Training Physicians to Prevent Diversion of Stimulant Medication for Attention-Deficit/Hyperactivity Disorder: A...

ObjectivesEvidence-based methods to deter the misuse of stimulant medications for attention-deficit/hyperactivity disorder (ADHD) are lacking. Diversion is the most common means by which stimulants are obtained for non-medical use and prevention should begin early. The current study is the first randomized controlled trial testing whether brief training of pediatricians in Stimulant Diversion Prevention (SDP) can reduce diversion by their adolescent patients with ADHD.MethodsA cluster-randomized controlled trial was conducted across seven pediatric practices in the U.S. (ClinicalTrials.gov NCT03080259). A detailed description of the study protocol is provided as well as results for pre-registered primary and secondary outcomes.ResultsThirty-two prescribing providers, 357 adolescent patients, and one parent or guardian for each patient participated. Three practices were randomly assigned to training, and four waves of electronic surveys were administered to all participants (at baseline and 6-, 12-, and 18-months post-training) with high retention (e.g., 89%-97% of providers, 92%-96% of patients). Methods for recruitment and retention and provider and staff training were successful: planned sample size at baseline was exceeded by 12% for providers and was 95% of planned patients; planned retention at 18-months was exceeded by 21% for providers and by 10% for patients; 99% of the patients' providers received training. Patient diversion, however, was infrequent at baseline, with only one endorsement in the treatment-as-usual (TAU) group and none in the SDP group. Diversion remained infrequent across follow-ups (6.7% TAU; 3.7% SDP), rendering tests of group differences under-powered for trustworthy statistical comparisons. Group differences were not found for any pre-registered a priori primary or secondary outcomes; one exploratory group difference emerged: perceived negative social consequences of diversion was higher among patients whose providers were trained.ConclusionsPediatric practices can be successfully recruited, retained, and trained with a brief workshop on stimulant diversion prevention with, as previously reported, high rates of satisfaction and sustained implementation. Future research might benefit from focusing on older adolescent samples to assess proximal effects of physician training on stimulant diversion. Longitudinal follow-up into early adulthood of the adolescent patients in this study might reveal later-emerging benefits of the SDP training.