Nonmedical use of psychoactive stimulant medication (medication that is prescribed for the treatment of Attention-Deficit/Hyperactivity Disorder; ADHD) is an increasingly prevalent form of prescription drug misuse among high school students (McCabe & West, 2013) and prevalence rates continue to rise. Stimulant-related emergency department visits increased threefold in recent years (SAMHSA, 2013a). Students with prescriptions are the primary source of stimulant diversion (selling, sharing one's medication). However, with the exception of developmental research we recently launched, clinical strategies for management of stimulant diversion have yet to be developed and empirically evaluated for primary care providers - a professional population that frequently treats ADHD and that is being targeted by NIDA (Volkow, 2012), especially with regard to nonmedical use of prescription drugs including stimulants (Volkow, 2010). Our work with primary care providers revealed 1) concern about the problem, 2) a lack of strategies for addressing it, and 3) willingness to adopt new strategies to decrease diversion potential. This application proposes to test the implementation of brief clinical practice strategies, designed to prevent stimulant diversion that pediatricians may use with their teenage patients receiving stimulant prescriptions and their parents. In response to RFA-DA-15-010, Interventions for youth who misuse/abuse prescription stimulant medications in high school and/or college-attending youth (U01), we will conduct a randomized trial to examine the effect on patient diversion, attitudes, and intentions, of an intervention to be delivered by pediatric providers at the time of stimulant prescribing. N=375 13-17 year old patients will be enrolled across six pediatric practices for assessment prior to, and following, provider training in stimulant diversion practices. Following baseline assessment, providers at half of the practices, randomly selected within matched pairs, will receive training in the Stimulant Diversion Prevention (SDP) protocol; the remainder will implement Treatment as Usual (TAU). Providers and parents will also participate in the assessments and electronic medical record data will be collected for participating patients. We will also characterize prescribing patterns in all participating and non participating practices in the UPMC pediatric provider network independent of study participation (543 pediatricians) for comparison to regional trends. The results of this study will provide the first empirical test of a brief provider-led intervention for stimulant diversion reduction in primary care. The goals are innovative given the complete absence of such strategies in evidence-based ADHD treatment guidelines. The project addresses an immediate public health concern and is based on developmental work (R34 DA035464) that includes stakeholders (providers) as consultants to develop feasible strategies with a high likelihood of delivery. Thus, the impact of the work is expected to be high, with the result being a pragmatic, low cost, and highly disseminable means by which prescription stimulant diversion may be decreased.
This study addresses the marked increase in diversion (selling, sharing, loaning, or trading) of prescription stimulant medications by adolescents in pediatric primary care treatment for ADHD. In complete absence of any standardized clinical strategies or interventions to prevent or decrease stimulant diversion, this project will develop pragmatic, testable, and highly disseminable strategies within the primary care provider:patient relationship with the ultimate goal of reducing stimulant diversion by adolescents and the accompanying negative consequences such as adverse medical and legal outcomes.
| Feldstein Ewing, Sarah W; Tapert, Susan F; Molina, Brooke S G (2016) Uniting adolescent neuroimaging and treatment research: Recommendations in pursuit of improved integration. Neurosci Biobehav Rev 62:109-14 |
