Preventing Prescription Stimulant Diversion and Medication Misuse Via a Web-Based Simulation Intervention

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PROJECT SUMMARY College students misuse and divert (i.e., give away, sell, or trade) prescription stimulants more often than any other class of prescription drugs (e.g., opiates). Half or nearly half of college students with prescriptions divert their stimulant medication, and a similarly high percentage misuse their medication (e.g., higher doses, via different routes of administration, etc.) or use someone else’s prescription. Diversion may lead students to go without needed medication to mitigate their symptoms, increasing their risk for unintentional injuries and substance use. Further, diversion perpetuates the non-medical use of prescription stimulants (NMUPS), which has become increasingly common among college students and is associated with other illicit drug use, lower grade point average, insomnia, irritability, headaches, and cardiovascular complications. Diversion also perpetuates medical misuse of stimulants among students with prescriptions, which is associated with poorer ADHD symptom management and may increase the risk for addictive disorders. Despite the fact that nearly 9 out of 10 students obtain prescription stimulants from a friend or acquaintance with a prescription, there are no evidence-based interventions targeting diversion of stimulants in college students. Being approached for one’s medication is a key risk factor for diversion, as is medication non-adherence and believing NMUPS and diversion are more prevalent than they are. Accordingly, in this multi-site study, we will conduct a randomized, controlled trial of 300 college-attending adults with current stimulant prescriptions to examine the preliminary efficacy and feasibility of a single-session, computer-based simulation intervention (with two booster sessions) to prevent prescription stimulant diversion and medication misuse and compare it to a placebo condition. Our intervention, which is grounded in social learning theory, the theory of planned behavior, and our preliminary research, uniquely engages students in interactive discussions with virtual humans to (a) learn about the actual prevalence of NMUPS and diversion and their related risks, (b) practice using refusal strategies when approached for their medication in high-risk situations, and (c) understand how to effectively communicate with prescribers and avoid medication misuse. Our primary aims are to determine if the intervention reduces diversion, intentions to divert, and medication misuse, and to assess user satisfaction with the intervention. Our secondary aims are to examine change in potential mechanisms of action targeted in the intervention, such as self-efficacy to resist diversion, knowledge about diversion and NMUPS, use of behavioral strategies to resist requests for one’s medication, and prescriber communication. Our study responds to PA-17-775, which calls for pilot testing of innovative technology for disseminating effective preventive interventions. It also aligns with NIDA’s Strategic Plan, which encourages the development of preventive interventions that target risk factors for substance use disorders. If effective, the intervention could be readily and widely disseminated to college counseling centers, psychiatrists/APRNs, and pediatricians.