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Doctors And Professors Rapidly Respond, Warning of “Unintended Risks” When Following NICE Guidance to Treat Covid with Morphine and Midazolam

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A letter to the editor of the British Medical Journal (“BMJ”) warning of “unintended risks” was published on 20 April 2020, the same day that BMJ published the NICE guidelines.  The letter was signed by eleven highly qualified doctors and professors.  “These doctors and professors raised concerns about the advice contained in the NICE guidance,” Clare Wills Harrison told Dr. Bryan Ardis.

Wills Harrison, a UK lawyer, has several legal cases where midazolam has clearly been misused.  Midazolam seems to have been used in the UK the same way as remdesivir has been used in the USA so Dr. Ardis discussed the use of midazolam in the UK with Wills Harrison.

As the discussion covers a great deal of important information, we are taking extracts and publishing them in a series of articles.  This article is the fourth in the series, follow the links to read Part 1, Part 2 and Part 3.  You can also watch the full 90-minute discussion ‘UK Attorney, Clare Wills-Harrison, exposes “End of Life” drugs, protocolsHERE.

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The National Institute for Health and Care Excellence (“NICE”) guidance NG163, ‘Managing COVID-19 symptoms (including at the end of life) in the community: summary of NICE guidelines’, stated that when managing key symptoms of Covid in the last hours and days of life, follow the relevant parts of NICE guideline NG31.

“We are concerned that uncritical use of NG163 may create unintended risks for people with suspected or actual Covid-19 infection,” wrote the authors of the letter to the editor of the BMJ.

The letter continued: “The earlier NICE guideline NG31 (2015) for symptom management at the end of life was based on studies … [from which] the evidence base was so poor that it did not publish detailed recommendations for drugs and doses. We are unaware of more recent high-quality research evidence that NICE could have used to produce such specific drug and dosing recommendations now for Covid-19 patients.”

The letter further explained that the NG31 guidelines “was aimed at care of people who were likely to die in the coming hours and days – usually from advanced diseases, from which recovery was deemed most improbable.”

“These doctors are telling you that they have no idea how NICE have come up with the recommendations that they have.  And, what they are referring clinicians back to is a guidance sheet for people in the advanced stages of cancer where the evidence base was so poor that, that didn’t even publish drugs that should be used and at what dosages,” Wills Harrison said.

“We have further specific concerns. NG163 recommends codeine and morphine for the management of cough and breathlessness … which can lead to little or no effect in some patients, or severe opioid toxicity in others,” the letter’s authors stated.

After describing alternative drugs that could be used the letter stated:

“The combination of opioid, benzodiazepine and/or neuroleptic is used in specialist palliative care settings for symptom control and for ‘palliative sedation’ to reduce agitation at the end of life.  It takes great skill and experience to use palliative sedation proportionately so that extreme physical and existential distress are palliated, but death is not primarily accelerated. NG163 states: ‘Sedation and opioid use should not be withheld because of a fear of causing respiratory depression’. If Covid-19 infection were uniformly fatal, this would be an acceptable statement. But for people not previously known to be at the end of life, there is potential risk of unintended serious harm, if these medications are used incorrectly and without the benefit of specialist palliative care advice.”

“I can’t stress enough that I believe that these eleven highly qualified and regarded doctors were trying to warn people and warn other doctors,” said Wills Harrison.

“When you consider midazolam and morphine was used in care homes and in the community: there was no specialist palliative care advice; there was no consideration of other drugs to use; there was no [benefit] to using midazolam and morphine to treat Covid.”

The Dr. Ardis Show: Clare Wills Harrison, BMJ Letter to the Editor, 17 January 2022 (7 mins)


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1 year ago

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