Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;14(6):1000-1009.
doi: 10.1177/1932296819888215. Epub 2019 Dec 4.

The Underground Exchange of Diabetes Medications and Supplies: Donating, Trading, and Borrowing, Oh My!

Michelle L Litchman  1 , Tamara K Oser  2 , Sarah E Wawrzynski  1 , Heather R Walker  3 , Sean Oser  2
Affiliations

The Underground Exchange of Diabetes Medications and Supplies: Donating, Trading, and Borrowing, Oh My!

Michelle L Litchman et al. J Diabetes Sci Technol. 2020 Nov.

Abstract

Background: The cost of diabetes medications and supplies is rising, resulting in access challenges. This study assessed the prevalence of and factors predicting underground exchange activities-donating, trading, borrowing, and purchasing diabetes medications and supplies.

Research design and methods: A convenience sample of people affected by diabetes was recruited online to complete a survey. Mixed method analysis was undertaken, including logistic regression to examine the relationship between self-reported difficulty purchasing diabetes medications and supplies and engagement in underground exchange activity. Thematic qualitative analysis was used to examine open-text responses.

Results: Participants (N = 159) self-reported engagement in underground exchange activities, including donating (56.6%), donation receiving (34.6%), trading (23.9%), purchasing (15.1%), and borrowing (22%). Such activity took place among a variety of individuals, including friends, family, coworkers, online acquaintances and strangers. Diabetes-specific financial stress predicted engagement in trading diabetes mediations or supplies (OR 6.3, 95% CI 2.2-18.5) and receiving donated medications or supplies (OR 2.8, 95% CI 1.1-7.2). One overarching theme, unmet needs, and three subthemes emerged: (1) factors influencing underground exchange activity, (2) perceived benefits of underground exchange activity, and (3) perceived consequences of underground exchange activity.

Conclusion: Over half of the participants in this study engaged in underground exchange activities out of necessity. Providers must be aware about this underground exchange and inquire about safety and possible alternative resources. There is an urgent need to improve access to medications that are essential for life. Our study points to a failure in the US healthcare system since such underground exchanges may not be necessary if medications and supplies were accessible.

Keywords: cost of illness; diabetes; diabetes technology; health services accessibility; insulin; social media.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Overarching theme, subthemes, and categories.
See this image and copyright information in PMC

References

    1. Biniek JF, Johnson W. Spending on Individuals with Type 1 Diabetes and the Role of Rapidly Increasing Insulin Prices. Health Care Cost Institute; 2019. https://healthcostinstitute.org/images/easyblog_articles/267/HCCI-Insuli....
    1. Cefalu WT, Dawes DE, Gavlak G, et al. Insulin access and affordability working group: conclusions and recommendations. Diabetes Care. 2018;41(6):1299-1311. - PubMed
    1. Berchick ER, Hood E, Barnett JC. Current Population Reports, P60-264, Health Insurance Coverage in the United States: 2017. Washington, DC: U.S. Government Printing Office; 2018.
    1. Herkert DM, Vijayakumar P, Luo J, et al. Cost-related insulin underuse is common and associated with poor glycemic control. Diabetes. 2018; 67(Suppl1).
    1. Sable-Smith B. Insulin’s high cost leads to lethal rationing. NPR. https://www.npr.org/sections/health-shots/2018/09/01/641615877/insulins-.... Accessed September 1, 2018.

Publication types

MeSH terms

Substances