Midazolam, the drug most commonly used drug in palliative care and a controversial ingredient of the toxic lethal injection concoction, is actively used as a “first-line sedative” for COVID-19 patients – particularly those classed as requiring critical care.

Whilst it is used as a sedative and anaesthetic to cause drowsiness, relieve anxiety, and in some cases cause total loss of consciousness, the drug can slow or stop your breathing completely and patients must be monitored closely if they are given a dose. Yet, why is a drug that can induce significant depression of respiration being used a key drug to treat COVID-19 patients?

It makes no sense to treat critically ill COVID-19 patients, who are battling a respiratory illness, with a sedative that causes breathing difficulties.

What is equally as disturbing is the news that the UK government obtained large quantities of midazolam through diverting shipments intended for France, which was allegedly done as a “precaution” in preparation for potential NHS shortages of the drug due to COVID-19.

Accord Healthcare, one of five manufacturers of midazolam, gained regulatory approval to sell French-labelled supplies of midazolam injection to the NHS, after having already sold two years’ worth of stock to UK wholesalers “at the request of the NHS in March 2020. For comparison, over the past five years, about 15,000 prescriptions were made each month in the UK for midazolam to be used outside of hospital, whereas in April, a staggering 38,582 prescriptions were made.

The Department of Health and Social Care (DHSC) said that the request for the extra stock was part of “national efforts to respond to the coronavirus outbreak”, including precautions “to reduce the likelihood of future shortages.”

The Royal College of Anaesthetists has labelled midazolam a “first-line” sedative when treating COVID-19 patients and has warned in guidance published on 2 April 2020 that it may be subject to demand pressure as a result of the pandemic.

In April, Matt Hancock told the House of Commons Health and Social Care Select Committee that intensive therapy unit medicines – including midazolam – are part of a “delicate supply chain” because they “are made in a relatively small number of factories around the world.”

The DHSC stated that midazolam is still available for primary and secondary care, but some suppliers of the drug had very limited stock or had completely run out.

In May 2020, a spokesperson from Accord Healthcare stated that it had no midazolam stock available after the NHS requested it “place all of its stock of midazolam – equivalent to around two year’s forecasted supply – into its wholesale partners”, despite the manufacturer currently not having any “NHS contracts in England” to supply the sedative.

Peter Kelly, managing director of Accord Healthcare, said: “As a result of the NHS request [in March 2020], we are subsequently out of stock.”

Although, according to Kelly, the Medicines and Healthcare products Regulatory Agency (MHRA) gave Accord Healthcare approval “for some French label stock – another 22,000 packs – to be sold into the NHS and [we] are currently waiting for the MHRA’s direction on where to place the stock.”

The drug manufacturer revealed that the French supply of midazolam only includes the drug at a variety of four different strengths.

A spokesperson for the DHSC said it was working with the NHS and the pharmaceutical industry to ensure that “patients can access medicines they need and precautions are in place to reduce the likelihood of future shortages.”

The DHSC confirmed that securing additional midazolam stock was one of these precautions, adding: “As part of our national efforts to respond to the coronavirus outbreak, we are doing everything we can to ensure patients continue to access safe and effective medicines.”

Considering how midazolam affects the respiratory system – potentially stopping patients from breathing – we need to question why this drug is being used to treat those with Covid, and why the UK government and NHS require such large quantities of stock of the sedative. Is it possible that midazolam may be being used to prematurely end the lives of thousands of people, who were then simply labeled another COVID-19 death?

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