Poverty, health care, and problems of prescription medication: a case study

Through the use of ethnographic research methods the authors examine the relationship between poverty, limited access to health care, and prescription medication use/misuse in rural eastern Kentucky. Four patterns of prescription drug misuse are documented in this study: 1) overuse of medications, often by means of multiple prescriptions obtained from different physicians; 2) the acquisition of prescription drugs for the purpose of resale through illegal channels; 3) borrowing or "swapping" medications through informal exchange; and 4) under- or nonuse of prescription drugs. Of the four patterns, the last is the one reported as having the highest prevalence due to residents' inability to afford the costs of medications prescribed by physicians. The public health implications of these findings are briefly discussed.