Call for coroners to record prescription drug use

THE niece of a County Tyrone man, who took his own life, is calling for coroners to record all the prescription medication a person has been taking in the period prior to their death.

Coalisland man, Stephen O’Neill, died in July 2016, less than two months after he suffered an adverse reaction to an antidepressant called Sertraline (also known as Zoloft).

While the coroner at Mr O’Neill’s inquest stated that the Sertraline “possibly contributed” to his death, his consumption of this drug was not recorded on his death certificate.

This has led Mr O’Neill’s niece, Colleen Bell, to campaign for change to the coronial system to ensure all the pharmaceutical drugs a person has been taking in the lead-up to their death, are officially recorded by coroners.

All unnatural deaths, including both drug and suicide deaths, must be reported to coroners.

However, Ms Bell is concerned that the current system doesn’t allow for “possible links”, between prescribed antidepressant medication and suicide, to be “fully known”.

Mr O’Neill, a brother-in-law of Sinn Féin deputy First Minister Michelle O’Neill, was prescribed Sertraline after he informed his GP that he was suffering with mild anxiety.

He began taking the drug on a Thursday. Ms Bell told The Detail: “By Friday night, Stephen was so agitated that he started feeling suicidal.”

On Saturday morning, Mr O'Neill went to his pharmacist to explain how much his mental state had deteriorated since he took the Sertraline. The pharmacist called the out-of-hours doctor who told him to stop taking the drug.

Mr O'Neill's family called a crisis team for advice and the 48-year-old musician then voluntarily admitted himself into the Bluestone Unit, a psychiatric facility in Craigavon.

In the weeks before his death, Mr O'Neill continued to be prescribed a range of drugs, from various sources, in an effort to improve his mental health.

However, his family now believe he would have been in a healthier state of mind had he stayed away from those drugs.

Ms Bell said: “In the last six weeks of his life, Stephen had been prescribed Sertraline; a selective serotonin reuptake inhibitor (SSRI), Quetiapine; an antipsychotic drug, Mirtazapine; a serotonergic drug, and other drugs such as Diazepam, Propranolol and Zopiclone.”

The last drug that he was prescribed before his death was Buspirone which is used to treat anxiety disorders.

Ms Bell said: “Stephen was poly-drugged. He had been on a real cocktail which just seemed to exacerbate his symptoms.

“His mental state deteriorated massively from the point that he was prescribed the Sertraline.”

Dr David Healy is an Irish psychiatrist, working in the Department of Family Medicine at McMaster University in Hamilton, Canada, who has examined Mr O’Neill’s medical history.

He was also the expert witness for the family at Mr O’Neill’s June 2019 inquest.

Dr Healy told The Detail: “It was very clear that after a few pills of Zoloft (Sertraline), the drug had an immediate, toxic effect on him. It was clear that it caused him to feel agitated and suicidal.

“In the hospital, Stephen then explained what had happened to him and they semi-listened, in that they recorded his view, but they didn’t take him seriously enough.”

Dr Healy added that if they had taken Mr O’Neill "more seriously", the doctors would have suggested keeping him drug free for a while, but instead they “threw drugs at him”.

He said: “Stephen was handing it to them on a plate, he explained what the drug was doing to him, but they weren’t listening.

“Six weeks later, he ended up dead. It seemed to me a very clear-cut case and I was happy to get involved, and to argue the case.”

However, while Coroner Patrick McGurgan said the Sertraline “possibly contributed with other identified stressors” to Mr O’Neill’s death, none of the drugs which he was prescribed were recorded on his death certificate as causing or contributing to his death.

Ms Bell said: “The coronial system should be reformed so that coroners have to, in some way, record and later compile, in an archive, all the pharmaceutical drugs which people have been taking in the lead-up to their death – including antidepressants prescribed by doctors.

“This would mean it’s not just the drugs which are recorded on death certificates, as causing or contributing to deaths, that we can draw statistics from.”

Change

In 2016, The Detail reported that prescription drugs featured on more death certificates than illegal drugs in Northern Ireland over a ten-year-period.

However, because of the limitations in the coronial system, Coroner Joe McCrisken explained that the number of pharmaceutical drug-linked deaths was much greater than official statistics showed.

For instance, Coroner McCrisken told The Detail he oversaw the inquest of a man who took his own life “when under the influence of Diazepam that he had bought illegally”.

He added: “The dose wasn’t enough to kill him but it was enough to make him feel that he wanted to self-harm or try to take his own life.

“In that case Diazepam didn’t go on the death certificate. Diazepam will be picked up in the toxicology report, it will be picked up in the post-mortem, but it won’t be recorded on the death certificate as a cause of death.”

Coroner McCrisken said he was, therefore, “confident” that the connection between certain prescription drugs and suicide is a “much bigger problem” than the figures suggested.

Unlike in the example referenced by Coroner McCrisken, neither Stephen O’Neill’s toxicology report, nor his post-mortem report, showed any of the drugs he had been prescribed, in the lead-up to his death, as being in his system when he took his own life.

However, guidance from the National Institute for Health and Care Excellence (NICE) – a statutory UK agency which produces ‘evidence-based guidance and advice for health, public health and social care practitioners’ – states that insomnia, depression, nightmares, agitation and anxiety are common or very common side effects of SSRIs, which Sertraline is.

NICE guidance adds that psychotic disorders, paranoia and suicidal thoughts are also possible side effects of SSRI drugs.

Ms Bell told us it’s these issues which are “more relevant” to her uncle’s case than "toxicity levels".

The Lord Chief Justice’s Office told The Detail: “In the case of a drug-related death, if any drug (illicit or otherwise) has caused or contributed to the death (confirmed by way of a post-mortem report with a toxicological analysis) the specific drug, if identified, is included in the formulation.

“If there is more than one drug involved then the cause of death may read multi-drug toxicity without specifically identifying each and every drug, but each case is fact specific.”

However, the Lord Chief Justice’s Office declined to comment on proposals for changes to the coronial system, citing that it is not responsible for legislation.

The Southern Health and Social Care Trust told The Detail: "Whilst we are unable to comment on any individual, the trust did participate fully in the inquest process regarding Stephen’s death and we accept the coroner’s findings.”

The Department of Justice (DoJ) and the Department of Health (DoH) both declined to comment on issues raised in this article.

Ms Bell said: “They are all passing the buck. It’s very frustrating. Really, it will require political action.”

Sinn Féin Mid-Ulster MLA Linda Dillon told The Detail her party is engaged in the “formative stages” of discussions in relation to these issues.

She added: “The DoH needs to have a statistical breakdown regarding prescription medication and suicide, which could come from coroners recording all prescription medication the person had been taking in the time leading up to their passing.

“We need to establish that data to see if there are patterns between suicide and a certain profile of person being on particular prescription drugs.”

Ms Bell has had some engagement with Mental Health Champion Siobhan O'Neill about her uncle's case, though she hopes to progress this further in the coming months.

She also runs a Facebook page in her uncle's memory, called Stephen’s Voice, which has around 9,000 likes.

The page says: “We are not medical professionals, we are Stephen’s family and are here to tell Stephen’s story and raise awareness of serious adverse reactions to prescribed medications, particularly antidepressants.”

Ms Bell added that suicide rates and prescription rates for antidepressants, and antipsychotics, are both “so high” in Northern Ireland.

She said: “To better understand potential correlations between the two issues, there needs to be change in the coronial system.”