Andre Roderick Stewart MICKLEY · Prevention of Future Deaths report

On 9th March 2015 I commenced an investigation into the death of Andre Roderick Stewart MICKLEY, age 36 years. The investigation concluded at the end of the inquest on 17th June 2015. The conclusion of the inquest was Narrative Conclusion.

Andre was a long term multiple drug user who had used Methadone, Cocaine, Diazepam, Heroin and Pregabalin for several years without major ill effects. On the morning of 17th February 2015 he used heroin and cocaine. He collapsed shortly thereafter, suffering a massive subarachnoid haemorrhage. Despite neurosurgical intervention, he died on 23rd February 2015. A few days before his collapse he had been prescribed Citalopram and this drug and its metabolites were present in hospital admission blood samples, together with Cocaine, Methadone and Heroin metabolites.

1. There are clear potentially adverse pharmacokinetic interactions between Cocaine and the SSRI group of drugs, as well as case reports. (e.g. FU K et al. ). Journal of Analytical Toxicology. 24C7:648-50, 2000). In general, the Summary of Product Characteristics (SPC) and the Patient Information Leaflet (PIL) do not suggest prescribers seek a history of substance misuse or patients exert caution and seek advice before prescribing or using medicines that have the potential to interact adversely with drugs of misuse. This includes adverse interactions other than just those between SSRI and cocaine