intravenous injection of foreign debris (crushed tablets) associated with chronic intravenous drug use, resulting in acute pulmonary hypertension
AI-generated summary
Timothy Wellington, a 44-year-old man with longstanding opioid and polysubstance use disorder, died from acute pulmonary hypertension caused by intravenous injection of foreign debris (crushed tablets). He had been prescribed methadone as part of opioid replacement therapy, with takeaway doses known to Dr White to be injected rather than consumed orally. The coroner found that Dr White should not have prescribed takeaway doses given Wellington's clear history of injecting drugs, and should have required supervised oral consumption at the pharmacy. While Wellington's complex mental health comorbidities (including psychosis, depression, and anxiety) and concurrent psychotropic medications were clinically defensible, the prescribing of injectable methadone doses to a known intravenous drug user represented a preventable risk. The death was accidental, occurring when Wellington injected crushed oral tablets. Systemic issues included lack of seven-day pharmacy dosing availability in Tasmania and absence of specialised dual diagnosis services.
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Specialties
general practiceaddiction medicinepsychiatrypharmacy
opioid use disorderstimulant use disorderbenzodiazepine use disordercannabis use disorderparanoid schizophreniaanxiety disorderdepressioncluster B personality disorderchronic painchronic obstructive pulmonary diseaseasthmachronic hepatitis with portal fibrosisemphysemagastro-oesophageal refluxkidney stones
Procedures
intravenous injection
Contributing factors
chronic intravenous drug use
prescription of takeaway methadone doses to patient with known history of injecting drugs
depression with anxiety
chronic hepatitis with portal fibrosis
emphysema
polysubstance use including methamphetamine and cannabis
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