The prevalence and correlates of prescription stimulant diversion in a large, multi-institutional, cross-sectional sample of US post-secondary students regularly taking prescription stimulants.

Abstract

Prior studies on past year prescription stimulant diversion (PSD) have used small samples with limited representation and generated a wide range of estimates for PSD. This study aimed to estimate the prevalence and identify correlates of PSD using a large, multi-institutional sample of post-secondary students in the United States. Secondary analysis of a cross-sectional survey administered to either random or census samples (i.e. a random subset or all students, respectively) across 196 post-secondary institutions in the United States during the 2023-2024 academic year. The non-representative sample included 4771 post-secondary students who (a) were aged 18-25, (b) reported taking a prescription stimulant regularly during the past year with or without a prescription and (c) answered a question about stimulant diversion. The mean age was 20.8 years (standard error = 0.05), and most students were female (60.7%), White (71.7%) and heterosexual (50.1%). The weighted prevalence of past-year PSD was calculated from a self-report question. Demographic, socioeconomic, educational, substance use and service characteristics were examined for association with PSD. Of 4771 students, 207 reported PSD (4.3%). In the multivariate regression model, PSD was associated with prescription stimulant misuse versus no misuse [adjusted odds ratio (aOR) = 4.02, 95% confidence interval (CI) = 2.32-6.99], binge drinking in the past two weeks versus no binge drinking (aOR = 1.57, 95% CI = 1.02-2.43) and use of other substances in the past 30 days versus no use (aOR = 4.94, 95% CI = 2.58-9.45, Ref = no past 30 day substance use). Receiving the prescription from a campus clinic versus any other source was also associated with PSD (aOR = 1.94, 95% CI = 1.04-3.63). Age, sex at birth, sexual orientation, race, Grade Point Average (GPA), fraternity or sorority affiliation, degree level, housing and receiving the stimulant from a psychiatrist were not associated with PSD. The prevalence of prescription stimulant diversion in a multi-institutional sample of post-secondary students in the United States was 4.3%, lower than prior estimates. Certain substance use behaviors and obtaining the prescription from a campus clinic were associated with prescription stimulant diversion.