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

通过基于网络的模拟干预防止处方兴奋剂转移和药物滥用

• 批准号: 10212996
• 负责人: Laura Holt
• 金额: $ 19.32万
• 依托单位: TRINITY COLLEGE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10212996
• 关键词: Academic achievement; Accidental Injury; Acquaintances; Adderall; Address; Adult; Advanced Practice Nurse; Area; Attention deficit hyperactivity disorder; Awareness; Behavior; Behavioral; Benzodiazepines; Cardiovascular system; Communication; Computer Simulation; Computers; Consumption; Counseling; Development; Dose; Drug Prescriptions; Emergency department visit; Evidence based intervention; Exposure to; Feedback; Friends; Goals; Headache; Health; Health Personnel; Healthcare; Human Resources; Injury; Insurance Carriers; Intervention; Knowledge; Lead; Learning; Medical; Mental Health; Moods; Morbidity - disease rate; National Institute of Drug Abuse; Online Systems; Opioid; Participant; Perception; Pharmaceutical Preparations; Physiological; Placebos; Planning Theory; Prevalence; Prevention strategy; Privatization; Provider; Psychiatrist; Randomized Controlled Trials; Reporting; Research; Resistance; Risk; Risk Factors; Route; Self Efficacy; Site; Sleeplessness; Strategic Planning; Students; Substance Use Disorder; Symptoms; Testing; Time; addiction; base; behavior change; college; conduct problem; cost; cost effective; disability; drug misuse; emerging adult; epidemiology study; evidence base; follow-up; high risk; illicit drug use; innovation; innovative technologies; intervention effect; intervention participants; medication compliance; medication nonadherence; misuse of prescription only drugs; nonmedical use; pediatrician; peer; prescription stimulants; prevent; preventive intervention; primary outcome; psychologic; psychological outcomes; randomized controlled design; response; satisfaction; secondary outcome; sex; side effect; simulation; skill acquisition; skills; social cognitive theory; stimulant misuse; stimulant use; substance use; symptom management; therapy design; university student; vehicular accident; virtual coach; virtual human; web-based intervention

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.

项目总结 大学生滥用和转移(即赠送、出售或交换)处方兴奋剂的频率比以往任何时候都要高 其他类别的处方药(如鸦片类药物)。有处方的大学生有一半或近一半会分流 他们的兴奋剂药物，以及同样高比例的滥用药物(例如，更高剂量，通过 不同的管理途径等)或者用别人的处方。分流可能会导致学生去 如果没有必要的药物来缓解他们的症状，增加了他们无意伤害和 物质使用。此外，转移使处方兴奋剂(NMUPS)的非医疗用途永久化，这 在大学生中变得越来越普遍，并与其他非法药物使用有关，较低 平均绩点、失眠、易怒、头痛和心血管并发症。分流也 在有处方的学生中持续医疗滥用兴奋剂，这与较贫穷有关 ADHD症状管理，并可能增加成瘾障碍的风险。尽管事实是几乎 每10名学生中就有9名从朋友或熟人那里获得处方兴奋剂， 目前还没有针对大学生兴奋剂转移的循证干预措施。存在 寻求药物治疗是转移注意力的关键风险因素，药物不坚持和 认为NMUPS和转移注意力比他们更普遍。因此，在这项多地点研究中，我们将 对300名目前服用兴奋剂处方的大学在校成年人进行随机对照试验 检查基于计算机的单次模拟干预的初步有效性和可行性 (有两个强化疗程)以防止处方兴奋剂转移和药物滥用，并进行比较 变成了安慰剂状态。我们的干预是基于社会学习理论，有计划的理论 行为，以及我们的初步研究，独特地让学生参与到与虚拟现实的互动讨论中 人类(A)了解NMUPS和转用的实际流行情况及其相关风险，(B)实践 在高风险情况下接受药物治疗时使用拒绝策略，以及(C)了解如何 有效地与处方医生沟通，避免误用药物。我们的主要目标是确定 干预减少了转移注意力、转移注意力的意图和药物滥用，并评估了用户满意度 进行了干预。我们的次要目标是检查潜在行动机制的变化，目标是 干预措施，如抵抗转移的自我效能感、转移知识和NMUPS知识、使用 抵制药物请求的行为策略，以及与处方者的沟通。我们的研究 响应PA-17-775，其中要求对创新技术进行试点测试，以传播有效的 预防性干预。它还与NIDA的战略计划保持一致，该战略计划鼓励 针对物质使用障碍风险因素的预防性干预。如果有效，这种干预可能会 随时向大学咨询中心、精神病学家/APRN和儿科医生广泛传播。