Coroner's Finding: Koeter, Jacqueline Francis

59y · Female·Global hypoxic brain injury due to mixed drug toxicity, specifically alprazolam toxicity

A 59-year-old woman with a 30-year history of alprazolam dependence for anxiety disorder died from global hypoxic brain injury following cardiac arrest caused by mixed drug toxicity, with alprazolam levels in the fatal range. She had intentionally taken excess medication on 28 September 2021 before receiving a COVID-19 vaccine dose, a pattern her daughter recognised as coping behaviour for anxiety-triggering situations. Her daughter discovered her unresponsive the next morning; despite resuscitation, she suffered severe anoxic brain damage. The coroner found no criticism of her GP, who was unaware of her medication misuse pattern and had appropriately managed her stable long-term benzodiazepine therapy. The case highlights risks of long-term benzodiazepine dependence and the difficulty patients face in disclosing medication self-adjustment behaviours to healthcare providers.