Crushing Medication Is Dangerous

Crushing psychiatric medication can come with serious risks. The way a medicine is dispensed is important. It determines whether or not the patient achieves any therapeutic advantage. It can also interfere with and exploit the adverse effects experienced by the patient.

So, naturally, I was upset when my loved one, an inmate at the Comanche County Detention Center in Oklahoma, told me the jail was crushing the medication of the women who are incarcerated there.

More than eight hundred people are waiting for drug treatment in Oklahoma. Many of them are in legal situations involving the court. Many of them also struggle with mental illness. My loved one struggles with Bipolar Disorder and addiction.

The Office of Diversion Control and the Drug Enforcement Administration (DEA) have policies in place which serve to protect vulnerable populations from such practice, including inmates. Oklahoma jails should be upholding the law.

The DEA Practitioner’s Manual stipulates that prescription medications are only to be given in accordance with the directions of the appropriate practitioner who has prescribing authority. Crushing tablets or opening capsules contrary to the prescribing practitioner violates the DEA’s assertion. It also places my loved one and every other inmate at risk. Because my loved one has had bariatric surgery, those risks increase even more. For bariatric patients, the “bioavailability of crushed medication can differ substantially compared to the same medication swallowed whole” (Rosko, 2011).

My friend has been in jail for over sixty days. She just saw the doctor today. On top of battling Bipolar Disorder, she has been detoxing from methamphetamine without any medical assistance. Now, she is starting new medication she has never tried before, and no attention has been given to the fact she had a Gastric Bypass and will absorb the medication at a different rate than most people. Yet, the jail can crush her pills without a written order to do so and consequently place her at risk of psychosis, suicidal ideation, stomach difficulties, cardiovascular problems, and even death.

If she wants to avoid that risk, she will have to ask the doctor to provide the jail with a written order not to crush her medication. It can take up ninety days for them to process her request to see the doctor again. In the meantime, she’s forced to consume the medicine as the jail demands. She waits for a bed. She waits for real help and real treatment. She waits with others who fight serious mental health conditions and who don’t even know their mental stability and well-being are at risk.

Like her bunkmate who takes quetiapine (Seroquel), which is crushed by the county jail. A study in 2008 confirmed a “widespread ‘abuse’ of quetiapine by inmates in the Los Angeles County Jail” (Tcheremissine, p. 740).  Quetiapine has street value and is sought out when other stimulants cannot be obtained. I wonder if workers at the Los Angeles County Jail crush the medication of their inmates without the direction of a physician, too. If so, I wonder if attempts to limit its abuse by way of presenting the drug in the exact way one would abuse it hurts or helps.

A report by Harvard Medical School confirmed that “stimulants used to treat ADHD have some potential for abuse because crushing and snorting (snuffing) them can produce a cocaine-like high” (Harvard Mental Health Letter, 2016). For inmates who struggle with addiction, I wonder how being forced to take crushed medication makes them feel. One might infer, it could and/or would trigger them back to the times they crushed medication while actively using illegal drugs.

It is one thing for Oklahoma to acknowledge that residents have a serious need for mental health and addiction treatment. It is another (completely unethical) thing to know and neglect the fact that those who are supposed to be helping fix the problem are fueling it instead and, in turn, placing themselves, the public, and our loved ones at risk.

It is unacceptable and it is dangerous. It must change. Lives depend on it.


References

Cosgrove, J (2017). Seven things to know about SQ 780, 781. The Oklahoman. NewsOK.com. Retrieved from http://newsok.com/article/5539223

Harvard Mental Health Letter (2006). ADHD update: new data on the risks of medication. Harvard Health Publications, Harvard Medical School. Retrieved from http://www.health.harvard.edu/mind-and-mood/adhd-update-new-data-on-the-risks-of-medication

Rannazzisi, J., & Caverly, M. (2015). United States Department of Justice Drug Enforcement Administration Office of Diversion Control “Practitioner’s Manual: An Informational Outline of the Controlled Substances Act” 2006 Edition.

Rosko, T. (2011). Psychiatric medications and weight gain: a review. Bariatric Times, 8(3), 12-15.

Tcheremissine, O. V. (2008). Is quetiapine a drug of abuse? Reexamining the issue of addiction. Expert opinion on drug safety, 7(6), 739-748.

Dissociative Identity Disorder: I Think I’m Me

It took 15 years of avoidance, the view from the end of a very long rope, and one newborn baby, to make me face my Dissociative Identity Disorder (DID) and to realize most people who have DID do not act like the main character of the Showtime series United States of Tara.

Before my child was born, I did not know anything about it and I didn’t want to. The only thing I knew about Multi Personality Disorder (now known as DID) was that every time I’d heard mention of it, the context of the conversation could pretty much be summed up like this:

“Those people are crazy.”

False. I’m not. In fact, I’m very intelligent and the process my mind created for me over the course of eighteen years of my life is meticulously and intellectually organized and understandable after coming to terms with the trauma that caused it.

Furthermore, the other “me.” is still me, and she is a teenager. I’m not a doctor, but now that I am learning more about the condition, my research would suggest that she is teen because that is the time in my life in which I endured some of the most severe trauma, and my mind felt the need to protect me.

Therefore, when I am dissociated, my emotional coping skills, social cues, and communication, reflect that of my teenage self around that particular time of trauma.

For me, the problem is that my teen-self was just as articulate and just as smart. As a teen, I was developing the guts to defend myself against my father via my mouth. (It usually ended up in the need to outrun him.)

Thus, she is the me who steps in now when Dissociative Identity Disorder wins the boxing round.

It sucks. It’s humiliating. It’s embarrassing. It’s enabling and disabling all at the same time. It causes me to lose track of days, projects, deadlines, commitments, forget whole conversations, say things I don’t mean, and lose my cool when I’m in a verbal altercation and someone throws the right words with their punches.

“She” is the side of myself that I hate. The side who would kill you with words and read you your book, and she knows how to hit where it hurts. She will destroy you and spit words in such a way that after you are done defending yourself, you will still play in your head over and over because they were accurate, but expressed in the most destructive way.

She’s not crazy, either, but she is a victim. She is scared, defenseless, and angry, so my mind’s choice to become her is dangerous. She will do anything it takes to defend herself or me from one more bad thing, but she’s a fraud and she knows it. She’s helpless, vicious, emotional, cold, careless, and reckless.

She is my DID, and if she wasn’t as smart as me, professionals could just feel sorry for me or write me off as “another crazy.” But I understand DID more than most people in the psychology field because I live it, and it seems to create even more of a struggle for me.

I do not take medication. I don’t write notes to my other selves or have conversations like Jekyll and Hyde situations you see on TV. I haven’t followed the DSM-5 method of treatment or integration. I don’t do any of those things.

I face the pain behind it head-on and I do that because my daughter’s future demanded it. That doesn’t mean that I can always control it. Understanding and the ability of articulation do not negate or invalidate the challenges of any mental health diagnosis, and neither should stigmas or personal biases against established mental health conditions.

When mental health professionals or educational institutions allow those things to cloud their judgment in providing services or meeting the needs of those who struggle with uncommon mental health diagnoses, it is people like me who suffer the consequences.

It is children like my beautiful 3-year-old daughter who are robbed of their futures because their parents cannot break through socialized perceptions of mental health conditions that have become common belief and spilled over into common practice.

We are not all the same! What helped me face it? Facebook. After 6 years of therapy had failed me, spilling my thoughts and being able to track my conversations on Facebook saved me. I helped myself, and I’m nobody.

I’m a mental health patient. I’m a suicide loss survivor. I’m a child abuse victim. I’m a domestic violence survivor. I’m a rape survivor. I am a “disabled” person.

I am a lot of things, but what I am not is a psychologist, a suicidologist, a doctor, an LCP, MSW, MD, any other certification or title, you name it! I’m not any of those people.

I’m someone who can be (no, someone who is!) part of the answer educational institutions and medical researchers are looking for. So goes the same for every single person with a mental health condition or illness.

We are a million different people, not one diagnosis, and there is no single solution.