Preventing Prescription Stimulant Diversion and Misuse via a Web-Based Intervention: A Randomized Controlled Trial

Prescription stimulant diversion (i.e., giving, selling, or trading one's medication) and non-medical prescription stimulant use (i.e., using in ways not prescribed) are common among undergraduates; however, few evidence-based interventions target these behaviors. This study evaluated the efficacy and feasibility of a 30-min, interactive web-based intervention providing psychoeducation around diversion and non-medical use, practice refusing medication requests, and medication adherence strategies. Students (M_age = 20.42 years; 74% female; 86% White) with current stimulant prescriptions from three US universities were randomized to the intervention (n = 128) or attention-matched placebo (n = 121) in a single-blind design, with 1- and 2-month boosters and 3- and 6-month follow-ups. Primary outcomes were diversion, non-medical use, and diversion intentions; secondary outcomes were perceived norms, perceived risk, self-efficacy to resist diversion and non-medical use, and prescriber communication. Contrary to pre-registered hypotheses, intervention participants did not report decreases in primary outcomes. There were small-to-medium effects on secondary outcomes of risk perceptions (d = 0.39 [0.12, 0.68]), perceived non-medical use norms (d = 0.51 [0.24, 0.76]), and self-efficacy to avoid non-medical use (d = 0.47 [0.10, 0.85]), but not on perceived diversion norms, self-efficacy to avoid diversion, and prescriber communication. Post-hoc analyses showed a 76% reduction in odds of any diversion (OR = 0.24 [0.08, 0.68]) and a 60% reduction of any non-medical use (OR = 0.40 [0.21, 0.77]) for intervention participants during the 6-month follow-up period. This intervention was acceptable and feasible to implement and evidenced some efficacy in modifying risk perceptions, self-efficacy, and perceived norms. Since diversion and misuse episodes were not reduced, future intervention refinements may tailor content to different levels of diversion and misuse risk. Registered in ClinicalTrials.gov on May 12, 2021: NCT04885166.