A woman has died from multiple organ failure after taking a “potentially toxic level” and “levels…associated with fatalities” of prescription-only medications (POMs), a coroner’s report last month (December 20) revealed.
Nottingham and Nottinghamshire assistant coroner Amanda Bewley said Susan Marie Karakoc “sought to treat her symptoms of fibromyalgia” with two medicines that she had purchased from websites selling prescription medication off-label.
Bewley found that the “catalyst for the chain of events leading to Karakoc’s death” was the toxicity of the two medicines, whose names were redacted from the report.
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Karakoc’s family shared evidence that she had made “over 100 purchases…in a period of a little over a year” of the drugs from websites “set up to sell prescription medication off-label”, the report said.
The coroner raised concerns around “how readily search engines return websites such as these”, in particular “those that sell highly addictive sleeping tablets and painkillers that can and do cause fatalities”.
She added that “the current system for monitoring the legitimacy of supply chains for medications available in England and Wales via prescription is not preventing the ready supply of such medications online”.
Current system “not effective”
The report said that Karakoc’s GP had not prescribed the medications and was unaware she was using them off-label to treat her fibromyalgia.
Karakoc collapsed at her home on December 1 2023 and after being transferred to hospital, she was found to have “suffered a hypoxic brain injury that was not survivable” and died the following day, it added.
Coroner Bewley said the medications “taken together acted synergistically to depress [her] cardiorespiratory system” and the brain injury that stemmed from this led to the multiple organ failure and her death.
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She warned that the “ready availability of medications such as these” from websites bypasses “patient safety measures in place and places vulnerable persons at risk of death” - representing “a real and ongoing risk of future deaths occurring”.
Bewley also raised concerns that there is “evidence that banks form a legitimate part of the supply chain and that this is crucial to the functioning of these criminal enterprises”.
“I am concerned that the current system for detecting such criminal enterprises and alerting the relevant authorities is not effective [and] I am not reassured that necessary actions to address the serious issue identified are in place,” she said.
Patient safety “top priority”
Bewley sent the report to the health secretary and science, innovation and technology secretary, as well as to the Medicines and Healthcare products Regulatory Agency (MHRA) and the Financial Conduct Authority (FCA), who all have until February 10 to respond.
A spokesperson for the Department of Health and Social Care (DH) expressed its “deepest sympathies” for Karakoc’s friends and family.
“Those selling medicines online illegally are putting patients in danger and the MHRA works with the police and Border Force to tackle this criminal trade,” they told C+D.
MHRA deputy director of criminal enforcement Andy Morling said the agency works “tirelessly with partners to tackle those responsible for selling medicines illegally and causing harm”.
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“We target all levels within these organised criminal gangs and as their tactics evolve, so do our methods to identify, disrupt and dismantle them,” he added.
“Patient safety is our top priority and we will continue working with our law enforcement partners in the police service and Border Force to prevent this offending where we can, to disrupt it where we can’t, and to bring offenders to justice where we should,” he said.
C+D approached the Department for Science, Innovation and Technology (DSIT) for comment, while the FCA said it will “carefully consider the report on this important issue and respond by the deadline”.