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prescription drugs opioid deaths inquest addictive drugs dependence

An inquest has found an ACT man died due to morphine toxicity, with signs he was stockpiling his medications

A coroner has made an open finding as to the manner of death of a 67-year-old man in the ACT in 2015, noting the possibility of accidental overdose.

The man, who had several health issues, had struggled with chronic pain due to a degenerative bone condition and was on what Coroner P.J. Morrison described as “a complex prescription regime”.

Many packets of prescription and non-prescription medication were located and seized at his residence by police following his death.

Police located morphine and codeine-containing medications including MS-Contin CR 10mg (5 packs of 28 tablets, and 1 pack with 1 tablet remaining, totalling 141 tablets); MS-Contin 15mg (1 pack with 23 tablets remaining); Ordine 5mg (200mL bottle with 102 mL remaining); and Codapane Forte 500/3mg (26 packs of 20 tablets, totalling 520 tablets).

All of this medication had been prescribed by his regular GP, who he had been seeing exclusively for the last four years, under the direction of a regular pain specialist.

There was no evidence to support that the man was a “doctor shopper” in the way the term is conventionally understood, said Coroner Morrison.

However the amount of prescription opioid medication located in his residence was cause for concern.

The GP testified that the man had been prescribed MS-Contin for more than 15 years, adding that he would only issue the man with a one-month supply of the drugs at a time.

In the months before his death, the man’s maintenance doses of MS-Contin were in fact slightly reduced, from 15mg MS-Contin in the morning and 20mg at night, to 15mg twice daily.

Codapane Forte was last prescribed on 10 July 2015 with five monthly repeats, and the man filled that script every month.

Meanwhile he was provided with a supplementary morphine liquid supply (Ordine), prescribed at roughly two-monthly intervals, which he could use for breakthrough pain.

The pain specialist said the back-up supply of morphine mixture was “only minimally used in recent times”.

However medical records showed that the man was prescribed Ordine six times during 2015, and he picked up all these scripts.

“Overall the picture illustrated by the evidence is one of [the deceased] having his medication dispensed on the first available opportunity and stockpiling his medication, whether he needed it or not,” found Coroner Morrison.

“I note particularly in this regard the 520 tablets of Codapane Forte located in [his] residence by police.

“The evidence of continued prescribing and a half empty bottle being found by police (having been dispensed approximately one month earlier) suggests that [the man’s] Ordine use was approaching the maximum limit of 3mL per day in the period before his death.”

The evidence did not warrant any adverse comment to be made against the GP and pain specialist for their treatment and care, the coroner found.

“[The deceased] had been placed on a complex prescription regime that he had apparently managed successfully for many years,” said Coroner Morrison.

“There is no evidence located suggesting suicide. While the existence of high levels of morphine in [his] blood might suggest the non-accidental consumption of high levels of medication, I note also that morphine does have an intoxicating effect such that a person might accidentally consume more than intended.”

Coroner Morrison pointed out that ACT coroners have commented in many recent cases about the difficulties of treating opioid-dependent patients, and the dangers that can arise from too-readily available prescription medication.

For example, the death of an ACT man in 2017 saw the territory’s Chief Coroner Lorraine Walker urgently call for real-time prescription monitoring in NSW following a man’s death after buying opioids in both states.

Coroner Morrison said the circumstances of this case were “different” and made no recommendations on the matter.

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