What Happens to a Pill After You Pop It?

Patients prefer to swallow drugs in little balls, but their ability to actually deliver drugs has a spotty history.

In early October, MIT announced that its researchers, along with those at Massachusetts General Hospital, had created a new type of drug delivery system. This "novel drug capsule" does not sound like something you'd usually want to swallow: Like a spiny blowfish, it has spikes all over it.
But these tiny needles make it possible to deliver drugs that would otherwise break down in the digestive tract (and that are usually delivered by much bigger needles) in pill form. The pills ferry the drug to the lining of the stomach, where the needles painlessly inject the drugs into the patient's system.
Patients, in general, prefer pills. (There are exceptions.) Swallowing a pill—especially if it's sugar-coated—is a much more pleasant experience than getting a shot or downing a dose of foul-tasting liquid, and people have been rolling medicinal ingredients into small, somewhat palatable balls for more than 3,000 years, one pharmacist told the Los Angeles Times. For a while, pharmacists would coat them in silver, or gold. But it wasn't until the late 1800s that pills started to become a staple of modern medicine, and even as medicine became more science and less art, pill-makers fought over whose pills actually worked.
In 1884, a Michigan doctor named William Upjohn created a "friable pill" that would crumble when pressed. It was meant as a solution to one of the problems that plagued the hard pills of the day—they were so hard or their coatings so impenetrable, that they would make it through a person's system without actually delivering the drug inside.
Upjohn marketed his pills by sending samples along with a pine board and instructing potential buyers to try crushing his pills against the board and compare the results to crushing his competitors's pills. His would crumble; the idea was that it would more easily dissolve in the stomach.
His competitors protested.
"Friability is no proof of solubility," they argued:
Upjohn responded:
This was fought out in medical journals, too. One doctor wrote that he had found 16 friable pills that passed through a patient's digestive system: "Some of them were nearly half worn away, and from that they were in nearly all stages back to those which showed traces of the pink sugar coating."
Better solubility won out in the end (although, even though most modern pills dissolve just fine inside a person's stomach, not all their contents make it into a person's bloodstream). Even the MIT team that made the spiky pill is interested in its fate inside the body: The researchers say that one of their next advances will be to try to make the needles of "degradable polymers and sugar that would break off and become embedded in the gut lining, where they would slowly disintegrate and release the drug."