Symposia
Addictive Behaviors
Brooke S. G. Molina, Ph.D.
Professor
University of Pittsburgh
Pittsburgh, Pennsylvania
Sarah Pedersen, PhD
Associate Professor of Psychiatry and Psychology
University of Pittsburgh Department of Psychiatry
Pittsburgh, Pennsylvania
Heather Joseph, DO
Assistant Professor of Psychiatry & Pediatrics
University of Pittsburgh Department of Psychiatry
Pittsburgh, Pennsylvania
Heidi Kipp, MEd, LPC
Clinical Coordinator
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania
David J. Kolko, Ph.D.
Professor of Psychiatry
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Elizabeth A. McGuier, Ph.D.
Assistant Professor of Psychiatry
University of Pittsburgh School of Medicine
Pittsburgh, Pennsylvania
Rachel Lindstrom, Ph.D.
Statistician
University of Pittsburgh
Pittsburgh, Pennsylvania
Daniel J. Bauer, Dr.
Professor
University of North Carolina at Chapel Hill
Chapel Hill, North Carolina
Geetha Subramaniam, MD
Deputy Director of the Center for Clinical Trials Network
National Institute on Drug Abuse
North Bethesda, Maryland
Objectives. Diversion (sharing, selling, or trading) of prescription stimulants supports non-medical use of ADHD medications by adolescents. Despite the typicality of pediatricians prescribing stimulants for their patients with ADHD, evidence-based strategies to reduce diversion and risk are not available to these primary care providers.
Methods. Seven pediatric practices in Southwestern Pennsylvania were assigned to receive a workshop on stimulant diversion prevention (SDP) or continue treatment-as-usual (TAU) in a cluster-randomized controlled trial (NCT03080259). Electronic surveys were completed by 341 adolescent stimulant-treated patients at baseline and again 6-, 12-, and 18-months post-training for both groups. Patient reports were analyzed to determine SDP efficacy.
Results. Intent-to-treat GEE analyses, adjusting for practice effects and baseline levels, compared SDP versus TAU at the follow-up assessments. Patient-reported diversion was infrequent at baseline (1% TAU, 0% SDP) and thereafter (6.7% TAU, 3.7% SDP, across follow-ups), and perceived risk of harm and intent to divert were at low risk levels, yielding no group differences. Secondary outcomes showed increased provider use of diversion prevention strategies, parent-patient communication about diversion, and increased patient expectations of negative social consequences from diversion in the SDP versus TAU group. Three indirect (mediating) associations were observed, no iatrogenic (adverse) effects resulted, and strong provider satisfaction was reported. Additional analyses of diversion prevention strategy use self-reported by the providers (n=76) showed greater use of patient/family education strategies at all follow-up assessments.
Conclusions. Overall, the current study demonstrated that a brief, one-hour training of pediatric primary care providers and their staff resulted in a small amount of benefit, and no negative effects, to risk of stimulant diversion by adolescent patients treated for ADHD. The low-risk nature of the sample prevented detection of stronger effects on our a priori outcome variables. Additional research with older, higher risk patients is warranted. Providers reported strong satisfaction with the training and changed behavior which, coupled with lack of iatrogenic effects, highlights palatability of the workshop for prescribers who wish to address concerns about stimulant misuse and diversion with their patients.