New Research: Primary Care Provider Training to Prevent Stimulant Diversion among College Students

Non-prescribed use of stimulant medications, such as Adderall®, by young adults is a growing problem, particularly among college students. It is often fueled by drug diversion, or the transfer of a legally prescribed medication to another person for illicit use. Among college students, stimulant use is frequently motivated by a desire to enhance academic performance or to use the drug recreationally. A team of researchers at the University of Pittsburgh led by Brooke Molina, PhD, Professor of Psychiatry, Psychology, Pediatrics, and Clinical and Translational Science, and including Heather Joseph, DO, developed an evidence-based workshop to train primary care providers in brief clinical practice strategies to reduce diversion of stimulants by their young adult patients being treated for attention-deficit/hyperactivity disorder (ADHD). Primary care interventions have demonstrated effectiveness in reducing a variety of behaviors including substance misuse.

Clinicians and staff at six pediatric and family medicine practices in or near Pittsburgh attended a one-hour workshop led by Dr. Molina and her team. One hundred and six participating patients responded to a survey—once before and once after the physician training—regarding environmental and psychosocial factors related to sharing, selling or trading controlled substances prescribed for ADHD, as well as the perceived consequences of drug diversion. Information gathered from the patients included various scenarios in which drug diversion could occur, such as situations in which the patient intended to share, trade or sell stimulants, or was approached by someone else—friend, family member, acquaintance or stranger—to do so. 

The study team found that after the training, a statistically significant reduction in diversion risk occurred among the patients of the providers who attended the workshop, including intent to divert. Although participants were substantially more likely to divert medications when approached by friends or family members—a key vulnerability in stimulant diversion and misuse—these occurrences decreased significantly after the primary care physician (PCP) training session. There was also a reduction in the extent to which other people knew about the patients’ medication following the PCP training, suggesting that patients may have followed provider recommendations (as suggested in the training) to be judicious when revealing details of their treatment.  

“Although a future study with a control group is needed, the findings are exciting because they provide the first evidence, from confidential patient reports, that PCP training in diversion risk management may have downstream beneficial effects on patient behavior,” said Dr. Molina.

Stimulant diversion risk among college students treated for ADHD: Primary care provider prevention training
Molina BSG, Kipp HL, Joseph HM, Engster SA, Harty SC, Dawkins M, Lindstrom RA, Bauer DJ, Bangalore SS. 

Academic Pediatrics. Published online June 8, 2019.