- UK health regulators first warned against combining benzodiazepines and opioids due to fatal breathing risks, then reversed guidance 16 days later to encourage the same drug mix on COVID-19 patients.
- National health guidelines urged doctors to use the combination without fear of causing respiratory depression, despite the drugs not being authorized for COVID-19 treatment.
- Patients were reportedly placed on end-of-life protocols shortly after diagnosis, even when they had a realistic chance of recovery.
- The Liverpool Care Pathway, abandoned in 2014, appears to have been reintroduced under a new name during the pandemic, with patients denied hydration.
- Then-Health Secretary Matt Hancock stockpiled two years' worth of midazolam, according to footage reported from April 2020, and now faces questions about its use on elderly and vulnerable patients.
UK health authorities issued a warning about a potentially fatal drug combination, then reversed course just 16 days later, encouraging doctors to use the same drugs on COVID-19 patients. The timeline, documented by medical commentator John Campbell, Ph.D., is now being questioned by a member of Parliament, and it suggests elderly and vulnerable patients may have been placed on end-of-life protocols shortly after diagnosis despite having a realistic chance of recovery.
According to Campbell, the UK's Medicines and Healthcare products Regulatory Agency issued a drug safety update on March 18, 2020, warning that benzodiazepines and opioids can each suppress breathing and that combining them raises that risk. The guidance told healthcare professionals to prescribe the drugs together "only ... if there is no alternative" and to closely monitor patients, since the combination can cause "potentially fatal respiratory depression."
Sixteen days and a complete contradiction
Campbell called the reversal "a national scandal which is being ignored." On April 3, 2020, the National Institute for Health and Care Excellence published its COVID-19 rapid guideline, NG163, recommending clinicians "consider an opioid and benzodiazepine combination" for COVID-19 patients at the end of life with moderate to severe breathlessness who were distressed. The guidance stated that "sedation and opioid use should not be withheld because of a fear of causing respiratory depression."
Campbell strongly disagreed. "Of course it should," he said, paraphrasing the guidance: "Sedation ... should not be withheld just because there's a risk it will kill your patient." He noted the drugs weren't even authorized in the UK for treating COVID-19 at the time, yet the guidance encouraged their use anyway.
"People were going on end-of-life care, basically, sometimes when they were just diagnosed with COVID, when they could have made a very good recovery," Campbell said. NG163 remained in effect until March 2021, when updated guidance replaced it.
The Liverpool Care Pathway returns under a new name
The controversy didn't emerge in a vacuum. The Liverpool Care Pathway, an end-of-life protocol abandoned in 2014 after heavy criticism, appears to have resurfaced under new labeling during the pandemic. A review commissioned by the Lords and Commons Family and Child Protection Group, published in March 2023, found "flagrant examples of the same old LCP practices" and noted patients were started on end-of-life treatment "without a proper assessment of being 'near to dying' by suitably experienced staff."
Professor Sam Ahmedzai, who reviewed cases for the report, said: "In my view, not all of these should have been considered as 'end of life.'" The report found that in 10 of the 17 cases reviewed, dying patients were denied hydration even as they and their relatives asked for a drink. Barrister James Bogle noted that "midazolam and morphine can be very useful in end of life care, if used appropriately, but it is precisely because they can be used well that makes it all the easier to conceal when they are being used badly or terminally."
Hancock faces new scrutiny over drug stockpile
Independent MP Andrew Bridgen has pressed the government on these issues, writing on Facebook: "This is why I am asking the Government questions about NG163 and the use of midazolam and morphine on elderly patients in care homes and hospitals during the covid-19 pandemic." His questions come alongside footage, reported from April 2020, showing then-Health Secretary Matt Hancock telling an MP he had stockpiled enough midazolam to last roughly two years. Hancock has since been accused — though not proven in court — of falsely claiming he'd never heard of midazolam before being confronted about its use.
A dark chapter demanding real answers
"So, a dark chapter in English medical history basically completely ignored," Campbell said. "There are all the facts on it, and this should be investigated. Is it incompetence? Is it professional negligence, or is it something else?"
That question deserves a real answer, not another government promise to "look into it" while the officials involved move on; Hancock, notably, now advocates for expanding assisted-dying laws. Britons who endured lockdowns and vaccine mandates in the name of "following the science" have earned the right to know what science, if any, justified handing dying patients' families no real say in their care.
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