"butter bullets"--narcotics mixed with butter for rectal administration

Specialties Hospice

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Specializes in RN,CHPN (Certified Hospice Nurse).

Have any of you used butter, which when cold molds like a suppository?

When a patient is no longer able to swallow, but still requiring larger doses of pain meds, and when IVs are too costly, I use this route. I mix the pain meds such as methadone (for the SRs we do not crush obviously). The family is told to administer every 8 to 12 hours and the patient is comfortable, the family relieved, and the hospice nurse happy the symptoms managed. There may be a first pass issue: ie the oral route goes via hepatic so the pain effect is reduced. The rectal avoids this so the pain effect may be potentiated. On the other hand, it is a valid and cost effective way to manage pain at the VERY end of life (usually only the last few days are when the pt cannot swallow the larger doses and the pain itself peaks) Any takers? I am looking for journals to support this since my work place is asking for more literature. IS ANYONE FAMILIAR WITH LITERATURE TO SUPPORT BUTTER RECTALLY AS A VEHICLE FOR ENDSTAGE PAIN MANAGEMENT

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Specializes in psych, addictions, hospice, education.

Is this something you "invented" yourself? I've never heard of it. The hospice I work with uses the practice of rectal administration of meds, but they are merely inserted as is or a sterile lubricant is used. I'd be concerned about using butter because of it's potential to carry microbes, as well as its saltiness which might draw fluid into the bowel...

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Specializes in LTC, assisted living, med-surg, psych.

I prefer surgical lubricant myself...........

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Specializes in RN,CHPN (Certified Hospice Nurse).

When I give a pill or two of course I just use lubrication from a water based thing like lubriderm.

But if a patient has 300 or 400 mg of morphine or 40mg plus of methadone (they are horse pills!) which requires administration then I think about an easy way to give it! The families where I work are usually OK with rectal administration ONLY if the patient is actively dying or near coma... (we all prefer a non rectal route of course). Ivs are so darn expensive and we try to use oral when possible as well....

SO if you take a little butter and put the pills in it (or crush for huge methadone tablets) make it shaped like a suppository and place it in the freezer then it easily slips in. It is easier then administer 5 or 7 pills in rectally as they get so slippering and families wig out over it. The family can administer every 8 or 12 hours and give roxanol or whatever PRN. The amt of salt is negligible and these are actively dying patients so salt is not an issue. Our hospice has done this for years. Again, this is only in the last days of life and would never be considered at other time. Just wondering if anyone has seen any literature about it....maybe it is our own hospice thing!

Thank you for responding!

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Sounds like a pretty good idea to me. Economical and efficient.

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Specializes in psych, addictions, hospice, education.

Thank you for explaining. I does make lots of sense.

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Specializes in Hospice, Psyc, post surg.

What a great idea!:yeah: Recently I had an ES Alz patient that had a lot of oral secrections at times (not able to control with scop patches or atropine gtts) so our pharm crushed MS IR tabs & put them in capsules for PR adm, they didn't think just putting the tab in would work as well. Possibly this could be done with higher doses also.

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Specializes in RN,CHPN (Certified Hospice Nurse).

They work well. The thing is the FDA has not given it its stamp of approval. Methadone is well documented to work rectally. But not in butter--although quite frankly unless they have a allergy to milk I cannot imagine it being any different then "surgical lube".If your pharmacy will put the tablets in a capsule for rectal administration then go with it. Some of the higher doses will obviously not work in capsule size, like you understand. When going above 4o mg of methadone I admit they look like monsters. At least they have a cooling effect! I too have used the capsules with pain meds inside but the capsules have to be the kind that easily "melt" into the rectal vault. Cheers.

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"Microbes", "water"? Um, they are dying....

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We just purchase glycerin supps and have them handy if we need to use them to insert a tablet into. Just let them soften. Olive oil works well too, but of course, it will not mold to a semi-solid state.

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Specializes in psych, addictions, hospice, education.

microbes--don't want an uncomfortable infection....water--don't want more diarrhea than is there already...

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Specializes in RN,CHPN (Certified Hospice Nurse).

Hi Nameste (BTW-I have spent YEARS in India!) I totally relate to you about "hello they are dying....",

And as for the glycerine suppositories. Now, that it a GREAT idea!

Our hospice is connected to a massive hospital-based center with over 10000 employees. As such, the "Jayco"

warriors, as well as the FDA, tend to target every little thing. We try to be very careful to adhere to the fear-based principles of modern medicine and conform to all the appropriate standards of care. As we know, in hospice, when there are times creativity, love, and good old fashioned nursing far outweigh "standards" (not). Butter bullets fall into the category "creativity, love and make it work in the home setting when our patient needs quick symptom management without the frills". Patients come first. Thanks for your support and the glycerin idea!

PS Have you seen any articles supporting your glycerin action? I am on a literature quest for my hospice. I am NOT a student (although I am considering an MSN)..

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