Prescription Medication Sharing: A Systematic Review of the Literature

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. A previous review article pointed out the negative consequences of medicine sharing, such as unanticipated adverse events, complications of incorrect use, delay in seeking professional help, antibiotic resistance, and addiction or misuse related to the addictive properties of some medications,^[2] but empirical research is limited.

Medication sharing has 2 distinct types; recreational and nonrecreational. Recreational sharing is the sharing of abusable prescription medications to get high, to relax, or for experimentation. Nonrecreational sharing is the sharing of any prescription medication for medical use or altruistic reasons.^[3] Both represent nonprescribed use of medication.

Past research on medication sharing has tended to focus on recreational sharing.^[4–10] Nonrecreational sharing has not received much research attention,^[2,3] and little information describing prevalence and practices of nonrecreational sharing has been published. Moreover, no previous systematic review has attempted to reveal the types of medicines shared, determinants of nonrecreational sharing, and consequences of sharing practices.

Researchers have reported a correlation between sociodemographic variables and prescription medicine diversion practices (i.e., trading, selling, or sharing of prescribed medicines).^[5,7,10,11] By and large, adolescent girls are more likely than adolescent boys^[7] and younger adults are more likely than older adults^[10] to share medications. Lower socioeconomic status and having drug addiction problems are also positive predictors of receiving medicines from others.^[10] Furthermore, disparities in health care access and utilization have been noted among ethnic groups,^[12,13] and these can lead to sharing of prescription medicines. Medicine sharing could also be driven by inappropriate self-treatment,^[14,15] and it is also possible that inappropriate drug information on the Internet inspires inappropriate self-treatment and sharing of prescribed medicines.

A systematic review of prescription medicine sharing could be useful in several ways for health planners, health care practitioners, and patients. For instance, understanding the determinants of sharing behaviors could aid in the development of specific interventions and targeted educational messages about safe medication use for patients. Moreover, the findings could help drug regulatory authorities and pharmaceutical companies to design messages targeted at reducing the risks of medicines sharing, for example, in product packaging, advertising and promotion, or public awareness campaigns.

We conducted a systematic review of the available literature on nonrecreational prescription medication sharing. Our objectives were to

1. identify the sources and types of medicines shared,

2. investigate determinants of medication sharing,

3. identify reasons for sharing prescription medicines,

4. explore the positive and negative consequences of medication sharing, and

5. explore the impact of medication sharing on the patient–health care provider relationship.

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