Deceased
LAMH
Demographics
31y, female
Date of death
2011-09-01
Finding date
2016-11-30
Cause of death
Mixed drug toxicity
AI-generated summary
A 31-year-old woman with long-standing opioid dependence enrolled in the Queensland Opioid Treatment Program died from mixed drug toxicity, with toxic levels of Fentanyl and other drugs in her system. A general practitioner prescribed her Fentanyl patches on eight occasions between April-August 2011 despite explicit regulatory warnings in June-July 2011 that she was registered on an opioid treatment program and could not legally receive such prescriptions without chief executive approval. The coroner found the GP had inadequate documentation, failed to perform proper assessments, and continued prescribing after being specifically notified of regulatory obligations. This case demonstrates the critical importance of checking opioid treatment program registries, adhering to regulatory directives, and maintaining proper clinical records when managing patients with substance use disorders.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Clinical conditions
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