Preventing Prescription Stimulant Diversion and Medication Misuse Via a Web-Based Simulation Intervention

Half or nearly half of college students with prescriptions divert their stimulant medication, and a similarly high percentage misuse their medication or use someone else's prescription. Diversion may lead students to go without needed medication to mitigate their symptoms, increasing their risk for unintentional injuries and substance use. Further, diversion perpetuates the non-medical use of prescription stimulants (NMUPS), which has become increasingly common among college students. Diversion also perpetuates medical misuse of stimulants among students with prescriptions, which is associated with poorer attention-deficit/hyperactivity disorder (AD/HD) symptom management and may increase the risk for addictive disorders. There are no evidence-based interventions targeting diversion of stimulants in college students. Being approached for one's medication is a key risk factor for diversion, as is medication non-adherence and believing NMUPS and diversion are more prevalent than they are. Accordingly, in this multi-site study, the investigators will conduct a randomized, controlled trial of 300 college-attending adults with current stimulant prescriptions to examine the preliminary efficacy and feasibility of a single-session, computer-based simulation intervention (with two booster sessions) to prevent prescription stimulant diversion and medication misuse and compare it to a placebo condition. The intervention, which is grounded in social learning theory and the theory of planned behavior uniquely engages students in interactive discussions with virtual humans to (a) learn about the actual prevalence of NMUPS and diversion and their related risks, (b) practice using refusal strategies when approached for their medication in high-risk situations, and (c) understand how to effectively communicate with prescribers and avoid medication misuse. The primary aims are to determine if the intervention reduces diversion, intentions to divert, and medication misuse, and to assess user satisfaction with the intervention. The secondary aims are to examine change in potential mechanisms of action targeted in the intervention, such as self-efficacy to resist diversion, knowledge about diversion and NMUPS, use of behavioral strategies to resist requests for one's medication, and prescriber communication. If effective, the intervention could be readily and widely disseminated to college counseling centers, psychiatrists, pediatricians, and other prescribers.

Study Overview

• Status: Completed
• Conditions: Prescription Drug Abuse (Not Dependent); Intentional Misuse
• Intervention / Treatment: Behavioral: Web-based simulation active intervention; Other: Web-based placebo presentation

• Study Type: Interventional
• Enrollment (Actual): 249
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • Hartford, Connecticut, United States, 06106
      • Trinity College
  • Texas
    • San Marcos, Texas, United States, 78666
      • Texas State University
  • Wyoming
    • Laramie, Wyoming, United States, 82071
      • University of Wyoming

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 17 years to 25 years (Child, Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Undergraduate or graduate student at Trinity College (CT); University of Wyoming; Texas State University.
• Will be enrolled at Trinity College (CT); University of Wyoming; Texas State University 6-months from their baseline study session.
• Have a recent (within the past 3 months) prescription for a stimulant medication
• Between the ages of 17 and 25.

Exclusion Criteria:

• None.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Web-based simulation intervention; Participants in this condition will receive psychoeducation about stimulant medication diversion, stimulant medication misuse, and will practice navigating and resisting requests for their medication with a virtual human.	Behavioral: Web-based simulation active intervention; This intervention engages students in interactive discussions with virtual humans to (a) learn about the actual prevalence of NMUPS and diversion and their related risks, (b) practice using refusal strategies when approached for their medication in high-risk situations, and (c) understand how to effectively communicate with prescribers and avoid medication misuse.
Placebo Comparator: Placebo condition; Participants in this condition will learn about psychological conditions that affect college students most often (e.g., depression), causes of those conditions, and pharmacological/behavioral treatments for those conditions.	Other: Web-based placebo presentation; This presentation will discuss the prevalence of psychological disorders in college students, their etiologies, psychiatric medications, and students' personal experiences navigating college with a diagnosis of an anxiety and learning disorder, respectively. Attention-deficit/hyperactivity disorder and stimulant medications will be addressed, but diversion and medication misuse will not be discussed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of Prescription Stimulant Diversion	participants will note how many times they have engaged in diversion (i.e., giving away, selling, or trading one's prescribed medication)	baseline, 3-months, 6-months
Intention to Divert Prescription Stimulant Medication	Intentions to divert stimulant medication were assessed with two questions from the Behavior, Expectancies, Attitudes and College Health Questionnaire (Bavarian et al., 2013) adapted to address diversion: "How likely is it that you will give away, [or sell, trade] your stimulant medication in the next three months?". These questions had a four-point response scale (1=very unlikely, 4=very likely). Responses were summed and ranged from 2-8, with 8 indicating the greatest intention to divert (worse outcome).	baseline, 3-months, 6-months
Frequency of Prescription Stimulant Medication Misuse	participants will indicate any instances of (a) using alternative routes of administration, (b) taking more than your recommended dose, (c) taking someone else's stimulant medication, (d) taking your stimulant with other drugs in order to experience intoxicating effects, or (e) intentionally getting high on your prescribed stimulant medication?	baseline, 3-months, 6-months
User Satisfaction With the Simulation/Placebo	We will assess the usefulness, information quality, and interface quality of the simulation using the 13-item Post-Study System Usability Questionnaire. A mean score of 1 indicates lowest level of satisfaction, while a mean score of 7 would indicate the highest level of satisfaction.	baseline (immediately after simulation or placebo presentation)
Usability of the Simulation/Placebo	Participants will respond to 15 items related to the perceived usefulness, user control, and impact of the simulation/placebo. A mean score of 1 would indicate the lowest level of perceived usability; a mean score of 5 would indicate the highest rating of usability.	baseline (immediately after simulation or placebo presentation)
1 Month Booster Engagement	Booster session #1 is delivered via a slide deck and reviews the key points from the slideshow they viewed at the beginning of the study. Then, participants have to answer 5 questions related to the content. We assess engagement in the online booster session #1 on a 0-5 scale by summing the number of correct answers to the five comprehension questions embedded in the online booster. Each correct item receives one point. Scores ranged from 0 to 5, with 5 indicating the most engagement and accurate understanding of the content.	1 month
2 Month Booster Engagement	Booster session #2 is delivered via a slide deck and reviews the key points from the slideshow they viewed at the beginning of the study. Then, participants have to answer 5 questions related to the content. We assess engagement in the online booster session #2 on a 0-5 scale by summing the number of correct answers to the five comprehension questions embedded in the online booster. Each correct item receives one point. Scores ranged from 0 to 5, with 5 indicating the most engagement and accurate understanding of the content.	2 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-efficacy to Resist Prescription Stimulant Diversion	Participants will rate their confidence to (1) resist giving away their medication, (2) resist selling their medication. These responses, each given on a 5-point scale, were summed and scores ranged from 2 to 10, with 10 indicating the highest level of self-efficacy.	baseline, 3-months, 6-months
Resistance Strategy Use	At the 3- and 6-month follow up, participants were asked to describe, through an open-ended response, how they responded if they were approached to give away, sell, or trade their medication since the last assessment. The data provided below is the count of participants who provided an open-ended response.	3- and 6-months
Perceived Behavioral Norms for Prescription Stimulant Diversion	Participants will indicate, on a scale from 0-100, the percentage of students they believe give away, sell, or trade their prescribed stimulant medication.	baseline, 3-months
Perceived Behavioral Norms for Prescription Stimulant Misuse	Participants will indicate, on a scale from 0-100, the percentage of students they believe use stimulant medication in a way it was not prescribed.	baseline, 3-months
Perceived Risks From Prescription Stimulant Diversion and Misuse	We will assess perceived legal risks associated with prescription stimulant diversion. We will assess perceived harm from non-medical prescription stimulant use and medical misuse by asking: "How much do people risk harming themselves (physically or in other ways) if they "take stimulants non-medically?" or "use their prescription in a way a prescriber did not intend? Scores ranged from 5 to 20, with higher scores indicating greater perceived risk (better outcome).	baseline, 3-months
Communication With Prescriber	Number of times participants communicated with their prescriber regarding their adherence to their prescription and any concerns they have regarding the dose, frequency of administration, and/or side effects in past 90 days. Responses ranged from 0 to 8, with higher scores denoting more communication with a prescriber (better outcome). (Investigator-generated scale)	baseline, 3-months, 6-months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Accidental Injuries	Participants will note whether they experienced any accidental injuries in the prior 6 months (e.g., car accidents, burns, etc.).	6-months
Other Substance Use	Participants will report any occasions of marijuana, cocaine, heroin, methamphetamine, or hallucinogen use, or other prescription drug misuse in the previous 90 days.	baseline, 3-months, 6-months
Attention-Deficit/Hyperactivity Disorder-related Impairment	Using the Impairment Rating Scale, participants reported on the extent to which they experienced problems in social, academic, familial, and vocational circumstances. Responses options ranged from 1=not at all to 7=extreme problem and were averaged to yield an overall impairment score (Range 1-6.25). A lower score indicates less impairment (better outcome), whereas a higher score indicates more impairment (poorer outcome).	baseline, 3-months, 6-months
Conduct Problems	Participants reported on the frequency with which they engaged in 11 problem behaviors before age 18 (0=never, 1=once, 2=twice, 3=three times, 4=more than three times). This scale was adapted from Johnson (1995). Consistent with Garnier (2008), we counted less severe items (e.g., lied, broke rules) as a "1" when rated at least a four. More severe items (e.g., hurt another physically, used a weapon, set a fire) had to occur >2 times to be counted towards the total score. The minimum score was a 0, the maximum an 11.	baseline

Collaborators and Investigators

• Sponsor: Trinity College
• Collaborators: University of Wyoming; Texas State University
• Investigators: Principal Investigator: Laura J Holt, PhD, Trinity College

Publications and helpful links

General Publications

• Holt LJ, Looby A, Feinn R, Schepis TS. Preventing Prescription Stimulant Diversion and Misuse via a Web-Based Intervention: A Randomized Controlled Trial. J Atten Disord. 2026 Feb;30(2):265-280. doi: 10.1177/10870547251405545. Epub 2025 Dec 30.
• Holt LJ, Looby A, Schepis TS, Feinn R. Preventing prescription stimulant diversion and misuse through brief intervention: Moderators and secondary outcomes from a randomized controlled trial. Exp Clin Psychopharmacol. 2026 Feb;34(1):61-67. doi: 10.1037/pha0000808. Epub 2025 Nov 10.

Study record dates

Study Major Dates

• Study Start (Actual): May 4, 2021
• Primary Completion (Actual): May 21, 2024
• Study Completion (Actual): May 21, 2024

Study Registration Dates

• First Submitted: May 4, 2021
• First Submitted That Met QC Criteria: May 7, 2021
• First Posted (Actual): May 13, 2021

Study Record Updates

• Last Update Posted (Actual): April 8, 2026
• Last Update Submitted That Met QC Criteria: March 18, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: diversion
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders
• Other Study ID Numbers: 1R34DA048345-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No