• Diversion;
  • Medication Adherence;
  • Opioids;
  • Prescription Analgesics;
  • Young Adults


Objectives.  To understand the extent to which medication adherence was related to diversion of prescription analgesics.

Design.  Cross-sectional analyses of data from the College Life Study, a prospective study of young adults.

Setting.  Participants were originally sampled as incoming first-time first-year college students from one large public university in the Mid-Atlantic United States.

Participants.  One hundred ninety-two young adults aged 21–26 who were prescribed an analgesic to treat acute pain in the past year.

Outcome Measure.  Diversion of prescription analgesics. The study tested two competing hypotheses: 1) individuals who skip doses (under-users) are at greatest risk for diversion because they have leftover medication; and 2) individuals who over-use their prescriptions (over-users) are at greatest risk for diversion, perhaps because of a general propensity to engage in deviant behavior.

Results.  Fifty-eight percent followed physician's instructions regarding their prescription analgesic medication; 27% under-used their prescribed medication and 16% over-used their prescribed medication. Twenty-seven percent of the total sample diverted their medication, with over-users being the most likely to divert (63%). Holding constant demographic characteristics and perceived harmfulness of nonmedical use, over-users were almost five times as likely as adherent users to divert analgesic medications (P < 0.05).

Conclusions.  Further research is needed to better understand the relationship between adherence and diversion. If these findings are replicated, physicians who are involved in pain management for acute conditions among young adults should take steps to monitor adherence and reduce diversion of prescription analgesics.