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

通过基于网络的模拟干预防止处方兴奋剂转移和药物滥用

• 批准号: 9895462
• 负责人: Laura Holt
• 金额: $ 24.49万
• 依托单位: TRINITY COLLEGE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9895462
• 关键词: Academic achievement; Accidental Injury; Acquaintances; Adderall; Address; Adult; Advanced Practice Nurse; Alcohol or Other Drugs use; Area; Attention deficit hyperactivity disorder; Awareness; Behavior; Behavioral; Benzodiazepines; Cardiovascular system; Communication; Computer Simulation; Computers; Consumption; Counseling; Development; Dose; Drug Prescriptions; Emergency department visit; Evidence based intervention; Exposure to; Feedback; Friends; Goals; Headache; Health; Health Personnel; Healthcare; Human Resources; Injury; Insurance Carriers; Intervention; Knowledge; Lead; Learning; Medical; Mental Health; Moods; Morbidity - disease rate; National Institute of Drug Abuse; Online Systems; Opioid; Participant; Perception; Pharmaceutical Preparations; Physiological; Placebos; Planning Theory; Prevalence; Prevention strategy; Preventive Intervention; Privatization; Provider; Psychiatrist; Randomized Controlled Trials; Reporting; Research; Resistance; Risk; Risk Factors; Route; Self Efficacy; Site; Sleeplessness; Strategic Planning; Students; Substance Use Disorder; Symptoms; Testing; Time; addiction; base; behavior change; college; conduct problem; cost; cost effective; disability; drug misuse; effective intervention; emerging adult; epidemiology study; evidence base; follow-up; high risk; illicit drug use; innovation; innovative technologies; intervention effect; intervention participants; medication compliance; medication nonadherence; misuse of prescription only drugs; nonmedical use; pediatrician; peer; prevent; primary outcome; psychologic; psychological outcomes; randomized controlled design; response; satisfaction; secondary outcome; sex; side effect; simulation; skill acquisition; skills; social cognitive theory; stimulant misuse; stimulant use; symptom management; therapy design; university student; vehicular accident; virtual coach; virtual human

PROJECT SUMMARY College students misuse and divert (i.e., give away, sell, or trade) prescription stimulants more often than any other class of prescription drugs (e.g., opiates). Half or nearly half of college students with prescriptions divert their stimulant medication, and a similarly high percentage misuse their medication (e.g., higher doses, via different routes of administration, etc.) 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 and is associated with other illicit drug use, lower grade point average, insomnia, irritability, headaches, and cardiovascular complications. Diversion also perpetuates medical misuse of stimulants among students with prescriptions, which is associated with poorer ADHD symptom management and may increase the risk for addictive disorders. Despite the fact that nearly 9 out of 10 students obtain prescription stimulants from a friend or acquaintance with a prescription, 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, we 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. Our intervention, which is grounded in social learning theory, the theory of planned behavior, and our preliminary research, 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. Our primary aims are to determine if the intervention reduces diversion, intentions to divert, and medication misuse, and to assess user satisfaction with the intervention. Our 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. Our study responds to PA-17-775, which calls for pilot testing of innovative technology for disseminating effective preventive interventions. It also aligns with NIDA’s Strategic Plan, which encourages the development of preventive interventions that target risk factors for substance use disorders. If effective, the intervention could be readily and widely disseminated to college counseling centers, psychiatrists/APRNs, and pediatricians.

项目摘要 大学生滥用和转移（即放弃，出售或交易）处方兴奋剂比任何人都要多 其他类别的处方药（例如操作学）。有处方的大学生的一半或一半 它们的刺激性药物和类似的高百分比会错过药物（例如，较高剂量，通过 不同的管理途径等）或使用别人的处方。转移可能会导致学生走 无需药物来减轻症状，增加其无意伤害的风险和 使用物质。此外，转移使处方兴奋剂（NMUP）的非医学使用永久使用，该使用 在大学生中已经变得越来越普遍，并且与其他非法药物使用相关，较低 平均成绩，失眠，烦躁，标头和心血管并发症。也转移 在有处方的学生中延续了对兴奋剂的医学失误，这与较差有关 多动症症状管理，可能会增加累加症的风险。尽管事实几乎 十分之一的学生中有9名从朋友那里获得处方兴奋剂或以处方的方式收购， 没有针对大学生兴奋剂转移的循证干预措施。存在 接受药物治疗是转移的关键危险因素，药物不遵守和 相信NMUP和转移比它们更普遍。根据这项多站点研究，我们将 对300名具有当前兴奋性处方的成年人进行随机对照试验 检查单节，基于计算机的模拟干预的初步效率和可行性 （有两个助推器会议）防止处方刺激性转移和药物失误并进行比较 达到安慰剂条件。我们的干预措施是基于社会学习理论，是计划的理论 行为和我们的初步研究，独特地吸引了学生与虚拟的互动讨论 人类（a）了解NMUP和转移及其相关风险的实际患病率，（b）实践 在高风险情况下使用拒绝策略时，使用拒绝策略，（c）了解如何 有效地与处方者沟通并避免滥用药物。我们的主要目的是确定是否是否 干预措施减少了转移，转移和药物的意图，并评估用户满意度 进行干预。我们的次要目的是检查针对目标的潜在作用机理的变化 干预措施（例如自我效力抵抗转移，都知道转移和nmups）的使用 行为策略，以抵制对药物的要求和处方者的沟通。我们的研究 响应PA-17-775，它呼吁对创新技术进行试点测试以发射有效 预防性干预措施。它还与NIDA的战略计划保持一致，这鼓励了 针对物质使用障碍的危险因素的预防干预措施。如果有效，干预可以 容易被广泛传播到大学咨询中心，精神科医生/APRN和儿科医生。