A coroner has warned NHS doctors of the dangers of repeat prescriptions after a pensioner’s death from an overdose.
Widower Peter Cole, 84, who had dementia, died after stockpiling hundreds of strong opiod painkillers.
An inquest heard that he received several repeat prescriptions per month, including 100 tramadol pills.
After his overdose a neighbour found him dead in the house in Welywn, Herts, where he lived alone.
Following an inquest into Mr Cole’s death, Hertfordshire coroner Geoffrey Sullivan issued a legal notice to NHS England warning of a risk of future deaths.
He told of concerns that poor checks meant patients were hoarding potentially lethal levels of drugs at home.
He wrote: “Repeat medication is not being adequately monitored, leading to many, often older and/or mentally infirm, patients building up dangerous quantities of prescribed medication.”
Mr Cole lived alone after his wife Joy died and was devoted to his dog. His family said they found “bags and bags” of drugs.
Sister-in-law Marina Hall, 75, said: “There was tramadol everywhere. Hundreds and hundreds of pills. It was clear he hadn’t been taking them yet they kept being prescribed.”
Mr Sullivan ruled Mr Cole’s death was “prescription drug-related” and issued a notice, called a Prevention of Future Deaths report, to NHS England chief Sir Simon Stevens after a nurse said the case was not unusual.
Recounting the nurse’s evidence, the coroner said she often visited patients, many with mental impairment, who had built up huge amounts of drugs. One had a “cupboard full”.
GPs were permitted to defer routine medication reviews to October under NHS guidance issued over Covid-19.
Age UK said it had concerns over drugs being prescribed in excessive numbers to people without the support to use them properly.
But NHS England says £80million had been invested in electronic prescription technology.
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