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 a way not prescribed) are common among undergraduates; however, few evidence-based interventions target these behaviors. This study evaluated the efficacy and feasibility of a 30-minute, interactive web-based intervention providing psychoeducation around diversion and non-medical use, practice refusing medication requests, and strategies for medication adherence. College students (Mage=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 decrease in number of diversion or non-medical use episodes. There were small-to-medium effects on 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 no effects on other outcomes. Exploratory 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 brief intervention was acceptable and feasible to implement and evidenced some efficacy in increasing risk perceptions and self-efficacy and changing perceived norms. Since the intervention did not decrease number of diversion or misuse episodes, however, future intervention refinements may tailor content to different levels of diversion and misuse risk.