Prescription Medication Sharing: A Systematic Review of the Literature

Kebede A. Beyene, MSc; Janie Sheridan, PhD; Trudi Aspden, PhD

Am J Public Health. 2014;104(4):e15-e26.

Abstract and Introduction

Abstract

We reviewed the literature on nonrecreational prescription medication sharing. We searched PubMed, EMBASE, PsycINFO, and a customized multidatabase for all relevant articles published through 2013; our final sample comprised 19 studies from 9 countries with 36 182 participants, ranging in age from children to older adults, and published between 1990 and 2011.

The prevalence rate for borrowing someone's prescription medication was 5% to 51.9% and for lending prescription medication to someone else was 6% to 22.9%. A wide range of medicines were shared between family members, friends, and acquaintances.

Sharing of many classes of prescription medication was common. Further research should explore why people share, how they decide to lend or borrow, whether they are aware of the risks, and how they assess the relevance of those risks.

Introduction

Medication sharing is defined as the lending or borrowing of prescription medications where the recipient of those medicines is someone other than the person for whom the prescription is intended.^[1]In other contexts, "lending" and "borrowing" imply a temporary transfer that will be returned, but these terms are used loosely in the literature regarding prescription medications, which are often not replaced into the supply of the person to whom the medication was prescribed.

Abstract and Introduction
Methods
Results
Discussion
References

Table 1. Customized Multidatabase Search for Systematic Review of Studies of Nonrecreational Prescription Medication Sharing
Database	Type
Australasian Medical Index	Index
Google Scholar	Search engine
International Pharmaceutical Abstracts	Index
ProQuest Central	Index
Psychology and Behavioral Sciences Collection	Index
ScienceDirect	Index
Scopus	Index
Springer	Electronic journals and books
DRUG	Index
ABI/INFORM Complete	Index

Table 2. Summary of Studies in Systematic Review of Nonrecreational Prescription Medication Sharing
Study (Year of Publication)	Location	Design	Sample Size, No.	Response Rate, %	Type of Shared Medicines	Reported Reasons/Sources	Recommended Interventions
Hogan et al. (1990)¹⁷	University hospital, Saskatoon Saskatchewan, Canada	Cross-sectional survey with one-on-one interviews of randomly selected dermatology outpatients with diverse sociodemographics	114	NR	Topical corticosteroids, topical antifungals and antibiotics, oral antibiotics, topical antiacne medications, crotamiton cream, codeine with acetylsalicylic acid	Got from family members or friends	Asking patients with cutaneous disorders about previous use of medications from all sources while delivering care
Anglin and White (1999)¹⁸	Community health clinic and other settings in rural eastern Kentucky	Ethnographic research: interviews with health and social workers and nonprofessional staff and observation of clinic	16	NA	Not specified	Ran out of medications, obtained from another person or health care provider, lacked money to pay for prescribed medications, to make prescriptions last longer, self-medication, got medicines through social networks	Close monitoring of medication use by health care providers, educating patients through pharmacy and nurses, reducing poverty and improving medication access, tightening communication between physicians and pharmacists to reduce overprescribing and leftover medicines
Thompson and Stewart (2001)¹⁹	Metropolitan areas of Melbourne, Australia	In-home interviews with noninstitutionalized persons aged ≥ 65 y	204	87	Central nervous system and musculoskeletal agents; genitourinary agents; alimentary, cardiovascular, respiratory agents; NSAIDs	Ran out of medications, person asked to share medication, forgot own medication, to try the medication	Promoting pharmacy collection of unwanted medicines from customers
Daniel et al. (2003)¹	United States	Analysis of data from Youthstyles (mail survey of respondents aged 9–18 y)	1568	52	NR	Got from family members, leftover medicines; had prescription for same medicine; had the same medical problem as the person who had the medicine; wanted something strong for pimples or oily skin; ran out of medications; emergency; cost; needed for pain, headache, or sleep; wanted to relax or feel good; influenced by advertising	Educating girls and their parents about the need to take medication safely, targeting educational messages to adolescents on safe use of medications
Sorensen et al. (2003)²⁰	Australia, 4 states	Cross-sectional survey (researcher-administered questionnaires) of community-dwelling, older war veterans and widowers at risk for medication misadventures and living in their own homes	1086	NR	NSAIDs, COX-2 inhibitors, benzodiazepines, cardiovascular medications, H-2 antagonists and proton pump inhibitors, codeine or dextropropoxyphene combinations, paroxetine, thyroxin sodium, warfarin, α-2 receptor agonists (inhalers), latanoprost, quinine, allopurinol, bethamethasone (ointment), diphenoxylate with atropine sulfate, prochlorperazine	Shared with spouse	NR
Hamrosi et al. (2006)²¹	Community health centers and hospitals in midwestern New South Wales, Australia	Qualitative in-depth interviews with Aboriginal health workers	11	NA	Not specified	Shared between family and friends	Providing education that considers community culture and giving appropriate and adequate education training for Aboriginal health workers
Goldsworthy et al. (2008)²²	United States, 20 cities	Cross-sectional survey (one-to-one interviews), of respondents aged 12–44 y, with diverse sociodemographic characteristics	700	NR	Allergy medications (e.g., Allegra, Claritin), pain medications (e.g., Darvoset, OxyContin), antibiotics (e.g., amoxicillin, doxycyclin, Bactrim/Septra), mood medications (e.g., Paxil, Zoloft, Valium, Ritalin), acne medication (e.g., Accutane), birth control pills	Got from family members; had leftover medicines; had prescription for same medicine; had the same medical problem as the person who had the medicine; wanted something strong for pimples or oily skin; ran out of medications; emergency; cost; needed for pain, headache, or sleep; wanted to relax or feel good; influenced by advertising; got from someone who knew about medications; helped a friend	NR
Petersen et al. (2008)²³	United States	Analysis of data from 2001– 2006 US Healthstyles survey (cross-sectional mail survey of individuals), with emphasis on women of reproductive age (n = 7400)	26 289	72.2	Allergy medications, pain medications, antibiotics, mood medications, birth control pills, acne medications	Got from family member; already had prescription but ran out; had the same medical problem as the person who had the medicine; needed for pain, headache or sleep; emergency; had leftover medicines; cost; wanted to relax or feel good; wanted something strong for pimples or oily skin; influenced by advertising	Discussing the risk of sharing with the patient during prescribing, designing programs to promote safe disposal of unwanted medicines, ensuring access to health care and medications for women of reproductive age
Goldsworthy and Mayhorn (2009)²⁴	United States, public spaces of 11 urban and suburban areas	Cross-sectional survey (one-on-one interviews) of demographically diverse adolescents aged 12–17 y	594	NR	Allergy medications, pain medications, mood medications, antibiotics, acne medications, birth control pills	To avoid health care provider visit	Providing training to health care providers on the risk of borrowed medications and educating patients on the proper use of medications and risks of sharing; developing messages on sharing, e.g., within product label; public awareness campaigns
Mayhorn and Goldsworthy (2009)²⁵	United States, 11 locations across country	Cross-sectional survey (one-on-one interviews) of demographically diverse individuals	2773	NR	Allergy medications (e.g., Zyrtec, Clarinex, Flonase), pain medications (e.g., Darvoset, OxyContin), antibiotics (e.g., amoxicillin, doxycyclin, Bactrim/Septra), mood medications (e.g., Paxil, Zoloft, valium, Ritalin), acne medication (e.g., Accutane), birth control pills	NR	Increasing public awareness on medication sharing dangers, adding sharing prohibition messages to labeling, providing training to health care providers
Ali et al. (2010)²⁶	Universiti Sains Malaysia	Cross-sectional survey (one-on-one interviews) of randomly sampled female students	481	90.7	Not specified	Got from family or friends, leftover medicines	NR
Goulding et al. (2011)²⁷	University College Cork, Ireland	Cross-sectional survey (anonymous electronic questionnaire) of students, aged 18–25 y	343	NR	Contraceptives, antibiotics, analgesics	Got from family or friend, cost, inconvenience of visiting doctors, didn't feel sick enough to see doctor	Educating about adverse drug events of medications, discouraging patients from sharing; advising patients to safely dispose of medications
Auta et al. (2011)²⁸	University of Jos, Nigeria	Cross-sectional survey (self-administered questionnaire) of randomly sampled students	730	81.6	Cold/flu medications, pain medications, antibiotics, dermatological medications, mood medications, antimalarials	Emergency, had the same medical problem as the person who had the medicine, influenced by advertising, ran out of medicines, got from someone who knew about medicines or from family members, leftover medicines	Educating public on danger of medication sharing
Goebel et al. (2011)²⁹	California, 2 hospitals and 6 affiliated community sites	Cross-sectional cohort study (one-on-one interviews), analysis of self-reported substance misuse for pain management among veterans	343	NR	NR	For pain management	NR
Ward et al. (2011)³⁰	New York, 4 clinical sites at an urban academic medical center	Cross-sectional survey (one-on-one interviews) of randomly sampled individuals aged ≥ 18 y	641	80	Opioids (Schedule II–IV), NSAIDs and COX-2 inhibitors, benzodiazepines, antibiotics, antihypertensives, others	Got from family members, friends, someone from street, or Internet; to get high, convenience, self-medication, cost	Regularly asking patients about medication use, cautioning patients about borrowing medications even if they deny the behavior
Ellis et al. (2011)³¹	Illawarra region, New South Wales, Australia	Mixed methods (focus group discussion followed by self-administered survey); convenience sample of independently living adults aged ≥ 65 y	focus group, n = 28; survey, n = 226	65	Antihypertensive, heart disease medications, arthritis or joint inflammation medications, strong pain medications, diabetic medications, depression/anxiety medications, antibiotics, others	Got from family members, ran out of medicines, forgot to fill prescriptions, severe pain, cost, could not go to chemist or doctor, self-medication, tried medication before visiting doctor, medication similar to previous prescription	NR
Kheir et al. (2011)³²	Qatar	Cross-sectional telephone interview with randomly sampled household representatives	49	18	Antidiabetic medications, anti-infective medications, inhaled bronchodilators, inhaled corticosteroids, oral corticosteroids	Shared with family members	NR
Hodgetts et al. (2011)³³	Central North Island, New Zealand	Focus group discussion with community health workers with heritage linkage with Māori people and employed by Māori tribal health provider	7	NA	Most prescription medications	Shared among family members and social networks, avoided visits to general practitioner/pharmacy, ran out of medications, obtained prescription medicines from general practitioner by presenting false proxy symptoms, cost, cultural barrier	Integrating medication-sharing concerns into training of health care providers
Kamutingondo et al. (2011)³⁴	Hamilton, New Zealand	Ethnographic research (interviews, photographs, diaries, mapping, material objects, and media content) among 4 Zimbabwean households	17	NA	NR	To demonstrate care among family members during illness, to sustain and nurture social relationship among households	NR

Note. COX = cyclooxygenase; NA = not applicable; NR = not reported; NSAID = nonsteroidal anti-inflammatory drug.

Table 3. Prevalence of Sharing in Quantitative Survey Studies in Systematic Review of Nonrecreational Prescription Medication Sharing
Studies	Sample Size, No.	Response Rate, %	Prevalence of Sharing			Recall Period
Studies	Sample Size, No.	Response Rate, %	Borrowing, No. (%)	Lending, No. (%)	Lending or Borrowing, No. (%)^a	Recall Period
Hogan et al.¹⁷	114	NR	20 (17.5)	7 (6.1)	NR	1 y
Thompson and Stewart¹⁹	204	87	14 (6.9)	26 (12.7)	NR	Ever
Daniel et al.¹	1568	52	212 (13.5)	171 (10.9)	210 (13.4)	Ever
Sorensen et al.²⁰	1086	NR	NR	NR	49 (5)	NR
Goldsworthy et al.²²	700	NR	188 (26.9)	160 (22.9)	236 (33.7)	1 y
Petersen et al.²³	26 289	72.2	6086 (23.2)	5065 (19.3)	7272 (27.7)	Ever
Goldsworthy and Mayhorn^24,b	594	NR	115 (19.4)	122 (20.5)	NR	1 y
Mayhorn and Goldsworthy²⁵	2773	NR	594 (21.4)	624 (22.5)	NR	1 y
Ali et al.²⁶	481	90.7	NR	NR	261 (54.3)	NR
Goulding et al.²⁷	343	NR	89 (26)	70 (20)	117 (34.1)	Ever
Auta et al.²⁸	730	81.6	379 (51.9)	127 (17.4)	385 (52.7)	1 y
Goebel et al.²⁹	343	NR	NR	NR	56 (16.3)	NR
Ward et al.³⁰	641	80	116 (18)	NR	NR	Ever
Ellis et al.³¹	226	65	10 (5)	12 (6)	NR	NR
Kheir et al.³²	49	18	NR	NR	NR	NR

Note. NR = not reported.
^aIf the rate of borrowing or lending was not provided by the authors, we calculated as No. of borrowers or lenders = No. lenders + No. of borrowers − (No. of both lenders and borrowers).
^bPart of larger study by Mayhorn and Goldsworthy.²⁵