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An inquest into the death of a man from complications of pneumonia and excessive use of codeine heard “compelling” evidence that GPs have no specialist commissioned service to refer patients to in order to help them reduce their intake of prescribed dependency-forming medicines. 

A report on the inquest in Essex published last month on the death of 46-year-old Michael Paul Barry, who died at Broomfield Hospital in Chelmsford in November 2023, said he had a long history of mental health problems and illicit drug and alcohol misuse and developed a dependency on prescribed opiate-based painkillers following surgery years before his death.

The report also said he attempted suicide by overdosing about three months before his death and although he had “significantly diminished” his use of illicit drugs, he was binge drinking “to excess”. 

Codeine taken in excess prior to his death

The coroner ruled Barry died from “fatal complications of a community acquired pneumonia on a background of excessive use of codeine medication” after receiving “optimal medical care following admission to hospital”.

The inquest heard the codeine identified in Barry’s post-mortem was “likely not from the medication prescribed by the deceased’s GP practice”, although “the evidence did not disclose the source of the codeine taken in excess prior to his death”.

“No direct causative link could be found, to the requisite standard of proof, between the prescribed medication itself and the death and no finding or determination was made that was critical of the GP’s ongoing prescribing of the pain-killing medication,” the report said.

It revealed a partner at the GP practice with a “particular specialism in dependency-forming medications” gave “compelling evidence” during the inquest that “there remains no specialist commissioned service available for GPs to which they might refer their patients to manage reduction of their intake of prescribed dependency-forming medications”.

That, the inquest heard, was in contrast to commissioned services available for patients who are dependent on illicit drugs and alcohol. The report said the “lack of specialist support” was “a significant concern”.

Commissioned service would need to be ‘very carefully managed’

The report went on to highlight that a commissioned service helping people reduce or stop taking dependency-forming medications would need to be “very carefully managed due to the risk of withdrawal symptoms” and required “specialist input and training”. It warned the absence of such a service meant “avoidable” deaths could occur in future.

Evidence that primary and secondary care lack such services was also provided by Paula Wilkinson, the director of pharmacy and medicines optimisation at Mid and South Essex Integrated Care Board.

The report said: “This witness helpfully set out important steps currently proposed and/or being taken to educate clinicians and service users alike of the dangers of opiate-based prescription medications with a view to reducing the size of the cohort of patients at risk of becoming dependent/addicted in the medium and longer term.”

However, the report warned those steps failed to “address the immediate and on-going risk of future deaths to those currently dependant (and) addicted to these medications”. It said the number of those patients had “significantly increased” because of “lengthy delays to chronic pain-relieving surgery”.

The report also noted that in 2019, Mid Essex clinical commissioning group said it would commission a prescribed opioid dependence local enhanced service in early 2020 which never materialised because of the Covid pandemic.

“Since then, including at the date of Mr Barry’s death in November 2023 and through to today, there remains no such, or similar, commissioned service across Essex or, it appears, consistently across England and Wales, with only rare pockets around the country where such a service is commissioned,” the report concluded.

The coroner gave Mid and South Essex Integrated Care Board, the Department of Health and Social Care and NHS England until August 7 to respond to the report and set out any action they have taken or propose to take.