Don’t Drink the Kool-Aid

Why the soft drink is used to administer drugs.

Why was Jared Loughner served his antipsychotic medication in Kool-Aid?

Photograph by James McQuillan/Thinkstock.

Alleged Arizona gunman Jared Loughner has been forced to take antipsychotic medication while under treatment at the U.S. Medical Center for Federal Prisoners. According to a USA Today article published Monday, a prison team mixed the drugs with Kool-Aid and gave them to him in a paper cup. In Tom Wolfe’s The Electric Kool-Aid Acid Test, Wolfe describes how Ken Kesey and his crew of Merry Pranksters used Kool-Aid to distribute LSD to unknowing partygoers. In the Jonestown massacre, more than 900 Americans committed mass suicide or were murdered by drinking a Kool-Aid-like drink laced with cyanide. Is there something about Kool-Aid that makes it especially good for masking drugs?

Yes, but doctors aren’t supposed to give patients drugs without telling them. Because Kool-Aid is a flavored drink mix, doctors and nurses can adjust the strength of the flavor needed to cover up the taste of any dissolved substance. Similarly, Kool-Aid’s bright coloring, when used in sufficient doses, allows for effective masking of any visual sign of a Mickey or a medication. Also helpful is the fact that the drink comes in a sugar-free form, which comes in handy when the patient should not be given too much sugar, either because of dietary concerns or—in the case of children—concerns that sugar will cause hyperactivity. Plus, Kool-Aid is cheap, and it’s unlikely to interact with medications the way that some beverages, like grapefruit juice, might. For these reasons Nebraska’s official soft drink is a favorite choice among pediatricians and other doctors when administering distasteful medications in oral suspension. Tang is another popular choice, and is often used in delivering methadone.

While Kool-Aid is a particularly effective vehicle, it’s not the only option. LSD, for example, has only a faintly bitter taste, so it might be mixed with any of a number of flavored beverages. Some drugs don’t work properly when crushed and mixed, however. Others are made to be sprinkled on food. For example, some ADHD medications, like Adderall XR, are approved by the FDA as a topping for applesauce.

While some foods and drinks like Kool-Aid can conceal medications very successfully, the courts have ruled that drugs should not be given to patients unawares. In U.S. hospitals, according to the landmark ruling Rogers v. Okin, competent patients can be manipulated into taking drugs only if they present an immediate danger to themselves or others, or if a court order has been issued to allow forced medication. Even if a court order has been issued, medical ethics dictate that the patient should be warned, and given the choice to take the drug voluntarily, before being compelled to take it. Dissolving a pill in Kool-Aid or another liquid proves useful even though there’s no deception in play: That way, a doctor can ensure that the patient won’t “cheek” the pill next to his teeth and spit it out later. Risperdal, the drug administered to Loughner in the Kool-Aid, commonly comes in the form of a very small pill that can be easily cheeked.

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Explainer thanks Liza H. Gold of Georgetown University and Timothy Wilens of Massachusetts General Hospital.