Covert medication; the last option: A case for taking it out of the closet and using it selectively

Abstract

Covert medication is the practice of hiding medication in food or beverages so that it goes undetected. Tablets may be crushed or liquid forms of medication may be used for patients who are either not in a position to give consent or refuse consent because of lack of insight. It is commonly practised in two distinct settings. The first is typically in the western world, in old patients, mostly suffering from dementia, admitted in nursing homes. The second is typically in resource strapped developing countries, in patients with psychosis, mostly at home, when patients refuse medication. The latter, from all accounts available, occurs on a large scale, but has not been studied owing to its questionable ethical and legal status and it is not discussed in the open by professionals. This paper examines the pros and cons of covert medication and argues that it should be acknowledged and studied like other therapeutic practices.