Epic morbidity and mortality, and intractability make prescription opioid diversion a wicked problem. Meanwhile, college undergraduates are vulnerable to opioid misuse and its consequences. The purpose of this quantitative study was to assess U.S. undergraduate students' opioid misuse and the relationship between mediating factors. The study's theoretical framework rested on Wakeland's et al. opioid system model and Shaw and McKay's social disorganization theory. This study bridged the gap, measuring collective efficacy and testing its relationship to undergraduate decisions to regulate misuse. Thus, research questions focused on gauging the problem's scope and assessing relationships between factors that drive or potentially regulate diversion. The Campus Opioid Diversion Survey, designed for this study, was administered to a nonrandom, undergraduate survey panel (N = 434), revealing past year opioid misuse at 6.9% and heroin use at 2.9%. While a chi-square test revealed no significant relationship between motives and sources for misuse, significant relationships were found between filling a prescription for opioids and misuse, between opioid and heroin use, and between observing the negative consequences of misuse and social action. An independent samples t-test showed a significant relationship between collective efficacy and social action. Findings show campus diversion remains an emerging health and safety issue, but that collective efficacy indicates a capacity for regulation. Anticipating misuse, public safety stakeholders should complement responses to diversion schemes with continuous assessment, communications that empower student-citizens, and focused promotion of social cohesion that will fuel mitigation via social action aimed at social change.