Louis Naumovski, a 59-year-old man with a long history of substance use disorder, chronic pain, depression, and multiple suicide attempts, was found deceased at his home after approximately three weeks. The exact date and cause of death could not be ascertained due to advanced decomposition. Toxicology revealed multiple drugs including fentanyl, benzodiazepines, alcohol, and THC. Possible causes included intentional or unintentional opioid overdose, or cardiac/respiratory complications. He had chronic dysthymia, social isolation, and poor engagement with addiction and mental health services. Clinical lessons include the challenge of managing complex polypharmacy in patients with substance use disorders and depression, the importance of coordinated care between addiction medicine and mental health services, and recognising that even engaged treatment may not prevent tragedy in highly vulnerable patients.
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