Coronial — Australian Coroners Findings

115 results for “prescription drug addiction”

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NSWcommunity2021-12-21

Inquest into the deaths of Lars FALKHOLT, Vivian FALKHOLT, Jessica FALKHOLT and Annabelle FALKHOLT, and Craig WHITALL

Male·Combined effects of multiple blunt force injuries and the effects of fire (Craig…

…ion monitoring between prescribers; (2) emergency doctors unaware of Whitall's repeated hospital visits and drug-seeking pattern; (3) decision to supply 20mg diazepam as take-home doses on Boxing Day despite signs of pro…

general practiceemergency medicinemedicationcommunicationmethadone

TAShome2025-12-02

Coroner's Finding: de-identified DQ

54y · Female·mixed drug toxicity (methadone and diazepam)

…cularly consecutive weekend doses), not documenting detailed risk-benefit assessments, not increasing urine drug screening frequency, inadequate investigation of reports she was diverting methadone, and not pursuing addi…

general practicepharmacologydiagnosticmedicationmethadone

NSWcommunity2019-03-01

Inquest into the death of DB, JD, DC, RG, AH, AB

multi-drug toxicity (opioids, heroin, benzodiazepines, prescription drugs)

…related deaths in NSW occurring in May 2016, with causes ranging from heroin and fentanyl toxicity to multi-drug overdoses. The coroner identified multiple preventable factors: inadequate treatment capacity (40-60% of th…

addiction medicinegeneral practicesystemdelayheroin

TASNew2026-06-03

Coroner's Finding: Brown, Nicholas, Wiki, Toni, Winwood, Matthew and Kemp, Belinda

Male, female, male, female·Nicholas Brown: combined drug (methadone and benzodiazepine) intoxication; Toni …

…PP) guidelines through excessive takeaway methadone doses to clinically unstable patients, dangerous co-prescription of high-dose benzodiazepines without safety controls, inadequate clinical assessments and reviews, abse…

addiction medicinegeneral practicediagnosticmedicationmethadone

WAhome2019-05-10

Inquest into the Death of Matthew Neil Hardy TONKIN

24y · Male·bronchopneumonia complicating oxycodone toxicity

…disorder and chronic pain who died from bronchopneumonia complicating oxycodone toxicity. He engaged in prescription shopping across multiple doctors and pharmacies, obtaining oxycodone and benzodiazepines despite prior …

general practicepain medicinediagnosticcommunicationoxycodone

VIChome2017-06-20

Finding into death of Finding Ms RF

50y · Female·Potentially fatal multiple drug toxicity (oxycodone, mirtazapine, citalopram, cl…

…ld woman with epilepsy and chronic pain from a workplace wrist injury, died from potentially fatal multiple drug toxicity involving oxycodone, mirtazapine, citalopram, clonazepam, and pregabalin. She engaged in prescript…

general practiceneurosurgerysystemcommunicationoxycodone

TAShome2020-06-12

Coroner's Finding: Arnold, Derek William

51y · Male·acute methadone toxicity

… revealed 35 breaches of the Poisons Act 1971 by the prescribing GP, predominantly (23 cases) involving prescription supplies where prior authorities had expired without renewal. The coroner could not determine if the ov…

general practicepain medicinemedicationsystemmethadone

VIChome2019-06-12

Finding into death of MKT

38y · Male·Toxicity to heroin

A 38-year-old man with a 24-year history of heroin addiction died from heroin toxicity shortly after release from prison. He had recently completed a 3-month custodi…

emergency medicinegeneral practicesystemcommunicationheroin

WAhome2004-10-28

Inquest into the Death of Kelly

33y · Female·Combined drug toxicity, with thioridazine as the principal component, in the con…

Lou Ann Kelly, aged 33, died on 3 April 2003 at Royal Perth Hospital ICU from combined drug toxicity, primarily thioridazine, after consuming large quantities of prescription medications with alcohol…

general practicepsychiatrysystemthioridazine

VIChome2014-06-12

Finding into death of Maree Arthur

45y · Female·Pethidine toxicity

…igns of medication dependence, including stories about lost/stolen medications—established indicators of addiction. Dr P. naively trusted Ms Arthur despite inconsistencies in her accounts. The case highlights risks of c…

general practicepain medicinemedicationdiagnosticpethidine

TAShome2020-02-18

Coroner's Finding: Evans, Conor Maclaren

19y · Male·mixed drug toxicity (methadone and diazepam)

A 19-year-old male died from mixed drug toxicity following ingestion of illicit methadone and diazepam. He was a regular user of illicit substances…

general practiceforensic medicinesystemcommunicationmethadone

VICcommunity2022-06-24

Finding into death of H YO

44y · Male·Heroin toxicity

A 44-year-old man with a 24-year history of opioid addiction died from heroin toxicity two days after release from prison on a Community Corrections Order. He had be…

addiction medicinecorrectional healthsystemdelayheroin

TAShome2025-12-11

Coroner's Finding: de-identified SH

57y · Female·aspiration of gastric contents caused by combined drug and alcohol toxicity resu…

…th complex medical and mental health conditions died from aspiration of gastric contents caused by combined drug and alcohol toxicity. She had severe chronic pain following abdominal surgeries, opioid addiction managed w…

general practicepharmacologymedicationmethadone

NSWhome2017-03-15

Inquest into the death of Meaghan Gardner

44y · Female·Acute bronchopneumonia complicating multi-drug toxicity (alprazolam, opiates, be…

…blems, pneumonia, schizophrenia, and substance abuse, died from acute bronchopneumonia complicated by multi-drug toxicity (alprazolam, opiates, benzodiazepines, hydrocodone, quetiapine, and cannabinoids). On 3 November 2…

respiratory medicinepsychiatrydelaycommunicationalprazolam

TAShome2021-12-21

Coroner's Finding: O'Donnell, Margaret Joy

51y · Female·Cannot be determined; likely mixed drug (including alcohol) toxicity or undeterm…

…5 June 2018. The cause of death could not be determined due to decomposition, but toxicology revealed mixed drug toxicity including fatal levels of methadone and hydromorphone (prescribed to her grandmother and likely ta…

general practicepsychiatrymedicationsystemoxycodone

VIChome2014-10-30

Finding into death of Anne Christine Brain

44y · Female·Intoxication by the combined effects of tramadol, methadone, diazepam, codeine, …

…madol, methadone, diazepam, codeine, alprazolam, risperidone, doxepin, and metoclopramide. She obtained prescriptions from seven different general practitioners without any coordinating physician awareness. Key failing: …

general practiceaddiction medicinesystemcommunicationtramadol

NSWhome2015-10-23

Inquest into the death of Scott Clements

36y · Male·Unknown - advanced decomposition precluded determination

…dy was in advanced decomposition, precluding determination of cause of death. He had recently relapsed into drug use including methamphetamine and prescription medications, and expressed suicidal ideation on 18 August 20…

psychiatrygeneral practicecommunicationsystemmethamphetamine

VIChome2017-07-04

Finding into death of NJ

35y · Female·combined drug toxicity

…5-year-old woman with long-standing substance use disorder, depression, and chronic pain died from combined drug toxicity involving methadone, pregabalin, methamphetamine, benzodiazepines, mirtazapine, promethazine and p…

general practiceaddiction medicineprescribingcommunicationmethadone

NThome2007-11-13

Inquest into the death of Richard Kiel

37y · Male·acute heart failure caused by multiple drug toxicity (methadone and alprazolam)

Richard Mark Kiel, a 37-year-old with chronic opioid addiction, died from acute heart failure caused by lethally high levels of methadone and alprazolam, likely consum…

general practiceaddiction medicinediagnosticmedicationmethadone

VIChome2022-01-31

Finding into death of Leeanne Matheson

52y · Female·Mixed drug toxicity (methadone, pregabalin, valproic acid, benzodiazepines)

A 52-year-old woman with chronic pain, epilepsy, and opioid dependence died from mixed drug toxicity after prescribed methadone, pregabalin, valproic acid, and benzodiazepines. She was admitted to Bo…

addiction medicinegeneral practicemedicationcommunicationmethadone

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