Results from the 2009 "National College Health Assessment" were analyzed by gender and sexual orientation for college students' nonmedical use of prescription drugs. Male and female students identified as having a minority sexual orientation (gay or bisexual) were significantly more likely to use nonmedical prescription drugs than heterosexual students. College students with a minority sexual orientation were engaged in more high-risk substance using behaviors than their heterosexual peers. Implications for assessment, counseling, and future research are discussed.