Doxylamine implicated in overdose

addiction illicit drugs dependency

More time needed to judge effect of Melbourne’s medically supervised injecting room following a man’s overdose late last year: Coroner

A 35-year old man died in Melbourne in November 2018 from combined heroin, doxylamine and alcohol toxicity, the Victorian Coroner has found.

Yara Mignon was found unconscious in a Victoria Street restaurant bathroom surrounded by drug paraphernalia.

Despite emergency medical treatment and support, Mr Mignon did not regain consciousness and he passed away in the St Vincent’s Hospital ICU a few days later.

His overdose happened just around the corner from the medically supervised injecting room (MSIR), four months after its trial had commenced in North Richmond.

North Richmond MSIC map location
Image credit: North Richmond Community Health.

However Coroner Audrey Jamieson said she still believes the MSIR is an “essential intervention” to address drug-related harms in the City of Yarra municipality.

Mr Mignon was described as a gifted student, having been offered two full scholarships to high school and another scholarship to pursue further studies while at university studying social work.

He began using illicit drugs at an early age, and during adulthood would buy heroin from sellers on Victoria Street.

The Coroner accepted forensic pathologist Dr Gregory Young’s opinion that Mr Mignon had died as a result of hypoxic brain injury complicating cardiac arrest in the setting of combined heroin, alcohol and doxylamine toxicity—an unintentional consequence of his use of illicit drugs.

Dr Young commented that the three drugs “all cause depression of the central nervous system”, which may lead to decreased respiratory drive and cardiac arrest.

Mr Mignon’s mother commented that he had occasionally attended the MSIR, and yet had overdosed in a public bathroom close by to the facility and during its usual operating hours.

She commented that the community would be better served if the facility was open seven days a week for 24 hours a day.

In response to the investigation, the Coroners Prevention Unit (CPU) was asked to prepare a report on heroin-involved overdose deaths in Victoria.

The CPU found that in 2018, following six years of steady increases, the frequency of Victorian heroin-involved overdose deaths declined by about 10%, from 220 to 201 deaths.

However the frequency of heroin-involved overdose deaths in the City of Yarra increased from 16 in 2017, to 25 in 2018.

The number of heroin-related overdose deaths in the six months after the MSIR trial commenced (12 deaths) was “practically the same” as in the six months leading up to the trial (13 deaths).

Yarra was the only local government area out of 20 where the majority of overdoses (57.1%) occurred at non-residential locations such as a restaurant, park or public toilet, with most others occurring in the deceased’s home.

The CPU suggested that a substantial number of people are travelling from other parts of Melbourne (and wider Victoria) to use heroin and subsequently overdose in Yarra – both before and after the MSIR commenced operation.

Ms Jamieson says six months is not long enough to judge the effect of the MSIR on heroin-related harms in the City of Yarra.

“Introducing an MSIR as a harm reduction intervention to an area where heroin use and related harms have long been concentrated, must surely have a range of impacts and ramifications that take time to manifest,” she said.

Source: Coroners Prevention Unit Report, 13 June 2019.

There are also other types of harm including non-fatal overdose, Ms Jamieson pointed out.

Data reveals the MSIR has handled more than 1,130 overdoses since it opened, with more than 3,300 health and social support interventions also carried out during that time.

The Victorian Coroner stated her support for the MSIR trial.

“I believe the MSIR is an essential intervention to address the drug-related harms in the City of Yarra and Victoria,” said Ms Jamieson.

“The MSIR has created valuable opportunities for clinicians to engage with a vulnerable group of people and link them with medical treatment and social services and other supports they may otherwise not have accessed.”

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