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

participants will note how many times they have engaged in diversion (i.e., giving away, selling, or trading one's prescribed medication)

Intentions to divert stimulant medication were assessed with two questions from the Behavior, Expectancies, Attitudes and College Health Questionnaire (Bavarian et al., 2013) adapted to address diversion: "How likely is it that you will give away, [or sell, trade] your stimulant medication in the next three months?". These questions had a four-point response scale (1=very unlikely, 4=very likely). Responses were summed and ranged from 2-8, with 8 indicating the greatest intention to divert (worse outcome).

participants will indicate any instances of (a) using alternative routes of administration, (b) taking more than your recommended dose, (c) taking someone else's stimulant medication, (d) taking your stimulant with other drugs in order to experience intoxicating effects, or (e) intentionally getting high on your prescribed stimulant medication?

We will assess the usefulness, information quality, and interface quality of the simulation using the 13-item Post-Study System Usability Questionnaire. A mean score of 1 indicates lowest level of satisfaction, while a mean score of 7 would indicate the highest level of satisfaction.

Participants will respond to 15 items related to the perceived usefulness, user control, and impact of the simulation/placebo. A mean score of 1 would indicate the lowest level of perceived usability; a mean score of 5 would indicate the highest rating of usability.

Booster session #1 is delivered via a slide deck and reviews the key points from the slideshow they viewed at the beginning of the study. Then, participants have to answer 5 questions related to the content. We assess engagement in the online booster session #1 on a 0-5 scale by summing the number of correct answers to the five comprehension questions embedded in the online booster. Each correct item receives one point. Scores ranged from 0 to 5, with 5 indicating the most engagement and accurate understanding of the content.

Booster session #2 is delivered via a slide deck and reviews the key points from the slideshow they viewed at the beginning of the study. Then, participants have to answer 5 questions related to the content. We assess engagement in the online booster session #2 on a 0-5 scale by summing the number of correct answers to the five comprehension questions embedded in the online booster. Each correct item receives one point. Scores ranged from 0 to 5, with 5 indicating the most engagement and accurate understanding of the content.

Participants will rate their confidence to (1) resist giving away their medication, (2) resist selling their medication. These responses, each given on a 5-point scale, were summed and scores ranged from 2 to 10, with 10 indicating the highest level of self-efficacy.

At the 3- and 6-month follow up, participants were asked to describe, through an open-ended response, how they responded if they were approached to give away, sell, or trade their medication since the last assessment. The data provided below is the count of participants who provided an open-ended response.

Participants will indicate, on a scale from 0-100, the percentage of students they believe give away, sell, or trade their prescribed stimulant medication.

Participants will indicate, on a scale from 0-100, the percentage of students they believe use stimulant medication in a way it was not prescribed.

We will assess perceived legal risks associated with prescription stimulant diversion. We will assess perceived harm from non-medical prescription stimulant use and medical misuse by asking: "How much do people risk harming themselves (physically or in other ways) if they "take stimulants non-medically?" or "use their prescription in a way a prescriber did not intend? Scores ranged from 5 to 20, with higher scores indicating greater perceived risk (better outcome).

Number of times participants communicated with their prescriber regarding their adherence to their prescription and any concerns they have regarding the dose, frequency of administration, and/or side effects in past 90 days. Responses ranged from 0 to 8, with higher scores denoting more communication with a prescriber (better outcome). (Investigator-generated scale)

Participants will note whether they experienced any accidental injuries in the prior 6 months (e.g., car accidents, burns, etc.).

Participants will report any occasions of marijuana, cocaine, heroin, methamphetamine, or hallucinogen use, or other prescription drug misuse in the previous 90 days.

Using the Impairment Rating Scale, participants reported on the extent to which they experienced problems in social, academic, familial, and vocational circumstances. Responses options ranged from 1=not at all to 7=extreme problem and were averaged to yield an overall impairment score (Range 1-6.25). A lower score indicates less impairment (better outcome), whereas a higher score indicates more impairment (poorer outcome).

Participants reported on the frequency with which they engaged in 11 problem behaviors before age 18 (0=never, 1=once, 2=twice, 3=three times, 4=more than three times). This scale was adapted from Johnson (1995). Consistent with Garnier (2008), we counted less severe items (e.g., lied, broke rules) as a "1" when rated at least a four. More severe items (e.g., hurt another physically, used a weapon, set a fire) had to occur >2 times to be counted towards the total score. The minimum score was a 0, the maximum an 11.