The painful passing of a loved one leaves Áine Mac Grory imploring pharmacist colleagues to make every contact count
Cause of death: Suboxone
It’s been four weeks now since I learned about the loss of my friend whom I held so very close to my heart. It feels as fresh as the day the call came in — Monday afternoon in the pharmacy. The Gardaí rang her husband and told him she was gone. “You can view the body if you get to the mortuary in the next hour.” I do not have the right vocabulary to bring this type of shock to life. It has yet to wear-off completely, but it lifts occasionally, and then pours in. How is this happening in my world? This kind of thing doesn’t happen to me. I don’t lose loved ones to overdoses — I support those who have.
How naïve
The pain is relentless. So are the questions, but the answers are mute. She was a mother, a daughter, a wife, a sister, and a dear friend. The circumstances surrounding her passing will never be fully known. It seems that the party was winding down, but there was someone there determined to keep it going at all costs. A life, in this instance. That someone shared their prescribed opioid substitution treatment (OST), Suboxone, with my opioid-naïve friend. She became unwell, and nothing was done to save her. The only concern when she lost consciousness was the removal of anything valuable from her failing body. Considerate enough to leave her driver’s license to aid with identification later. The lack of care or instinct to provide even basic life-saving intervention haunts me. How is that not instinctual? At this stage in my writing, rage and grief overtake me, and my ability to articulate fails. You get the picture.
International Overdose Awareness Day (IOAD)
What an irony of fate. What should have been her 28th birthday is also IOAD. Is the universe mocking me — or imploring me to rise to the challenge? My emails were full of reminders and activities about IOAD; events I had registered for and was looking forward to. Now I will endure them, but I dread the emotions that will come upon completion. As part of the world’s annual campaign to raise awareness of drug-related overdose, the HSE National Social Inclusion Office invites you to join them at their event — to help end overdose, remember those who have died without stigma, and acknowledge the grief experienced by family and friends left behind. The sub-theme for the 2025 event is: ‘Community, Driven by Hope.’
Overdose doesn’t just shatter a family — it fractures a community
We are one community, not just because we share the pain of loss, but because we share the power to change what comes next. The power to change what comes next. I’ll admit, I paid little heed to this blurb before this tragedy occurred. Now, I feel like it was written just for me. Having to accept the ‘what next’, because there’s no going back. The stigma behind this type of loss is worse than I ever thought it could be. The idea that your grief is less valid because the person it pertains to made a bad decision. This doesn’t resonate with me. It never did. I never understood it. Do people really respond so unkindly? Who hasn’t made a bad decision in their lifetime? Sometimes that’s all it is. How many deaths occur due to poor lifestyle choices — smoking, alcohol, diet, lack of exercise? We make poor decisions every day, decisions that lead to negative health outcomes and fatality. But nobody scoffs at these deaths. I fail to see any difference, if I’m honest. We are human. We are not without fault. We all want to light-up our reward pathways, and we all choose different methods to do it. There’s no control over other people’s reactions, and this makes the sadness more isolating and painful. It’s an added layer of cruelty to an already distressing situation.
Hypotheticals
The ‘why’ is the hardest. Why did this happen? Why did she have access to Suboxone? Why did the person who uses drugs with a tolerance not understand the harm he was going to cause to someone without? Why didn’t he have naloxone?
This…
This is the question that stabs my heart. I remember so vividly the training evening I attended at the end of November 2023: ‘Diagnosis and Treatment of Suspected Narcotic (ie, Opioid) Overdose and the Supply and Administration of Naloxone. Given by Jenny Smyth, HSE Naloxone Project Lead and The National Naloxone Oversight Quality Assurance Group Chair, Dr Denis O’Driscoll.’ It was one of the most interactive sessions I’d attended — and one of the most infuriating. I’m not sure Dr O’Driscoll or Ms Smyth anticipated dwelling on certain points, but I was compelled to voice my frustrations. To their credit, they heard them and engaged with them. The facts were clear: Naloxone saves lives. Naloxone reduces harm, and yet, at that time, there were still huge barriers to access. Frustrating legislative restrictions — my personal pet peeve in healthcare. The rules are the rules, and that’s that. And as we all know, legislative change takes time. And time is more precious than we’ll ever know. Over the past 10 years, incremental changes in legislation have expanded access to emergency medicines. Starting in 2015, trained non-medical staff were allowed to administer certain prescription-only medicines; naloxone was added in 2018, HSE training approved in 2023, and updated product options were introduced in 2024. The distribution and use of naloxone in Ireland has grown significantly. From just over 3,000 units in 2022 to nearly 7,000 in both 2023 and 2024, the use of intranasal products like Nyxoid and Ventizolve has increased, with hundreds of overdose administrations reported each year — and dozens of lives saved as a result. Seven lives saved so far this year. Could it have been eight? I’ll never know. In my Utopian world, that question will never be uttered again by those grieving the loss of their loved one. Let them have one less ‘what if’.
The guidance
If the postmortem confirms buprenorphine as a contributing factor, this case should be highlighted and considered in future prescribing decisions. The idea of people sharing their medicine, intended for their use only, is not new. It happens across the board, in all walks of life. Antibiotics left over in the medicine cupboard is a classic. This case now reinforces the urgent need to address the risks of sharing prescribed medicines. I wonder how much credence is given to certain points in the guidance. When I was told it was prescribed OST, I couldn’t come to terms with it. Who misuses buprenorphine?
3.4.1 Prescribers
“Once a decision has been made to prescribe OST, patients should be informed of the rationale for treatment, the expectations placed on them (such as daily attendance for supervised doses), and what they can expect, either verbally or by a written consensual agreement. There should be a mechanism whereby the treatment provider records that the information regarding safety measures with OST is imparted to the patient.”
3.4.2 Pharmacists
“Prior to commencing supply to an OST patient, the pharmacist should discuss with the patient any issue that either deems significant, including: ‘Risks associated with giving methadone or other medicines to another person’.” It’s there, but is this another case of ‘everyone thought someone else did it, so no-one did’? There are cases cited in the guidance referencing the death of a baby due to accidental ingestion of methadone. Does my loved one’s passing need to be cited to support the importance of these points? Do we need to reassess and re-emphasise to the healthcare professionals involved in these services? Is compassion fatigue creeping in? This death was an avoidable tragedy. A member of an OST programme produced their personal supply of suboxone, which was taken via intranasal insufflation — the nail in the coffin that caused an untimely death. I do not know any casual recreational drug users who seek out buprenorphine to catch a buzz. Does more work need to be done to make the public aware? I am certain she did not know what she was taking. She did not know what buprenorphine was. It is not a commonly used drug of abuse. Why would it be? As opioid buzzes go, it plateaus regardless of how much is taken. Overdose is rare — but not rare enough.
Do me a favour
For the month that’s in it, I implore those reading this to get involved. Do the naloxone training. Register for the webinar. The HSE National Social Inclusion Office is hosting a free live webinar on Friday 29 August from 11:00–12:30. Much is already being done, but there’s still a long way to go. The next opportunity you get, engage with your OST patients and explain what you are giving them. Tell them not to share — tell them again, and again, and again. Tell your patients who use drugs, whether recreationally, rarely, or never, to use in familiar surroundings and with people they know and trust. Don’t stop reinforcing this. It might seem so obvious to us, and I did what I tell all my team members not to: Do not assume any baseline level of knowledge, no matter who comes through the door. I wish so badly I could go back in time and tell her what I knew. What good is knowledge if I don’t pass it on?
Make every contact count
That contact doesn’t have to be confined to the four walls of the pharmacy. You never know when it might land. You never know who that might save. Maybe you will spare a child the pain of being told that mommy had to go and she can’t come back for the weekend, even though she promised to buy you sweets if you were good. The damage is irreparable, and the harm is not contained to that of the deceased. The harm impacts all those left behind. The best you can do is cope with it, exist with it. It is here to stay. We owe it to those we’ve lost to make sure there are no more needless goodbyes.
USEFUL LINKS
- WebinarRegistration:https://zoom.us/webinar/register/WN_sbrIHj0tRWmFaauy5zzWrA#/registration.
- https://www.hse.ie/eng/about/who/primarycare/socialinclusion/addiction/clinical-matters/naloxone/opioid-overdose-awareness-and-naloxone-administration-training.html.
- clinical-guidelines-for-opioid-substitution-treatment.pdf.
- https://drugs.ie/KnowingtheSigns.
- Naloxone – Drug and Alcohol Information and Support in Ireland – Drugs.ie.
- Drug Overdose Campaign – Drug and Alcohol Information and Support in Ireland – Drugs.ie.
- https://www.hse.ie/eng/services/list/5/addiction/drugshivhelpline/.
