Portsmouth dad of six died after being prescribed more than 200 opioid tablets in one week - and his family will fight for more answers

At Portsmouth Coroner’s Court, an inquest was held into the death of Richard Peters from North End, Portsmouth, who died aged 40 on March 22 last year.

The inquest, heard by area coroner Jason Pegg, heard how Richard suffered a respiratory failure in his home, after suffering with long-term pneumonia and recent broken ribs. A post-mortem found a lethal dose of tramadol in his system, as well as a combination of morphine and gabapentin – the latter of which he had been taking since 2013 after a fall.

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In the week leading up to his death, the Derby Road GP surgery increased his morphine prescription and gave him a total of 202 tramadol tablets, despite Richard having a history of becoming addicted to prescription medication. No risk assessment was recorded by the practice.

Dr Jennifer Vanner from the GP practice explained that he received 30 tablets on March 14, 60 extra tablets on March 17 as he planned to travel to Yeovil, and 112 on March 18 as a repeat prescription.

She said: ‘Richard gave me a reasonable reason as to why he needed the increased prescription on March 17 – I increased his prescription as he told me he would be out of the area, to last for the time he said he was away. That is standard practice.

‘We cannot withhold medication for people in acute pain just because of their past history; he was in pain.

‘I wouldn't be happy [with a patient having extra medication] but I accept that it happened.'

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The post-mortem, carried out by Dr Adnan Al-Badri, discovered that Richard had 2.3mg per litre of tramadol in his system – four times the therapeutic rate. Having 2mg per litre is enough to be fatal.

He was also found to have 0.162mg per litre of morphine.

Dr Al-Badri said: ‘I think he would have died even without pneumonia because of the levels [of tramadol] we found, although it would have contributed.

‘I would say the morphine levels were not sufficient to cause death. It was above the therapeutic level but it’s probably that he had built up a tolerance over the years.’

The court heard how Richard's gabapentin medication would also have lowered his body’s tolerance to the opioids he was taking.

Paying tribute to her husband, widow Helen Peters said: ‘You would remember him if you met him – he was loud but in a good way. He would talk to anybody and had an amazing soul.

‘We were married for four-and-a-half-years and had a little girl together.

‘He did have an addictive personality to anything, including prescription medication. But he was my soulmate.’

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Coroner Jason Pegg recorded Richard's death as one of misadventure, concluding that he likely took more of the painkillers to dull the ‘significant’ pain he was experiencing.

He said: ‘Richard died on March 22 having suffered a respiratory failure, in consequence to consuming substantial quantities of tramadol, morphone and gabapentin.

‘It seems to me that he chose to consume those three drugs, and when he did so it was likely to alleviate the pain he was suffering. The appropriate conclusion in this case is one of misadventure.’

A statement from the family, given to The News, said: ‘Our loving Rich was a son, brother, uncle, nephew, husband, friend and above all a dad-of-six . His blended family of children are all aged between three to 19 years old. Rich was a big character, his infectious laugh and big bear hugs were things you would never forget.

‘He lived for his children and as a family we are heartbroken that he has been taken away from them so suddenly. Our legal team, Middleton Law, will be taking over the case to seek more answers into the circumstances of his death and his treatment in the months leading up to it.

‘No family should have to go through this. Miss you Rich – forever 40.’