'Sorry, I don't give away my medication': an examination of refusals todivert stimulant medication.

Background: Prescription stimulant misuse is a common illicit behavior on college campuses and is fueled, in part, by prescription stimulant diversion (PSD), which involves giving away, selling, or trading one's medication. Being approached for one's medication predicts PSD; however, no research has examined resistance strategies used by prescribed students in the real world. Method: We analyzed open-ended responses from students who refused a medication request in a 6-month randomized, controlled trial focused on preventing PSD ( Results: We identified four strategies consistent with prior literature: explanations (49%), excuses (22%), direct refusals (17%), and alternatives (6%) and one novel but uncommonly used strategy: non-response (i.e., deflecting/ignoring) (6%). Chi-square tests showed that treatment and placebo did not differ in use of strategies perceived to be more effective; however, students who consistently (vs. inconsistently) used these strategies had a lower risk of any PSD at 6 months. Most students (70-71%) reporting PSD also refused a medication request and a t-test showed these students were approached more often. Conclusions: Students largely use strategies perceived as effective for resisting stimulant requests; nonetheless, most students who divert also resist requests, suggesting these behaviors are not mutually exclusive. Interventions that encourage consistent use of explanations, direct refusals, and alternatives may curb PSD. Registered on ClinicalTrials.gov on 05/12/2021: NCT04885166.