Coroner Warns Wholesalers After Man Dies From Painkiller Overdose

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A coroner in the UK has raised concerns over weak safety checks by medicine wholesalers after a man died from an overdose using painkillers he was able to purchase in bulk without scrutiny.

Paul Pidgeon, a mechanic from Surrey, was found dead in March 2022 with empty packs of paracetamol and ibuprofen beside him. An inquest later heard that he had “deliberately overdosed on paracetamol.”

Pidgeon, who owned a garage in Wimbledon, had a long-standing business account with Booker, a wholesale distributor owned by Tesco. In February 2022, he used his account to purchase paracetamol and ibuprofen in bulk, before buying more paracetamol less than a month later.

However, coroner Anna Crawford found that Pidgeon’s business “did not involve the onward supply of medication to the public,” and that “no checks appear to have been carried out” by Booker to confirm whether he was authorised to buy such products.

Crawford concluded that the case highlighted “a potential risk of future deaths” if wholesalers sell medicinal products to customers who are not licensed to supply them.

She said in her Prevention of Future Deaths report that Booker “may be selling medicinal products to customers who are not authorised or entitled to supply them to the public,” adding that this could result in “significant amounts of medicines being sold in single transactions.”

Investigations determined that Pidgeon’s death was due to paracetamol toxicity. The coroner noted that he suffered from coronary artery disease and hepatic steatosis (fatty liver disease), conditions that made him more vulnerable to paracetamol poisoning.

Health authorities have long warned of the dangers of obtaining medicines directly from wholesalers or unregulated online sellers. The UK’s General Pharmaceutical Council (GPhC) requires all legitimate online pharmacies to display its logo and registration number, allowing consumers to verify them through the official GPhC register.

Crawford said wholesalers must only sell medicines to individuals or companies with the necessary wholesale distribution authorisation or those legally permitted to supply them to the public.

Her report was sent to the Medicines and Healthcare Products Regulatory Agency (MHRA), Booker, and the Chief Coroner’s Office, noting that all had “the power to prevent future deaths.”

In a written response, Booker expressed its condolences to Pidgeon’s family and said it was unaware of the case prior to the report. The company noted that Pidgeon had held an account for over 20 years and that “qualification requirements for members were different at the time.”

It added that “various aspects” of its customer systems had since been strengthened, with new verification measures now requiring customers to prove they are authorised to sell or supply medicines.

“Booker is confident that its current systems would prevent the sale of medicines to any customers who are not authorised or entitled to supply medicines to the public,” the wholesaler said.

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