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.

How I Became A Preacher

I have been given a lot of reasons not to like Christians. I wish I could say I know in my heart God is real and Jesus loves me, but no one really knows that for sure, and I am a very logical, practical, girl. I always have been.

When I was a teenager, I went to youth camp every summer. The Pentecostal kind. At the end of the service each night, I would watch all of the other kids flock to the altars. They’d be there all night; slain in the spirit, speaking in tongues, crying, and holding hands, and I’d just be in my seat… watching.

I remember one year, I made sure I was “slain by the Holy Ghost.” I thought people would think something was wrong with me if I kept choosing to stay in my seat. Everyone else was hugging the concrete, so I faked it. It hurt like hell when my head hit the ground! (Note to self: Make sure you have somebody there to catch you.) I never tried a second time around.

My last church sealed the deal on my view of Christian organizations. Around age fifteen, I decided church wasn’t the place for me. I began to see through it.

I had just signed a ministry contract. I thought it over for a week before I finally committed. They included a whole clause about tobacco use, and I did not want to be dishonest by alleging that I wouldn’t use it. I was an underage smoker.

I told my youth pastor my dilemma and he encouraged me to step into leadership anyway. I poured myself into the youth group. I spent my weekends and summers at the church. I lead national See You At The Pole day at high school, helped organize the first statewide youth rally in our town and led praise and worship.

Yet, the very second that I was placed in an Oklahoma psychiatric children’s center, my family-owned church deemed me unworthy to serve. I wasn’t worthy enough to be a leader. I wasn’t even worthy enough to sing in the choir. People like me aren’t worthy of positions like that.

“Like me” meaning suicidal. People, like me, who struggle with the impacts of trauma, we’re tormented. In the eyes of the church, we’re sinners in need a deeper relationship with God and a closer walk with Jesus Christ. We’re not worthy of anointing, love, or light.

So, there I was — shunned at Christmas. I wasn’t even allowed to sing in the church cantata! I couldn’t possibly worship God with my voice. It was spotted. The choir director did her best to pretend she wasn’t judging me as she stopped me in the bathroom and told me,

It’s for the best.

That is the same thing the youth workers on the children’s behavioral unit said. And how many times did my church leaders or church family come to see me? Not once. Who came to visit outside of my parents? Nobody. Did any of them confirm or hear me say that I wanted to die or that I had made an attempt on my life? No. Nobody asked me.

After that, I was behind in school six months before graduation. I lost my only social outlet, and I worked until 2 o’clock in the morning nearly five days a week. I tried to hold onto the church and the fake smiles they all seemed to master. But every time I dared to attend, I was blinded by darkness.

It was full of judgment. We made the same judgments in our family. A lady in our church was dating an ex-convict and living with him out-of-wedlock and wanted to serve in the church. They wouldn’t allow her. They asked her not to return until she got her life right with the Lord. The sad thing is, the deacons and youth ministers were judged the same way. It was the same way the pastor treated his children.

When we’re younger, we’re not deaf and we’re not blind. I meticulously watched people my entire life. No one in the church or the family bothered to get to know me. They didn’t then. They don’t now. I was never accepted into their church… or family. Not since that new poor-little-adopted-girl smell wore off.

While the last three years have found me verbally open about it and in public confrontations on social media platforms, I find it all ironic. All this judgment as if they know who I am, all my sins, and my soul’s darkness. Yet, here I am shining the brightest light.

Not once did those who served in our church tell me I was anointed or called, but they had plenty to speak over my sisters. I must have been really terrible at faking it. The only part of the church I embraced was worship. My voice. I lived and breathed for the youth group and music.

Since my birth, people have prophesied over my sisters and me and stamped our lives with scripture. I remember each time. The last person to speak anointing over the three of us girls was Ms. Brown. She was a vibrant lady. She professed God would use each of us; one of us would write, one of us would sing, and one of us would preach His word. I always liked her.

While people routinely praised and ordained my sisters, purpose in my life was merely remnants written in cards from my foster parents, DHS workers, or people from the church, like Lydia. She prophesied Psalm 100 over my life. Years later, after dad gave me a box of our adoption records and collective other things, I found an old card addressed to a younger me. “Charity.” Mrs. Brawner, my foster mom, penned Psalm 101 inside. All those notes and cards stopped by the age of five.

What do I do today, even though I don’t get to feel the warmth of the sun on my face or know what it’s like to face the world every day, much less face myself in the mirror? Write, sing, and … preach.

I am a preacher. I send God’s love out into a dying world, and I don’t throw conviction or scripture, but I shout His word. When I speak, people listen, and I have a powerful voice! The world is my church.

Funny how home became my prison. Blame mental health (or religious culture?). Today, I have a full congregation. And we don’t worry about building funds, smokers, gay people, or offering plates. We don’t abandon suicidal children, addicts, or whores. We serve.

I guess that is the kind of sinner I am. I shine brightly from all the way inside of a dark, forgotten, apartment. And on the days I remember to pray, it’s usually to ask Jesus what happened to all of His lighthouses.

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.