Isaac Reis died with a toxic combination of drugs in his system, but it was not an overdose or suicide

The night before Isaac Reis died, the 22-year-old knew something wasn’t right.

Isaac was so concerned about all the prescription medication he was taking, he asked to stay at his parent’s house.

The 22-year-old had recently moved out of home, but he phoned his father Paul Reis late that night asking to be picked up.

« When I picked him up, he was slightly sedated. He’d taken his night-time medication, » Mr Reis told the ABC.

Isaac told his father he wanted to be readmitted to a psychiatric hospital to have all of his medications reviewed.

« He was concerned. And I was concerned at the time too, because the further we got to home he became a lot more sedated. »

When they arrived home, Isaac was groggy and unsteady on his feet. He fell asleep in a chair and Mr Reis helped his son into bed at around midnight.

« I just didn’t know the gravity of the situation and I didn’t know all of these medications that had been prescribed to Isaac. »

Isaac had taken a toxic combination of 10 different drugs, as prescribed by his doctors, and was entering what a forensic physician has described as a « terminal slide ».

The next morning, Mr Reis found his son unconscious. Paramedics worked on Isaac for an hour but could not revive him.

Isaac’s death is being investigated by Brisbane coroner Donald McKenzie.

Mr Reis says his son died because of a « litany of failures » in the healthcare system.

« Isaac is no longer here, not because he did not follow the advice of doctors, but because he did. »

Mr Reis says Isaac’s doctors and his pharmacist failed to warn him of the deadly risks of taking so many prescription drugs.

And the family believe a centralised real-time script monitoring system and better consumer medication warnings might have saved their son.

Isaac Reis was an active, happy child who was passionate about his rugby.

« He was always cracking jokes and making people laugh, » his father, Paul Reis, said.

« He was very compassionate and caring and if someone was a bit upset, he’d brighten their day. »

In year 12, Isaac was working part-time at his father’s Brisbane seafood shop when he injured his lower back lifting a crate.

« That had a huge effect that stopped him from being able to go to the gym, » Mr Reis said.

« It stopped him from playing sport. He put on a lot of weight. It also affected his mental health. He got depressed and anxious because he was worried about his future. »

In 2018, Isaac had suicidal thoughts and was admitted to hospital twice after attempting to overdose on his medication.

In June 2019, Isaac was admitted to a private psychiatric hospital, New Farm Clinic. He stayed there for eight weeks.

« The psychiatrist got him on an effective antidepressant whilst he was in hospital, » Mr Reis said.

« He wasn’t taking any opioids. He was on a benzodiazepine to be taken as needed for anxiety and panic and his mental health improved incredibly.

« He returned to the Isaac from old where he was happy, looking forward to the future. »

His best friend, Beau Ransome, said Isaac came out of hospital with a sense of optimism.

« He was planning to move out and gain that independence that you kind of get when you move out and become an adult, » Beau said.

After his release from hospital, Isaac gave his parents flowers and a handwritten card.

« Thank you for your support and understanding during this period of my life, just know it has helped immensely in my recovery and I love you both dearly — Your son Isaac xxxo. »

Things were looking up for Isaac.

He’d lost weight, lined up a job interview and had moved out of home.

But despite his determination to get better, within weeks he would be dead.

When he left the psychiatric hospital in early August 2019, Isaac was on seven medications.

They included an antipsychotic and two antidepressants

an antihypertensive and an anticonvulsant …

a benzodiazepine and an opioid.

On August 10, a week before he died, Isaac bought a packet of over-the-counter antihistamine.

On August 15, he aggravated his back injury and his GP prescribed two opioids.

On Saturday August 17, the day before he died, Isaac had a panic attack.

His GP prescribed the benzodiazepine Kalma, a generic form of Xanax.

Isaac turned up at his father’s shop that afternoon. Mr Reis said his son appeared confused and sedated.

« He had slurred speech and was unsteady on his feet. I took his car keys off him as he should not have been driving. He came out of the back of my shop and slipped over. He was screaming in pain and I called triple-0. »

Isaac was taken by ambulance to St Andrew’s Private Hospital, where the emergency doctor noted a « red flag for addictive substance ».

Despite this, the doctor gave him another script for Endone.

That night Isaac called his father and asked to stay at home.

« He said to me that he was concerned about the amount of medication he was on and he wanted me to contact New Farm Clinic on the Saturday morning so that he could be readmitted, so that he could have all of these medications reviewed. »

At midnight, Paul put Isaac to bed with a glass of water.

Mr Reis checked on his son several times through the night before going to bed around 3am. He set his alarm for 8am.

« When I checked on him at 8am and then around 8:40am he was still on his back in the same position, » Mr Reis said.

Mr Reis telephoned the New Farm Clinic to book Isaac in for a medication review.

He went back to check on Isaac around 9:30am.

« He wasn’t snoring loudly which I found odd, » Mr Reis said.

« I went over to him and he was just — something wasn’t right. »

« I called his name out, and there was no response, and then I put my hand over his mouth and there was no breathing, then I’ve touched his chest and his face and he was warm to touch, and then I grabbed his left hand and it was stone cold.

« And my heart just sank. »

« While I was doing that I was just in an absolutely frantic state because I just felt that he’d already passed away and I didn’t know whether I was helping or not, » Mr Reis said.

« It’s just an absolutely horrific, traumatic situation to be in. »

« I worked on him and ended up then doing CPR on him waiting for the ambulances to arrive. I just kept listening for sirens and I just couldn’t hear any. It was about 20 minutes to half an hour where I was working on him. »

The paramedics worked on Isaac for another hour before pronouncing him dead. He was 22 years old.

« It’s just unbelievable. For a while after Isaac’s death, I used to blame myself and was very hard on myself because I thought I’d failed him, » Mr Reis said.

« But when I found out the medications that were in the system from the autopsy report … I just think Isaac didn’t have a hope in hell of surviving from that mix of medications, given his sleep apnoea. »

Isaac’s death is being investigated by Brisbane coroner Donald MacKenzie.

« I would go as far as to say it was a death sentence because he was on … medications whose serious side effects were sedation, respiratory depression, coma and death, » Mr Reis said.

« Just the simple fact of taking one opioid and benzodiazepine increases the risk of death to patient by 15 times. »

According to the Penington Institute’s latest Annual Overdose Report, opioids are the leading cause of all drug deaths in Australia – responsible for 900 unintentional deaths in 2018.

Benzodiazepines are the second leading cause of unintentional drug deaths — 684 in 2018.

These two drugs alone cause more deaths than the national road toll.

The report finds deaths involving multiple drugs are the norm and have more than doubled in the four years to 2018.

The Reis family has found an ally in retired insurance executive Patrick O’Connor.

 « Isaac had no chance of survival with that level of medication and I wanted to do anything I could to help them, » Mr O’Connor said.

« It was a cumulative effect for Isaac. They just kept loading him up with drugs that slowed his heart rate and breathing until it stopped. »

Mr O’Connor left his highly paid executive job in 2012 after being diagnosed with severe depression. He was prescribed a range of medications including antidepressants, benzodiazepines, opioids, mood stabilisers, and antipsychotics.

« I was struggling. I reached a point where I didn’t think I was going to make it. »

In desperation, he sought treatment in the United States. He was surprised to find there were far more consumer warnings about prescription drugs than in Australia.

In Australia, these warning leaflets are known as CMIs — consumer medicines information.

« The warnings that are not in the CMI’s are the exact warnings risks and side effects that are causing drugs deaths in Australia. »

He’s used his report to complain to the Therapeutic Goods Administration (TGA) and Australian Human Rights Commission.

In a written response to Mr O’Connor complaint, TGA head Professor John Skerritt wrote:

« While the CMI should inform patients about the relevant risks of their medicines, the content is framed in less technical language, so that it is easily understood and does not disadvantage those with lower levels of health literacy. Provision of the CMI to a patient is an important tool for educating patients about their medicines but it is not meant to be a substitute for the discussion about risks and benefits that occurs between a patient and their doctor ».

« I’m not complaining to the TGA that there is not a warning that I might have a rash behind my ear, » Mr O’Connor said.

« I’m complaining to the TGA that I could die and that’s not in the CMI. »

In April 2020, the TGA added black box warnings to opioid CMIs, including Endone and Mersyndol Forte. The warning states the drugs can cause life-threatening respiratory depression and carry the risk of coma and death when mixed with other drugs.

Mr O’Connor says the new warnings were added too late to save Isaac Reis and are not included in the CMIs for other medications including benzodiazepines, antihistamines, antidepressants, antipsychotics or gabapentinoids.

Prominent psychiatrist Professor Ian Hickie believes the bigger problem in Australia is the lack of a single, national database that would enable all doctors and pharmacists to check, in real time, what medications a patient is taking.

« We can’t be using papers and pens to record key information. We can’t be not noticing what is happening as a person moves with complex health problems through a complex and, in our case, a fragmented health system, » Professor Hickie said.

« It’s no longer good enough. It puts lives at risk. »

The federal government announced a national real-time script monitoring system in 2017 but it has not been implemented. Each state and territory is still developing its own system.

Queensland, where Isaac died, has a prescription drug monitoring program that collects dispensed schedule 8 (S8) prescription drug information on a weekly basis and provides a telephone enquiry service for doctors. However, the data is not available in real-time or automatically accessible to clinicians.

In October 2019, Queensland Health signed an agreement with the Commonwealth for the development of a real-time monitoring system. A spokesperson was unable to provide an implementation date, saying it was subject to « parliamentary process ».

Medical negligence lawyer Tom Ballantyne believes the delay in establishing a national scheme is costing lives.

« Unfortunately, deaths like Isaac’s occur all the time. We’ve seen them for years, coroners around Australia have been investigating them for years. And to me that really demonstrates that there’s something wrong with the system, » Mr Ballantyne said.

« It’s not something that can be left to a piecemeal approach. It needs to be national, it needs to be comprehensive and real. It needs to happen soon. »

Mr Ballantyne said GPs should be better equipped to provide a holistic and detailed level of care.

« When it comes to prescribing, so much is just left to the GPs to manage, but they’re often operating in the dark because they don’t have the right information, » he said.

« They’re operating under time and resourcing stress and it really doesn’t create an environment where they’re able to give appropriately tailored, detailed and comprehensive advice and treatment. »

Paul Reis is urging Coroner MacKenzie to recommend systemic changes which might prevent more medication deaths.

« To prescribe and dispense these medications without warning Isaac of the risk of death is abhorrent. We deserve answers and accountability, » he wrote.

« I just want to stop one father, one mother, from finding their child and having to go through what I went through. »

Isaac’s GP and psychiatrist did not respond to requests for comment. His pharmacist declined to comment.

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