Upstream Approaches to Addressing Prescription Stimulant Misuse and Diversion: Exploring Perspectives of College Students Who Misuse and Divert

• Author: Kate Diaz Roldan,Jacquelyn Garcia,Brian Valencia,Jeovanna Amador Ayala,Candelaria Garcia,Jaimie McMullen,Niloofar Bavarian
• DOI: http://doi.org/10.1177/00220426221090176
• Published date: 01 October 2022
• Date: 01 October 2022
• Subject Matter: Articles

Article

Journal of Drug Issues

2022, Vol. 52(4) 585–600

© The Author(s) 2022

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DOI: 10.1177/00220426221090176

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Upstream Approaches to

Addressing Prescription

Stimulant Misuse and Diversion:

Exploring Perspectives of

College Students Who Misuse

and Divert

Kate Diaz Roldan

1

, Jacquelyn Garcia

1

, Brian Valencia

1

,

Jeovanna Amador Ayala

1

, Candelaria Garcia

1

, Jaimie McMullen

2

, and

Niloofar Bavarian

1



Abstract

Background: We interviewed college students who engage in prescription stimulant misuse and

diversion to better understand perspectives on prevention and intervention strategies.

Methods: Trained student researchers at one southern California university completed 32 face-

to-face interviews with students who had a history of misuse and/or diversion. Participants

provided insights on programs, policies, and practices that have the potential to deter behavior.

Data were analyzed inductively via thematic analysis.

Results: Students were often misinformed or unaware of existing programs, policies and

practices. Additionally, some students felt their behaviors would not be detected, whereas other

students felt the fear of being detected would lead them to change their behaviors. Harm re-

duction and treatment-based approaches to address misuse were also recommended.

Conclusions: Our f‌indings emphasize the importance of better educating students about, and

enforcing, existing policies. In addition, the need to better inform students of existing campus

programs is warranted.

Keywords

prescription stimulants misuse, prescription stimulant diversion, upstream approaches, college

students

1

California State University, Long Beach, CA, USA

2

University of Northern Colorado, Greeley, CO, USA

Corresponding Author:

Niloofar Bavarian, Department of Health Science, California State, University, Long Beach, 1250 Bellf‌lower Blvd, Long

Beach, CA 90840, USA.

Email: Niloofar.Bavarian@csulb.edu

Introduction

Prescription stimulant (e.g., Adderall, Ritalin, and Vyvanse) misuse and diversion are inter-related

and co-occurring problems, particularly on college campuses (Faraone et al., 2020). Moreover,

misuse (i.e., use without a prescription, in excess of a prescription, and/or for nonmedical

purposes) and diversion (i.e., sharing, selling, and trading) occur among students with and without

a prescription for stimulants. For example, in one study with college students who have a

prescription for stimulant medications, the prevalence of past-year misuse and diversion was 33%

and 18%, respectively (Ramachandran et al., 2020). In a separate study including students with

and without a prescription, the prevalence of having ever misused or diverted during college was

approximately 21% (Bavarian et al., 2018) and 10% (Lam et al., 2020), respectively. These levels

of diversion are particularly problematic because when friends and/or acquaintances serve as the

primary source of prescription stimulants (Garnier-Dykstra, Caldeira, Vincent, O’Grady, & Arria,

2012), the oversight provided by health care providers is lacking, thereby increasing the chance for

adverse effects (Goldsworthy, et al., 2008). Adverse effects associated with prescription stim-

ulants include increased blood pressure, irregular heartbeat, seizure, psychosis, paranoia, de-

pendence, and overdose (e.g., National Institute on Drug Abuse [(NIDA], 2018), and the risk of

adverse events may be pronounced in adults (e.g., Westover & Halm, 2012). As such, addressing

misuse and diversion among college students with and without a prescription on college campuses

is warranted.

To date, three published interventions have aimed to address prescription stimulant misuse.

Interventions led by Looby and colleagues (2013), Stock and colleagues (2013), and LaBelle and

colleagues (2020) targeted students and focused solely on misuse. Strategies employed included

expectancy modif‌ication (Looby et al., 2013), psychoeducation on poor academic and health

outcomes associated with misuse (Stock et al., 2013), and implementation of a theory-guided

communications campaign (LaBelle et al., 2020). Although these interventions had impact on

precursors to behavior, none were successful in inf‌luencing actual misuse. LaBelle and colleagues

(2020) attributed their limited impact, in part, to not addressing diversion (a focus that was also

omitted from the two preceding interventions). This explanation is in line with prior research by

DeSantis and colleagues (2008), who suggested targeting diversion may be the most effective way

to minimize misuse. The research team (DeSantis et al., 2008) also noted the potential of policy

change (i.e., related to monthly prescription allotments) to address both diversion and misuse.

Given the limited impact of these person-level interventions, their focus solely on misuse, and

their lack of attention to the broader contexts in which these behaviors occur, there is a need to

better understand the inf‌luence of upstream (i.e., factors beyond the individual-level) efforts on

both misuse and diversion.

Ecological theories of health behavior are an ideal resource when aiming to identify upstream

approaches to behavior change. For example, the Theory of Triadic Inf‌luence (TTTI; Flay, Snyder,

& Petraitis, 2009) is a meta-theory that posits behavior is inf‌luenced by factors that fall within

three streams of inf‌luence (i.e., Intrapersonal, Social Situation, and Cultural Environment) and

three levels of causation (i.e., ultimate, distal, and proximal). As suggested by the TTI’s ultimate-

level of the Cultural Environment stream, policies, programs, and practices at both the campus-

and state-levels have the potential to better deter the co-occurring behaviors of prescription

stimulant misuse and diversion. To date, however, these approaches have yet to be fully examined

for their inf‌luence on prescription stimulant misuse and diversion (Faraone et al., 2020).

To deter prescription stimulant misuse and diversion, state-level policies have been im-

plemented and guided by availability and deterrence theories (Ross, 1984;Rush & Gliksman,

1986). Availabilitytheory sugges tsstrategi esthat restrict access to prescription stimulants (e.g., by

reducing the ease with which students can obtain prescriptions) should be effective. Deterrence

586 Journal of Drug Issues 52(4)