ARTICLE IN PRESS

Journal of Adolescent Health - (2009) 1–4

Adolescent health brief

Prescription Medication Sharing Among Adolescents: Prevalence,

Risks, and Outcomes
Richard C. Goldsworthy, Ph.D.a,*, and Christopher B. Mayhorn, Ph.D.b
a
The Academic Edge, Inc., Bloomington, Indiana
b
North Carolina State University, Raleigh, North Carolina
Manuscript received April 2, 2009, manuscript accepted June 16, 2009

Abstract We interviewed 594 adolescents throughout the United States. One in five reported sharing prescrip-
tion medication. Of these, less than half received instructions, many delayed professional care, few
informed providers, and a third reported experiencing side effects. Efforts to reduce medication
sharing prevalence and risks among adolescents may be justified. Ó 2009 Society for Adolescent
Medicine. All rights reserved.
Keywords: Prescription medication sharing; Loaning; Borrowing; Diversion; Prevlaence; Risks; Adolescents

Prescription medication sharing has received heightened Method

attention as a public health concern, with approximately
one-third of the U.S. population self-reporting this behavior
[1]. Several researchers have suggested diverse personal
and societal consequences associated with such sharing,
including exposure to side effects, delayed care, and
increased antibiotic resistance (Figure 1) [1–3]. Despite indi-
cations that adolescents are engaging in this potentially risky
behavior [1,4,5], few efforts have directly investigated
sharing among adolescents [1,2,4–7]. Boyd and colleagues
[8], for example, reported girls (27.5%) and boys (17.4%)
frequently gave away their abusable prescription medications
(i.e., sleeping, sedative or anxiety, stimulant, and pain medi-
cations). Poulin [7] reported that Canadian youth (n ¼ 13,
549) had given away (14.7%) or sold (7.3%) prescription
stimulants. Daniel and colleagues [5] found girls and young
women borrow (10%) prescription acne medication, a prac-
tice that entails teratogenic risk [9,10]. No studies to date,
however, have broadly examined prevalence of adolescent
prescription medication sharing, types of medications shared,
and consequences of such sharing. Our research specifically
examines a wider range of loaning and borrowing behaviors
and associated consequences among adolescents.
*Address correspondence to: Richard C. Goldsworthy, Ph.D., Academic
Edge, Inc., 108 E. 14th Street, Bloomington, Indiana 47408.
E-mail address: rick@academicedge.com
1054-139X/09/$ – see front matter Ó 2009 Society for Adolescent Medicine. All rights reserved.
doi:10.1016/j.jadohealth.2009.06.002
Prescription medication sharing behaviors and conse-
quences were assessed through interviews conducted in
malls, parks, and public streets in 11 U.S. urban and suburban
locations. Five hundred ninety-four (>50/location) demo-
graphically diverse adolescents aged 12-17 (mean ¼ 14.8,
SD ¼ 1.7) were approached individually, had the study ex-
plained to them, provided written consent, and were screened
for eligibility based on age. Eligible adolescents were inter-
viewed verbally in English or Spanish by field researchers
with experience in each recruitment location, and provided
a $10 gift certificate and a parental notification letter. Inter-
view questions were drawn from a previous study conducted
among adults, pilot tested among a small group of adoles-
cents, and modified. The following behaviors and conse-
quences were investigated:
1. Have you ever borrowed prescription medication?
2. Have you had ever loaned prescription medication?
Participants who indicated loaning or borrowing were
asked these questions:
1. Which kinds of medicine did you borrow (and which
did you loan)?
2. Did you receive (or provide) written or verbal warnings
and instructions?
3. Did you borrow medicine rather than visit a healthcare
provider?
4. Did you end up going to a doctor anyway?
 ARTICLE IN PRESS
2 R.C. Goldsworthy and C.B. Mayhorn / Journal of Adolescent Health - (2009) 1–4
Figure 1. Enhancement of original medication-sharing impact framework (adapted from Goldsworthy et al., 2008).
5. Did you tell the doctor about borrowing?
6. Have you experienced an allergic reaction or side
effect when borrowing prescription medications?
Descriptive statistics and inferential analyses were gener-
ated in SPSS (SPSS Inc., Chicago, IL).
Results
Loaning prescription medications
One in five participants (122 of 592, 20.5%) reported
loaning prescription medication (Table 1), with allergy medi-
cations and pain relievers most commonly loaned. Among
loaners, 47.5% reported providing printed instructions and
55.7% reported providing verbal instructions. Results did
not significantly vary by participant characteristics; however,
blacks were more likely to report loaning medication and
were specifically more likely to loan allergy medications or
birth control.
Borrowing prescription medications
Borrowing was similar to loaning: one in five (115 of 592,
19.4%) had borrowed prescription medication. Specific
medication borrowing rates mirrored those for loaning.
Half the borrowers reported receiving written and/or verbal
instructions or warnings at least once. Nonnative English
speakers were half as likely to report receiving verbal instruc-
tions. Borrowing did not vary by gender or age, blacks were
more likely to borrow allergy medications, and those who
spoke a language other than English were less likely to report
borrowing allergy medicines.
Impact on care
Seventy-four percent (74%) of borrowers reported doing
so rather than making an appointment with a healthcare
provider. Of these, 32.4% eventually visited a healthcare
provider for the unresolved problem, with young women
being more likely than men to do so. Forty percent of the
adolescents who visited providers after borrowing medica-
tions failed to mention the medication borrowing to the
provider (28 participants, 4.7% of the overall sample).
Finally, 37.4% of borrowers (43 participants overall) re-
ported experiencing a side effect.
Discussion
Approximately 20% of adolescents have shared prescrip-
tion medication. This is troubling, because sharing presents
a number of potential risks (Figure 1). Adolescents are
sharing antibiotics, which may exacerbate bacteriologic anti-
biotic resistance: neither those loaning nor those borrowing
are likely to have completed a full regimen. Adolescents
are sharing acne medication, a class of pharmaceutical that
includes a well-known teratogen. Previous findings
regarding adolescents’ sharing of abusable prescription
medications are confirmed [7,8]. Participants reported
frequently not providing or receiving instructions or warn-
ings. Such omission increases risk for incorrect medication
usage.
Three-fourths of participants borrowed to avoid a health-
care provider visit. A third of these participants reported
eventually visiting a provider because the borrowed medicine
did not resolve the initial problem. Avoided or deferred care
can lead to delayed diagnosis and treatment and potentially
increase sequelae, morbidity, and mortality. Patient disclo-
sure of medication borrowing was reported in less than
50% of the cases, indicating that providers may need to
specifically ask about borrowing. Finally, self-report of
side-effects was surprisingly high (almost two of five
borrowers).
All sites were urban and suburban, which limits generaliz-
ability. Nonetheless, this is an improvement over previous
Table 1
Prevalence of medication sharing behaviors and related outcomes
Gender Age Race Home Lang
Base No.(%) Total Male Female 12-14 15-17 Caucasian Black Hispanic Other^ English Other
Base No.(%) 594 (100) 289 (100) 305 (100) 249 (100) 345 (100) 293 (100) 129 (100) 123 (100) 49 (100) 501 (100) 83 (100)
Loaning Behaviors
Have you previously loaned prescription medicine(s)? 122 (20.5) 60 (20.8) 62 (20.3) 53 (21.3) 69 (20.0) 46 (15.7) 39 (30.2)* 24 (19.5) 13 (26.5) 108 (21.6) 12 (14.5)
Which types of medicine have you loaned?
Allergy medications (like Zyrtec, Clarinex, 33 (27.1) 17 (28.3) 16 (25.8) 15 (28.3) 18 (26.1) 12 (26.1) 16 (41.0)* 3 (12.5) 2 (15.4) 32 (29.6) 1 (8.3)
Flonase, etc.)
Pain medications (like Darvoset, Oxycontin, etc.) 29 (23.8) 12 (20.0) 17 (27.4) 10 (18.9) 19 (27.5) 14 (30.4) 8 (20.5) 3 (12.5) 4 (30.7) 26 (24.1) 2 (16.7)

R.C. Goldsworthy and C.B. Mayhorn / Journal of Adolescent Health - (2009) 1–4
Mood medications (like Paxil, Zoloft, Valium, 10 (8.2) 5 (8.3) 5 (8.1) 5 (9.4) 5 (7.3) 4 (8.7) 4 (10.3) 1 (4.2) 1 (7.7) 9 (8.3) 1 (8.3)
Ritalin, etc.)
Antibiotics (like Amoxicillin, Doxycycline, 14 (11.5) 6 (10.0) 8 (12.9) 4 (7.6) 10 (14.5) 5 (10.9) 4 (10.3) 1 (4.2) 4 (30.7) 12 (11.1) 1 (8.3)
Bactrim/Spectra, etc.)
Acne Medication (like Accutane) 14 (11.5) 9 (15.0) 5 (8.1) 6 (11.3) 8 (11.6) 7 (15.2) 7 (17.9) 0 (0) 0 (0) 14 (13.0) 0 (0)
Birth control pills 9 (7.4) 4 (6.7) 5 (8.1) 2 (3.8) 7 (10.1) 2 (4.4) 5 (12.8) 2 (8.3) 0 (0) 9 (8.3) 0 (0)
Have you provided printed instructions or warnings 58 (47.5) 28 (46.7) 30 (48.4) 26 (49.1) 32 (46.4) 20 (43.5) 20 (51.3)* 10 (41.6) 8 (61.5) 51 (47.2) 6 (50.0)

ARTICLE IN PRESS
when loaning?
Have you provided verbal instructions or warnings 68 (55.7) 35 (58.3) 33 (53.2) 31 (58.5) 37 (53.6) 26 (56.5) 21 (53.8) 11 (45.8) 10 (76.9) 60 (55.6) 6 (50.0)
when loaning?
Borrowing Behaviors
Have you previous borrowed prescription medicine(s)? 115 (19.4) 58 (20.1) 57 (18.7) 44 (17.7) 71 (20.6) 52 (17.8) 29 (22.5) 24 (19.7) 10 (4.9) 103 (20.6) 10 (12.0)
Which types of medicine have you borrowed?
Allergy medications (like Zyrtec, Clarinex, 35 (30.4) 20 (34.5) 15 (26.3) 15 (34.1) 20 (28.2) 15 (28.9) 15 (51.7)* 1 (4.2) 4 (40.0) 34 (33.0)* 0 (0)
Flonase, etc.)
Pain medications (like Darvoset, Oxycontin, etc.) 31 (27.0) 16 (27.6) 15 (26.3) 8 (18.2) 23 (32.4) 15 (28.9) 9 (31.0) 5 (20.8) 2 (20.0) 27 (26.2) 3 (30.0)
Mood medications (like Paxil, Zoloft, Valium, 11 (9.6) 4 (6.9) 7 (12.3) 4 (9.1) 7 (9.9) 5 (9.6) 2 (6.9) 2 (8.3) 2 (20.0) 10 (9.7) 1 (10.0)
Ritalin, etc.)
Antibiotics (like Amoxicillin, Doxycycline, 15 (13.0) 6 (10.3) 9 (15.8) 4 (9.1) 11 (15.5) 8 (15.4) 5 (17.2) 1 (4.2) 1 (10.0) 13 (12.6) 1 (10.0)
Bactrim/Spectra, etc.)
Acne Medication (like Accutane) 17 (14.8) 10 (17.2) 7 (12.3) 4 (9.1) 13 (18.3) 11 (21.2) 4 (13.8) 1 (4.2) 1 (10.0) 17 (16.5) 0 (0)
Birth control pills 5 (4.3) 2 (3.5) 3 (5.3) 1 (2.3) 4 (5.6) 3 (5.8) 1 (3.5) 1 (4.2) 0 (0) 5 (4.9) 0 (0)
Have you been given printed instructions or warnings 55 (47.8) 30 (51.7) 25 (43.9) 18 (40.9) 37 (52.1) 27 (51.9) 13 (44.8) 10 (41.7) 5 (50.0) 48 (46.6) 5 (50.0)
when borrowing?
Have you been given verbal instructions or warnings 64 (55.6) 35 (60.3) 29 (50.9) 25 (56.8) 39 (54.9) 31 (59.6) 14 (48.3) 10 (41.7) 9 (90.0) 59 (57.3)* 3 (30.0)
when borrowing?
Have you ever borrowed instead of making an 86 (74.8) 45 (77.6) 41 (71.9) 36 (81.8) 50 (70.4) 35 (67.3) 29 (100)* 13 (54.2) 8 (80.0) 78 (75.7) 7 (70.0)
appointment with a healthcare provider?
Did you end up going to a healthcare provider after 23 (32.4) 8 (20.5) 15 (46.9)* 10 (35.7) 13 (30.2) 13 (48.1) 6 (24.0) 3 (25.0) 1 (12.5) 21 (32.8) 2 (33.3)
trying the borrowed medicine?
Did you NOT tell the healthcare provider about 28 (40.6) 14 (36.8) 14 (45.2) 7 (25.9) 21 (50.0)* 12 (46.2) 10 (40.0) 3 (25.0) 3 (37.5) 26 (41.9) 1 (16.7)
borrowing the medicine?
Have you ever had an allergic reaction or other side 43 (37.4) 18 (31.0) 25 (43.9) 24 (54.6) 19 (26.8) 14 (26.9) 14 (48.3) 10 (41.7) 5 (50.0) 33 (32.0) 8 (80.0)
effect when you borrowed?
As a result of multiple responses and omitted answers, values across categories do not always yield the same total.
* Value significantly greater than other values in the category, p < .01. ^ Because of small cell sizes, the Other category was omitted from comparisons.

3
 ARTICLE IN PRESS
4 R.C. Goldsworthy and C.B. Mayhorn / Journal of Adolescent Health - (2009) 1–4
studies that have been limited to single geographic locations
and often to single schools. Items were self-reported and are
subject to limitations, including social response bias. The
likely impact is an underestimation of the actual prevalence
of sharing behaviors and outcomes. The study found a high
rate of ‘‘allergic reactions or side effects’’; however, we are
not able to determine whether adolescents perceived these
as positive or negative (e.g., for certain classes of drugs,
the ‘‘side effect’’ may be exactly the effect they sought).
Future research should consider adolescent definitions and
perceptions of ‘‘side effects’’ more closely. Such efforts
should also examine reasons for and sources/recipients of
sharing. These are not directly addressed here and would
provide important contextual information.
Finally, efforts to reduce the prevalence and consequences
of adolescent medication sharing may be justified, including
training providers to ask specifically about borrowed medica-
tion and educating patients about proper use of prescriptions
and risks of sharing. Development of messaging related to
sharing, for example, within product packaging or public
awareness campaigns, may merit further consideration.
Acknowledgments
The research discussed herein has been supported by grant
DD00001 to the first author from the National Center on
Birth Defects and Developmental Disabilities (NCBDDD),
a part of the Centers for Disease Control and Prevention
(CDC). The article’s contents are solely the responsibility
of the authors and do not necessarily represent the official
views of NCBDDD/CDC. The research reported herein
was approved, with a parental consent waiver, by the institu-
tional review board of the Academic Edge, Inc. (FWA
0000439).
Richard Goldsworthy is Director of Research and Devel-
opment for the Academic Edge, Inc., a research group
specializing in healthcare communication and education.
Christopher B. Mayhorn is an associate professor in the
Human Factors and Ergonomics Psychology Program at
North Carolina State University.
References
[1] Goldsworthy RC, Schwartz NC, Mayhorn CB. Beyond abuse and
exposure: framing the impact of prescription medication sharing. Am
J Public Health 2008;98(6):1115–21.
[2] Petersen EE, Rasmussen SA, Daniel KL, et al. Prescription medication
borrowing and sharing among women of reproductive age. J Womens
Health 2008;17(7):1073–80.
[3] Mitchell AA. Prescription medication sharing. Am J Public Health
2008;98(11):1926–7.
[4] Boyd CJ, Esteban McCabe S, Teter CJ. Medical and nonmedical use of
prescription pain medication by youth in a Detroit-area public school
district. Drug Alcohol Depend 2006;81(1):37–45.
[5] Daniel KL, Honein MA, Moore CA. Sharing prescription medication
among teenage girls: potential danger to unplanned/undiagnosed preg-
nancies. Pediatrics 2003;111(5 Pt. 2):1167–70.
[6] McCabe SE, Boyd CJ, Young A. Medical and nonmedical use of
prescription drugs among secondary school students. J Adolesc Health
2007;40(1):76–83.
[7] Poulin C. Medical and nonmedical stimulant use among adolescents:
from sanctioned to unsanctioned use. Can Med Assoc J 2001;
165(8):1039–44.
[8] Boyd CJ, McCabe SE, Cranford JA, et al. Prescription drug abuse and
diversion among adolescents in a southeast Michigan school district.
Arch Pediatr Adolesc Med 2007;161(3):276–81.
[9] Wysowski DK, Swann J, Vega A. Use of isotretinoin (Accutane) in the
United States: Rapid increase from 1992 through 2000. J Am Acad
Dermatol 2002;46(4):505–9.
[10] Goldsworthy RC, Kaplan B. Warning symbol development: A case
study on teratogen symbol design and evaluation. In: Wogalter MS,
ed. Handbook of Warnings. Mahwah, NJ: Lawrence Erlbaum,
2006:739–54.