Coroner's Report -Canadian Society of Addiction Medicine 2011

Dr. Karla Pederson of the BC Coroner's Office presented their findings on the mortality associated with drug abuse.  Dr. Karla Pederson was quick to say that the Coroner's Office was there for 'fact finding" not "fault finding".  She said , "There is no good news at the Coroner's office. We see the worst of the worst".  The following are some of the notes I took but they really don't do justice to a far reaching and very compelling presentation.

Classify death

5 categories

natural, accident, suicide, homicide, undeterminied

1)RX  Opiate Death

Cases represent person overdosing on opiate medications prescribed to them

Deaths due to opiates 2005 to 2009  - consistent - 67-80 deaths each year

61% accidental

35% sucidial

4% undetermined

gender 50/50

2)Illicit Prescription death

-start as triplicate prescription

they started as legitimate prescription but went to someone else

‘street drugs’ are excluded

pharmacy robberies happen but marjority go back to a prescription pad in doctor's office

90 to 125 deaths due to diverted medication

Primarily male problem

30 -39  principal age

seen in all regions but more in metro areas and sold on the street

Illicit and Rx Opiate deaths - may be on rise

95% are accidental deaths

problem seems more criminal

3) RX Methadone Deaths

Prescription methadone

Overdose deaths where relevant drug was methadone

Methadone precribed to individual for maintenance or for pain

It's recognised that this is harm reduction model and harm reduction patient

Carries are a common theme, but no universal

Also high starting doses, too much initital dose

60% male 40% female

40 - 59

Happening in all regions

85% accidental 9% suicidal

4) Illicit Methadone deaths

Person was not on methadone

Uniformly has to be a carry diversion

40 50 yo population peak

The take home message here was 'a carry can end up anywhere".

The presentation was extremely well conceived and brought together. Dr. Pederson was a remarkable professional and handled the most difficult questions at the end with amazing dexterity. There was concern among the physicians with the direct buying of drugs from other countries and access across borders.  The contrasting message of physicians not treating pain sufficiently or clients complaining that doctors don't give them sufficient methadone replacement medication in a timely fashion was all brought together. Especially concerning was the prescribing of excessive benzodiazepines by physicians other than the methadone doctors and the respiratory failures being ascribed as a 'methadone death'.  Indeed the discussion was one of the best following a presentation and Dr. Pederson did a marvellous job of answering the wide range of questions.  Obviously physicians as well as the coroner's office were especially concerned about death.
"First do no harm" was a concern we all shared.