Stimulant Diversion Risk Among College Students Treated for ADHD: Primary Care Provider Prevention Training

Abstract

Objectives: To address increasing rates of stimulant misuse in college students, this study developed an evidence-based, brief clinical practice intervention for primary care providers (PCPs) to reduce stimulant medication diversion among young adults with ADHD.Methods: College students (N-114; 18-25 years; 68% attending universities; 24% attending community college) treated for ADHD with a stimulant and their PCPs across six practices participated in this initial, uncontrolled study of pre-to post-intervention change. An educational workshop providing strategies aimed at reducing stimulant diversion was developed and delivered to providers and staff across all practices (50% pediatric; 50% family medicine). Patients and providers completed baseline and post intervention surveys.

Outcomes and Predictors of Stimulant Misuse in College Students with and Without ADHD

“…Consequently, prescribing clinicians should be mindful of these motives and provide information regarding misuse of prescription stimulants (e.g., definition of misuse for those with a valid prescription, along with possible outcomes) to the clients they serve in an effort to decrease misuse and diversion among the college student population. Recently Molina et al (2020) found preliminary support for brief clinical practice intervention for primary care providers in reducing diversion of prescription simulants among young adults with ADHD. Further research is warranted in this area.…”

Adolescents Treated for Attention-Deficit/Hyperactivity Disorder in Pediatric Primary Care: Characterizing Risk for Stimulant Diversion

“…We include this in our stimulant diversion prevention training in the current randomized clinical trial and in the college student study in which disclosure decreased after training. 14 Regarding the intrapersonal domain of diversion risk factors, adolescents felt (on average) that refusing requests for their medication was easy. This high selfefficacy may explain why requests to divert are more common than diversion.…”

“…We include this in our stimulant diversion prevention training in the current randomized clinical trial and in the college student study in which disclosure decreased after training. 14…”

“…In the current study, because of the dearth of the literature, we extrapolate from these findings and draw from our previous research on the prevention of stimulant diversion by college students 14 to offer a conceptual model of stimulant diversion risk (Fig. 1) and associated measurement of these presumed risk factors.…”

Pediatric Primary Care Providers Play a Central Role in Reducing Stimulant Diversion

“…Four categories of diversion prevention strategies were rated by participating PCPs, including (1) the use of patient/family education, (2) medication management/monitoring, (3) assessment of mental health symptoms/ functioning, and (4) assessment of risky behaviors. These four categories of strategies were previously developed and used in a stimulant diversion reduction clinical trial aimed at PCPs for college students with ADHD based on their perceived direct or indirect relevance to diversion [9].…”