Original article| Volume 68, ISSUE 4, P808-815, April 2021

Use of Stimulant Diversion Prevention Strategies in Pediatric Primary Care and Associations With Provider Characteristics



      Diversion of stimulant medications for ADHD is a prevalent problem. Pediatric primary care providers (PCPs) are well-positioned to reduce diversion risk among adolescents prescribed stimulants, but little is known about their use of prevention strategies. The objectives of this study were to describe the frequency with which pediatric PCPs use diversion prevention strategies and examine potential determinants (facilitators and barriers) of strategy use.


      Participants were pediatric PCPs (N = 76) participating in a randomized controlled trial of stimulant diversion prevention strategies. At baseline, before randomization, PCPs rated the frequency with which they used specific strategies in each of four categories: patient/family education, medication management/monitoring, assessment of mental health symptoms/functioning, and assessment of risky behaviors. They completed measures of attitudes toward diversion prevention, subjective norms (i.e., implementation climate), and perceived behavioral control (i.e., knowledge/skill, resource constraints). Associations between determinants and strategy use were tested with correlational and regression analyses.


      PCPs used strategies for assessing mental health symptoms/functioning most frequently and patient/family education strategies least frequently. Attitudes about the effectiveness of diversion prevention, implementation climate, knowledge/skill, and resource constraints were positively correlated with the use of at least one category of strategies. In regression analysis, PCP knowledge/skill was positively associated with patient/family education, medication management, and risk assessment strategies.


      Findings suggest that improving knowledge and skill may increase the use of diversion prevention strategies by PCPs. Identifying provider-level determinants of strategy use informs implementation efforts in pediatric primary care and can facilitate efforts to prevent stimulant diversion among adolescents.


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      Linked Article

      • Pediatric Primary Care Providers Play a Central Role in Reducing Stimulant Diversion
        Journal of Adolescent HealthVol. 68Issue 4
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          When used as prescribed, stimulant medications such as methylphenidate and amphetamine salts are safe, effective, and Food and Drug Administration approved for attention deficit hyperactivity disorder (ADHD) treatment [1]. At the same time, stimulant medications are also increasingly being used nonmedically. Recent epidemiological data suggesting that one in 20 high school seniors reports past-year nonmedical use (NMU) of a stimulant [2]. Unlike college student motives for perceived academic performance enhancement, motives for high school student stimulant NMU are more aligned with classic substance abuse motives (e.g., “get high”) and substance abuse correlates (e.g., binge drinking, cannabis use) [2].
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