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. 

In This Article


In close consultation with an expert librarian, we searched PubMed and the OvidSP databases EMBASE and PsycINFO for published articles on medicine-sharing practices. We selected these databases because they contain a wide range of both health (medical) and social science literature. To ensure the retrieval of all relevant research reports, we also conducted a customized multidatabase search (Table 1). We identified further articles by scanning the reference lists of all articles retained for eligibility testing and by using an advanced Google search. Databases varied in the dates of their earliest articles; we scanned all of them through March 31, 2013, and set auto-alerts on the same searches and followed up to August 15, 2013, to ensure the inclusion of the latest articles. However, we identified no relevant articles published after March 31.

We used the following MeSH terms, combined with Boolean operators: "prescription" AND ["medication" OR "medicine" OR "drug"] AND ["sharing" OR "borrowing" OR "lending" OR "loaning" OR "swapping"] AND NOT ["cost sharing" OR "needle sharing" OR "syringe sharing"]. To ensure automatic term mapping and explosion of MeSH terms, we did not use truncation or wild cards in the database searches. However, in advanced Google search, we conducted phrase searching by enclosing the phrases "medication sharing," "medication lending," "medication loaning," "medication swapping," and "medication borrowing" in double quotes. In all searches, we avoided the use of hyphens and abbreviations. To maximize the chance of finding relevant articles, we searched literature on both recreational and nonrecreational sharing and differentiated them by reading the abstracts.

To capture all relevant studies, we did not impose language, date of publication, age, gender, or type of article limitations or any other restrictions in database searches. However, we did not identify any relevant articles in languages other than English.

Inclusion and Exclusion Criteria

An article was eligible if (1) its main aim or a major theme was assessing nonrecreational sharing of medications; (2) it described a study that employed a well-defined method of measuring medication-sharing behaviors, or a verbatim description of sharing practices in the case of a qualitative study; (3) it clearly described the study's objectives, methods, and findings; and (4) it was a peer-reviewed research article or a conference abstract or proceeding. We excluded

  1. books, book chapters, personal communications, case reports, review articles, and commentaries;

  2. letters, if they did not report original or primary data;

  3. studies whose full text could not be retrieved;

  4. studies with a primary focus on sharing of over-the-counter medicines or recreational use of prescription medications; and

  5. unpublished research reports.

K. B. conducted the initial screening and assessment of the eligibility of retrieved articles, according to the predetermined inclusion and exclusion criteria. All authors independently assessed all articles retained for eligibility testing (Figure 1). We evaluated the eligibility of retrieved articles by reading the title and abstract; for articles whose eligibility could not be determined by these, we read the full text. Articles eliminated by reading titles concerned bank loans and were irrelevant to the review. We eliminated 3 studies because they reported both recreational and nonrecreational sharing, and the data were difficult to separate. In 1 instance, we resolved a disagreement on eligibility by discussion. We held a series of meetings to ensure the quality of the overall review process. Figure 1 is a flow diagram describing the selection procedure in detail, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).[16]

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram summarizing selection procedure for studies of nonrecreational prescription medication sharing.

Quality Assessment and Data Analysis

K. B. performed the initial quality appraisal and abstracted data for eligible articles with a data abstraction form we designed for this review. The other authors rechecked the data; we resolved disagreements through group discussion. We compared the setting, design, study population, sample size, response rate, findings, and recommended interventions of eligible studies.

The heterogeneity of the eligible studies rendered available validated systematic quality evaluation tools inappropriate. However, we evaluated the studies according to the following criteria:

  1. Did the study have a clear definition for medication sharing?

  2. Were the objectives of the study sound?

  3. Was the method used to measure sharing behaviors (in quantitative studies) appropriate?

  4. Was the data analysis technique appropriate?

  5. Was the study setting appropriate?

The studies in our review used qualitative, quantitative, and mixed-methods research designs; thus, statistical combination of eligible articles was not possible. Furthermore, the study settings, characteristics of participants, and data collection methods varied. The analysis process largely involved answering the preset review objectives. Table 2 displays the studies in chronological order to show the focus of medication-sharing research over time. As far as possible we followed PRISMA reporting guidelines.[16]