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Amy Ross* is a 37-year-old public defender in Manhattan, fit and high energy, with a closetful of killer outfits and a group of girlfriends as devoted to their high-power jobs as she is to hers. But her crushing workload and the pressure of constant court appearances sometimes give her anxiety attacks -- pounding pulse, cold sweats, and a feeling that she's about to die. Her psychiatrist prescribes Xanax to help alleviate the panic.
Ross also takes the drug to relax at the end of a hard day. "It's fewer calories than a glass of wine," she says. Many of her friends use it for that purpose, too. Not all of them have a prescription, so Ross and her pals share their chill pills on a regular basis. "It's like that book The Joy Luck Club," she says, "where a group of friends put money in a pot each week and give it to whichever woman is in trouble."
Eileen Coleman,* 54, occupies a different universe from those chic New Yorkers and their Xanax club. She's a librarian in a Northern California suburb. Rather than courtroom showdowns, she and her friends grapple with the minor ailments of middle age, from backaches to insomnia. Yet they have one thing in common with Ross's crowd: They stockpile any leftover prescription drugs for friends in need.
"It started a few years ago when I threw my back out and was in a lot of pain," Coleman recalls. "A friend said, 'Hey, I have some muscle relaxants left from the last time I had a back problem. I'll give you one or two to tide you over until you get to the chiropractor.'" Since then she and her circle have also shared prescription painkillers, sleeping pills, and the occasional Valium -- whatever the situation demands.
Most people still obtain their prescription drugs the old-fashioned way -- by carrying a scribbled-on slip of paper from their doctor to the local pharmacy. But health care practitioners say that a growing number of patients are bypassing the professionals altogether by getting pills from friends and family members. "My colleagues and I see it all the time," says primary care physician Sharon Orrange, MD, an assistant professor at the University of Southern California's Keck School of Medicine. "People will say, 'I had a urinary-tract infection, so I took my friend's amoxicillin. I couldn't concentrate, so I took my friend's Adderall.'"
According to the Centers for Disease Control and Prevention, just over 36 percent of women aged 18 to 44 admit that they've borrowed or shared prescription drugs. One survey by the research firm Academic Edge found that the five most frequently shared prescription drug types were painkillers, allergy medicines, antibiotics, mood or anxiety medications, and acne medications.
As Amy Ross and her lawyer friends are uncomfortably aware -- though other sharers often aren't -- it's illegal for anyone without a license to dispense prescription meds, even for free, or for anyone without a prescription to take them. (Both are class E federal felonies, punishable by up to five years in prison.) Sharing can also be dangerous because even seemingly innocuous drugs can cause unexpected side effects or interact disastrously with other medications. Which raises the question: Why do so many women do it?
Experts point to a variety of factors. The first is the increased number of people taking prescription drugs. Since 1999 U.S. spending on prescription medications has more than doubled, to $234 billion. "Ten years ago you might have been the only person on your block taking a prescription drug," says psychiatrist Neil Capretto, DO, medical director at Gateway Rehabilitation Center in Aliquippa, Pennsylvania. "Now there's simply more opportunity to share."
There's also a wider variety of prescription drugs on the market and more public awareness of all those options, since the Food and Drug Administration decided in the late '90s to allow drug companies to advertise to consumers. The "ask your doctor" ads helped launch an era of consumer-driven medicine, says Kaitlin Bell Barnett, author of Dosed: The Medication Generation Grows Up. Patients used to just take their physician's advice. "Now people are more proactive in doing research about medications. There's a sense of feeling educated about your own body and symptoms."
When you talk to drug sharers that sense of self-empowerment comes through clearly -- as does an impatience with the bureaucracy that surrounds modern medical care. "There are so many gatekeepers," says Coleman, the California librarian. "If you need to see a specialist, you have to get approvals from your primary physician and the insurance company. It can take forever." Her group is scrupulous about proper dosage and drug interactions, she adds. They keep an eye out for side effects and consult the latest copy of Physicians' Desk Reference when they have questions. For these women, sharing is a matter not only of convenience but also of philosophy, Coleman says. "Our generation has the sense that we're all responsible for our own health and that doctors don't know everything. We know there are risks, but we make our decisions based on the available information."
Familiarity can make people more cavalier about sharing as well, experts say. For example, women who were treated for ADHD as children have a more casual attitude toward the use of stimulants like Ritalin and Adderall. "The longer you've taken something, the more comfortable you feel with it and the more likely you are to lend it to friends," says Barnett.
Fiona Kramer,* 25, was diagnosed with mild ADHD in middle school and took Adderall two or three times a week to help her focus. In college she let her prescription lapse. (She sold the remaining pills to classmates -- a common practice among college students, many of whom use ADHD drugs as study aids.) But when she got her first job, at a San Francisco PR firm, her symptoms returned. "It's a very intense agency, and it was taking me hours longer to do things than it took the next person," she says. Kramer went to a psychiatrist, who put her back on Adderall.
She takes the drug only when she feels the need. So when her office friend Kaylie complained that she, too, was feeling overwhelmed -- and mentioned that she also had been diagnosed with ADHD as a child -- Kramer offered to share her leftovers. "It doesn't feel like a big deal," she says. "She only asks for a pill or two when she's got a big assignment coming up. And we've both become much more productive."
Pearl Gliatto,* 44, of Providence, Rhode Island, used to share her ADHD drugs freely. She also borrowed some Ativan (a tranquilizer) from a friend to calm her while she quit smoking. Another friend once gave her a Valium to help her cope with a family member's sudden death, though in retrospect, she thinks the dose may have been dangerously high for her small frame. "It knocked me out completely," Gliatto says. "I took it that afternoon and next thing I knew it was morning." All of that happened before she went to nursing school. She was shocked to learn that sedatives can cause psychotic reactions in some people and that certain antibiotics can negate the effect of blood thinners. At the hospital where she works, Gliatto recently treated a woman who permanently damaged her heart by taking a friend's prescription diet pills. "Now I don't feel comfortable lending anything," she says. "I know all the bad things that can happen."
Dr. Orrange ticks off a few more of the dangers. "The most common problem we see is people sharing antibiotics," she says. "But it's often not the right antibiotic, or they take only a partial course, so they're creating drug-resistant bacteria." Then there are the ADHD drugs, which can cause spikes in blood pressure in patients with hypertension or when combined with certain antidepressants. Taking sleeping pills with anti-anxiety drugs can amp up the effect of both, making driving risky the next day -- or even, in extreme instances, lead to fatal oversedation. Mixing pain relievers can be hazardous, too. "People come in saying, 'I took a Tylenol, and it wasn't strong enough, so I took my friend's Vicodin,'" says Dr. Orrange. Both meds contain acetaminophen -- and acetaminophen overdose is the leading cause of liver failure in the United States.
Acetaminophen, of course, is available over the counter. That brings up an argument that sharers often make: The boundaries regarding which drugs really need a doctor's supervision aren't always clear. Nondrowsy antihistamines, for instance, used to require a scrip; now they don't. Also, some drugs that are prescription-only in the United States (like codeine-based pain relievers or benzodiazepine anxiety meds) are available over the counter in other countries. But the FDA is cautious for a reason, says Dr. Orrange. "Remember that weight-loss drug, Meridia, that was pulled from the market after it was found to cause cardiac problems? Sometimes tighter regulation isn't a bad thing."
Another reason to get your drugs from an actual doctor: You may not have the ailment you think you have. Anxiety, for example, can be a symptom of anything from a thyroid disorder to a heart attack, neither of which can be effectively treated with Xanax. And then there are dosing issues, says pharmacist Armon Neel, Jr., author of Are Your Prescriptions Killing You? For example, the dose of Macrobid that cures a young woman's bladder infection can trigger dementia in a 70-year-old. "An older person's kidneys don't clear this medication as quickly," Neel explains.
"By passing along medication, you're depriving someone of the help of a professional who's trained to prescribe it," says Kim Dennis, MD, medical director of Timberline Knolls Residential Treatment Center in Chicago. "And you're putting yourself in the position of potentially harming your friend."
Dr. Dennis points to a 2011 federal report showing that drug poisonings now nearly equal car crashes as the leading cause of accidental death in the United States. Some 36,500 Americans died from overdoses in 2008, the latest year for which numbers are available; of those incidents, more than 40 percent involved prescription painkillers. Another report showed that the 10 drugs leading to the most emergency room visits in 2009 included commonly shared medications like anti-anxiety drugs (Xanax, Valium, Ativan, Klonopin); opioid painkillers (Vicodin, OxyContin); and the sleeping pill Ambien. The study doesn't distinguish between those who had prescriptions and those who didn't. But many doctors can cite examples of innocent borrowers who made a fatal error.
In an ideal world, no one would share prescription drugs. But Pauline McKinley,* 52, a receptionist in Little Rock, Arkansas, does not live in that perfect world. She started having panic attacks after a series of family crises: Her mother-in-law died, her husband's siblings were fighting over the assets, and another relative was terminally ill. McKinley's doctor prescribed the antidepressant Zoloft to control anxiety. The medication worked well, with a daily dose of half a pill.
Her husband, Roger, was also struggling with emotional issues. "He was constantly on edge," she recalls, "angry and stressed-out." Yet as an unemployed construction worker, he had no health insurance -- and without it, treatment was too expensive. So McKinley began giving him her unused half-pills and soon he was noticeably calmer. That made her feel so much better that she stopped taking Zoloft. She kept refilling the prescription, though, and raised Roger's dose to a full tablet. "It sucks that I have to lie to get him what he needs," she says. "But I think it saved our marriage."
McKinley is not alone in finding ways to work the system. According to a recent poll by the Kaiser Family Foundation, about 60 percent of Americans said they have "cut corners" to avoid health care costs. Nearly 50 million Americans are uninsured, according to the most recent report from the Census Bureau, and many more have plans that don't adequately cover medications. But even for the fully insured, the gift of a pill can sometimes seem too tempting to turn down. Last year Helen Greeley's husband was rushed to the hospital. Greeley,* a 49-year-old jewelry designer in Cedar Rapids, Michigan, was waiting outside the ICU when a family friend called. "Can I bring you anything?" he offered. "A Xanax, maybe?" Greeley gladly accepted his offer.
She's done similar favors for friends and relatives. But lately she's begun to have second thoughts. Her grown daughter confessed that, after a minor surgery, she'd sold some leftover Percocet to a friend of a friend. That seemed perilously close to drug dealing, and Greeley wondered if she'd set a bad example. Then her brother took a common antibiotic, prescribed by his doctor, and nearly died of an allergic reaction.
"That scared me," she says. "You never know what can happen. I used to tell everyone, 'Oh, you're having trouble sleeping? Take a couple of these.' I'm not sure I'll do that anymore."
Originally published in Ladies' Home Journal, September 2012.