Stimulant diversion by young adults with ADHD: piloting primary care prevention

说明(由申请人提供)：精神活性兴奋剂药物(用于治疗注意力缺陷/多动障碍的药物；ADHD)的非医疗用途是年轻人，特别是大学生中日益普遍的处方药滥用形式(Smith&Farah，2011；Wilens等人，2008)。大学校园中非医疗用途(无处方使用)的流行率正在上升(例如，DeSantis等人，2008年)。近年来，与兴奋剂相关的急诊科就诊次数增加了三倍(SAMHSA，2013a)。有处方的大学生是兴奋剂转移(赠送或出售自己的药物)的主要来源。然而，还没有为初级保健提供者制定管理这一问题的临床战略--这是一个经常治疗ADHD的专业人群，也是NIDA的目标群体(Volkow，2012)，特别是关于包括兴奋剂在内的处方药的非医疗使用(Volkow，2010)。我们与初级保健提供者的初步焦点小组显示，要么缺乏对兴奋剂转移/滥用的认识，要么缺乏解决这一问题的战略；所有人都表示关切。这一R34应用程序建议初步开发简单的临床策略，初级保健提供者可以使用这些策略来防止ADHD患者转移兴奋剂。我们专注于家庭医学和儿科提供者，为18-25岁的青少年提供高等教育。在R34计划公告PA-12-171，药物和酒精滥用预防试验准备中的试点和可行性研究的背景下，我们将1)调查提供者及其医生推广人员(护士从业人员和医生助理)的当前做法；2)制定和试点防止转移到e的测试策略；以及3)使用实施后调查和EMR数据，检查与可行性、满意度和实施相关的患者变量。我们根据Weiner的创新实施理论(Weiner等人，2009年)选择在战略制定和评估中要考虑的变量。我们建议将主要利益攸关方(社区提供商)和相关顾问纳入开发进程，以增强创新的可行性和实施。这些策略的开发将是创新的，因为它们完全没有出现在循证ADHD治疗指南文献中。该项目解决了一个迫在眉睫的公共卫生问题：大学生对附表II处方药(中枢神经系统兴奋剂)的非处方药使用量不断上升。在R01资助的有效性和主持人研究之后，解决这一知识差距具有最终的潜力，可以提供一种务实、低成本和高度可传播的方法，通过这种方法可以减少处方兴奋剂的转移。

DESCRIPTION (provided by applicant): Nonmedical use of psychoactive stimulant medication (medication that is prescribed for the treatment of Attention-Deficit/Hyperactivity Disorder; ADHD) is an increasingly prevalent form of prescription drug misuse among young adults and in particular college students (Smith & Farah, 2011; Wilens et al., 2008). Prevalence rates of nonmedical use (use without a prescription) on college campuses are rising (e.g., DeSantis et al., 2008). Stimulant-related emergency department visits have increased threefold in recent years (SAMHSA, 2013a). College students with prescriptions are the primary source of stimulant diversion (giving away or selling one's medication). However, no clinical strategies for management of this problem have been developed for primary care providers - a professional population that frequently treats ADHD and that is being targeted by NIDA (Volkow, 2012), especially with regard to nonmedical use of prescription drugs including stimulants (Volkow, 2010). Our preliminary focus groups with primary care providers revealed either lack of awareness about stimulant diversion/misuse or lack of strategies for addressing it; all indicated concern. This R34 application proposes the initial development of brief clinical strategies that primary care providers may use to prevent diversion of stimulants by their patients with ADHD. We focus on family medicine and pediatric providers treating 18-25 year olds in post-secondary education. Within the context of the R34 Program Announcement PA-12-171, Pilot and Feasibility Studies in Preparation for Drug and Alcohol Abuse Prevention Trials, we will 1) survey providers and their physician-extenders (nurse practitioners and physician assistants) about their current practices; 2) develop and pilot test strategies for prevention of diversion to e utilized within the context of the provider:patient relationship; and 3) examine, using post- implementation survey and EMR data, provider, practice, and patient variables associated with feasibility, satisfaction, and implementation. We base our selection of variables to consider in strategy development and evaluation on Weiner's theory of innovation implementation (Weiner et al., 2009). We propose inclusion of key stakeholders (community providers) and relevant consultants in the development process to enhance innovation feasibility and implementation. The development of these strategies will be innovative due to their complete absence in the evidence-based ADHD treatment guidelines literature. The project addresses an immediate public health concern: escalating non-prescribed use of a Schedule II prescription medication (CNS stimulants) by college students. Addressing this knowledge gap has the ultimate potential, following an R01- funded well-powered study of effectiveness and moderators, to provide one pragmatic, low cost, and highly disseminable means by which prescription stimulant diversion may be decreased.