Think Before You Crush
Making sure patients are taking prescriptions appropriately in the correctional healthcare setting can be a challenge. When detainees cannot swallow pills or there are concerns of diversion, sometimes an order is given to crush medications. However, you should think critically about that order. Some medications may not be as effective when crushed, such as buprenorphine.¹
Don’t crush XL, XR, DR, or SR
XL, XR, DR, and SR in a medication’s name is a quick clue that it should not be crushed. These are extended-release medications that are meant to be slowly absorbed by the body. When crushed, this process does not work as intended and too much of the drug can be absorbed at one time. This can lead to negative side effects for the detainee. When in doubt, check with the practitioner or a pharmacist to see if a medication is extended-release. Don’t crush XL, XR, DR, or SR medications.
Do a mouth check
Mouth checks can be used to prevent diversion when crushing is not an appropriate option. Look in a detainee’s mouth to make sure they have not diverted medications under their tongue, behind their lips, in their cheeks (cheeking), or underneath false teeth or implants. Use gloves and a flashlight for mouth checks – remember to change gloves between detainees. During a mouth check, ask the detainee to:
Take meds with water
Open mouth and tilt head back
Lift their tongue
Move tongue left and right
Pull lips up and down
Make sure detainees keep their hands visible at med pass and do a mouth check to prevent diversion.
Don’t crush without a doctor’s order
Some pills have coatings to delay the medication’s effects, some have coatings to protect the mouth and throat from irritation, and some have liquid centers or capsules that cannot be opened. Get medical guidance from a practitioner to determine if it is okay to crush. Crushing without a medical order may lead to injury. Don’t crush without a doctor’s order.
For more information, please contact training@sparktraining.us.
1. Welsh, C., & Valadez-Meltzer, A. (2005). Buprenorphine: a (relatively) new treatment for opioid dependence. Psychiatry (Edgemont), 2(12), 29–39. https://pmc.ncbi.nlm.nih.gov/articles/PMC2994593/
Disclaimer
All materials have been prepared for general information purposes only. The information presented should be treated as guidelines, not rules. The information presented is not intended to establish a standard of medical care and is not a substitute for common sense. The information presented is not legal advice, is not to be acted on as such, may not be current, and is subject to change without notice. Each situation should be addressed on a case-by-case basis. When in doubt, send them out!®
