis decreased during this period but no change in students use patterns was seen for beer, wine, sedative hypnotics, stimulating medication, XTC, cocaine, or amphetamines. Tobacco use decreased initially, but increased in 2013. More men indicated having used drugs in the past year than women. Only for cannabis did more younger students indicate having used in the past year. Conclusions/Importance: The data from this study could provide valuable insights for academic and governmental bodies and health care professionals into the use of drugs by higher education students since this subgroup shows specific use patterns.