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 In a survey, about half of people who participated in these
underground exchanges said they do it because they lack access to
the proper medications and supplies to manage their diabetes,
researchers report in the Journal of Diabetes Science and
Technology.
"It is important for healthcare providers and policymakers to
understand what people are doing to support diabetes management when
faced with medication and supply access issues," said study leader
Michelle Litchman of the University of Utah College of Nursing in
Salt Lake City.
The price of insulin continues to increase, translating to $15 per
day for the average user, the study authors note. Recent research
indicates that one in four people with diabetes ration their insulin
due to cost, they add.
"While there are risks to using medications and supplies that are
not prescribed to them, there are also risks to rationing or not
taking medications or using supplies at all," Litchman told Reuters
Health by email.
In early 2019, the researchers surveyed 159 people who were involved
in online diabetes communities, including patients and caregivers.
They asked questions about underground exchange activities, access
to healthcare and difficulty in purchasing diabetes items from
standard sources.
More than half of the survey participants said they had donated
medications or supplies, 35% received donations, 24% traded
medications, 22% borrowed items and 15% purchased items. These
exchanges took place among family, friends, co-workers, online
acquaintances and strangers.
Overall, people who reported financial stress due to diabetes
management were six times more likely to engage in underground
exchanges and three times more likely to seek donations.
"The current healthcare situation in the United States is
substandard for many people with chronic disease," said Mary Rogers
of the University of Michigan, in Ann Arbor, who wasn't involved in
the study.
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"It is too costly. It is too slow. It is too complicated," she said
by email. "Failure to fix these problems leads to diabetic
complications and unnecessary hospitalizations."
Participants who donated medications felt compelled to give because
they knew about the dire need of others, the study authors note.
These respondents described a sense of duty and obligation to help.
Others built up stockpiles that they donated, including insulin,
pills, glucose strips, sensors and pump supplies.
Underground exchange could lead to several repercussions, including
unanticipated side effects, complications of incorrect use, delay in
seeking professional help and drug interactions, the authors
caution. In addition, sharing and trading prescription medicines is
illegal in the U.S. and other countries.
In this study, the researchers did not identify any adverse events,
Litchman said.
Kebede Beyene of the University of Auckland, in New Zealand, who
wasn't involved in the study, told Reuters Health, "It seems that
health professionals rarely ask patients about medicine sharing,
trading or exchange, so it would make sense for health professionals
to ask about medicines exchange during consultations and when
dispensing medicines, particularly for high-risk medicines, such as
diabetes medications, antibiotics and strong pain medications."
"Patients can then be given information about the possible risks of
taking someone else's medicine or giving their prescribed medicines
to another person," Beyene said by email. "Community pharmacy
practitioners are also in a unique position to educate about risks
of medicine exchange."
SOURCE: https://bit.ly/2MtPQa6 Journal of Diabetes Science and
Technology, online December 4, 2019.
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