Share now, pay later
Family physician Mary Frank couldn’t understand why one elderly patient with high-blood pressure wasn’t responding to his medication. She had been steadily increasing his dose, but his blood pressure remained unstable.
Finally, the man admitted he had been sharing his pills with his wife. He also would stop taking his medication a few days before his appointment hoping his blood pressure would be higher so that he and his wife could then split a higher-dose drug.
But the practice put the couple at risk of a stroke or heart attack. “This is not something people should take lightly. It’s truly dangerous and frustrating,” said Frank, of Rohnert Park, Calif.
When it comes to prescription medications, many people embrace the adage to share and share alike. Armed with good intentions and largely unaware of the dangers, they gladly hand over leftover antibiotics, asthma inhalers, antidepressants, insulin and pain pills. After all, if the drugs worked for them, then perhaps they’ll help similarly suffering family members, friends or colleagues. And, considering the drugs’ expense, throwing away excess, out-of-date or ineffective pills can seem like a waste.
Some consumers even appear to be sharing medications for prolonged periods of time out of necessity. With the costs of drugs and medical care rising, they have trouble paying for their own prescriptions or the doctor visits required to obtain them.
Researchers say those most likely to share prescription drugs are the poor and the elderly, as well as family members who have a common chronic illness, such as diabetes.
“If you ask people why they are doing this, they say they have no other option,” said Chien-Wen Tseng, an assistant professor at the University of Hawaii who has studied the ways people deal with rising prescription drug prices. “To many of them, it’s better than not taking the medication at all.”
Such cost-saving tactics have not been extensively studied, but dozens of interviews with researchers, doctors, pharmacists and senior centers in California and across the country suggest the problem is growing.
Moreover, the number of pills that can be shared is multiplying; almost half of Americans take a prescription drug and 17% take three or more. The dangers of sharing medications may be overlooked, experts say, by a public overly confident in its ability to self-medicate -- a perception amplified by the dramatic rise in direct-to-consumer pharmaceutical advertising in recent years.
When the AARP asked seniors last fall about sharing medications, about 4% of Medicare beneficiaries -- or nearly 1.7 million people -- said they had shared prescription medications with family and friends in the last year. By comparison, in a smaller 2002 study, UCLA found that 2% of people shared medications.
Doctors say many patients don’t acknowledge sharing medications because they fear they’re breaking the law -- in some cases they may be -- and many suspect the number may be higher.
Although no one tracks adverse events caused by drug sharing, adverse drug reactions overall are responsible for up to 7% of hospital admissions. In some circumstances, sharing drugs can be extremely dangerous because one of the people taking the drug hasn’t been seen by a physician to determine if he or she indeed needs the drug, what dosage, or possible allergic reactions.
“It’s possible that people are ending up in the hospital and even dying from [sharing prescriptions],” said Dr. Stephen Soumerai, director of drug policy research at Harvard Medical School.
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A growing trend
Dr. Yehuda Handelsman, a Tarzana endocrinologist, estimates that as many as 15% of his diabetes patients share diabetes drugs or other medications with family members to save on costs, something he saw only “rarely” a few years ago.
In Beverly Hills, internist David Alessi said he sees up to “several patients a month” who are sharing medications. Last month, a 42-year-old man came to his office after using his wife’s leftover antibiotics from a foot infection to treat his sinus infection for two weeks. By the time the patient arrived, the infection had spread into his eye socket and showed signs of moving into his brain, a potentially deadly scenario. (He’s now on an aggressive antibiotics regimen and is expected to survive.)
Teenagers are also likely to give and take others’ medications. A report from the Centers for Disease Control and Prevention in 2003 found that 20% of girls and 13.4% of boys share medications with friends, although cost wasn’t usually the motivation. Many share sleeping pills and acne medication such as Accutane, the report found. Sharing Accutane is extremely worrisome; the drug is believed to cause birth defects, and girls and women of child-bearing age are supposed to take a birth control pill while taking the medication.
The risks of prescription-sharing vary dramatically depending on the user and the medication.
For example, although some users might think all blood pressure medications are the same, doctors choose from among dozens of varieties depending on the patient’s weight, medical history and other diseases. Taking high blood pressure medication improperly can lead to strokes, heart attacks and heart failure.
People with diabetes, likewise, may need different drugs; some drugs can be safe for some users, but cause potentially dangerous allergic reactions in others. Those who take too little or too much of a diabetic drug can risk going into insulin shock or damage their liver. Giving antidepressants to someone who seems depressed but is actually manic depressive can worsen the disorder. And many patients, of course, may not realize how one drug could interact with others they are taking.
More broadly, antibiotic-sharing not only fuels overall resistance levels to the drugs, but it can also increase the chances of a lingering individual infection. “It’s hard to convince people, but this is like driving 90 mph in a 25 mph zone,” said Handelsman of Tarzana.
The Food and Drug Administration generally forbids the redistribution of prescription drugs once they have been dispensed to consumers, but states can supplement that with their own regulations.
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Making costs bearable
Although many patients are reluctant to talk with their physicians about drug costs, doctors and patient advocates say that’s where cost-cutting begins. If patients ask, doctors may be willing to prescribe generic medications or double-dose pills that can then be split in half. Some people may qualify for federal or state assistance or one of the pharmaceutical companies’ assistance programs, which can often be accessed through local senior centers or on the Internet.
In March, the industry trade group Pharmaceutical Research and Manufacturers of America pledged $10 million to create a clearinghouse (www.Rxhelp4ca.org) that directs Californians to 350 drug programs run by manufacturers, nonprofits or governments.
The California state legislature is debating whether to compel drug companies to offer heavily discounted drugs to people with incomes up to four times the federal poverty level, or $38,280 for an individual. And the upcoming Medicare drug benefit may alleviate some costs for seniors, although many people will still have large drug bills.
Alessi, of Beverly Hills, said doctors must become more vigilant about asking patients if they’re sharing medications, even if they don’t have any reason to suspect a patient is doing it. “You feel badly for people who can’t afford to fill their prescriptions,” he said. “But people need to trust us that this isn’t the solution to their problems.”
