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.
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.