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

Background and aims 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. Design and setting 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. Participants 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%). Measurements 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. Findings 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. Conclusions 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.