Man died from 'drug toxicity' days after release from HMP Altcourse

Neil Yates, 53, died on April 25, last year, four days after his release from HMP Altcourse, in Liverpool.

A post-mortem examination found he died from mixed drug toxicity and an infection of the lungs, bronchopneumonia.

A report into his death has been produced after an investigation by the Prisons and Probation Ombudsman.

Mr Yates had 'history of opioid misuse'

On February 20, 2023, Mr Yates, who had a "history of opioid misuse", had been remanded into HMP Altcourse, charged with driving offences, of which he was later convicted and sentenced to 20 weeks' imprisonment on March 6.

The report stated that when Mr Yates arrived at the prison on February 20, he told a GP "that in the community, he was taking 600mg of MST (an opiate medication used to treat pain) each day".

He had "initially been prescribed opiate medication for pain relief but then began to use it illicitly too, and also had a long history of heroin use".  

The GP was unable to continue prescribing MST, a controlled drug that must be administered a few times a day, which is difficult within a prison setting, and instead, prescribed him methadone, used to treat the symptoms of opiate withdrawal), which only needs to be administered once a day.

The following day a substance misuse service (SMS) worker at Altcourse gave Mr Yates training on naloxone, a medication that can rapidly reverse the effects of an overdose of heroin or other opioids.

On March 1 he said to a nurse that he was having withdrawal symptoms and would like to have his methadone dose increased, and on March 3 this was increased by 10mls.

On April 17, Mr Yates said to a GP he would like to be prescribed zopiclone to help him sleep. However, the GP said that as he was already on five other sedative drugs, this would not be safe and advised him that "he should consider weaning off some of the sedative drugs".

However Mr Yates said that as he was being released soon, he would prefer to explore this with his GP in the community.

On April 21, Mr Yates was released under a home detention curfew with a two-week supply of his medication and attended St Helens Probation Office as instructed.

On April 24, Mr Yates attended an assessment appointment at community substance misuse service Change Grow Live (CGL) and it was said he "engaged well and did not appear under the influence of any illicit substances".

In the early hours of April 25, Mr Yates returned home with a friend after getting some food. The friend said he left Mr Yates sitting in a chair at around 2am while he went to a bedroom to sleep. At around 6pm, the friend woke up and found Mr Yates unresponsive in his chair.

He called the emergency services and when paramedics arrived at approximately 7pm, they confirmed Mr Yates was dead.

Heroin use 'likely to have contributed to death'

A post-mortem examination concluded Mr Yates "died of mixed drug toxicity and bronchopneumonia".

The pathologist found a "medium level of methadone", a "high level of morphine" and "a high concentration of pregabalin" in Mr Yates' blood.

He said "the presence of a heroin metabolite suggested recent illicit heroin use and that this was highly likely to have contributed to Mr Yates’ death"

The pathologist noted "the combined use of opiates with pregabalin would have enhanced the toxicity of both drugs and increased the likelihood of respiratory depression and death".

Also, the pathologist noted that "the effects of respiratory depression would have been more severe due to Mr Yates’ COPD" and that "Mr Yates' cirrhosis would have increased the likelihood of developing infections".

Failure to offer naloxone kit an 'error'

The report noted Altcourse’s "local operating policy for take home naloxone acknowledges that for prisoners with a history of opioid use, the risks related to overdose and death are extremely high in the immediate period after release due to high rates of relapse and lower opioid tolerance".

Adrian Usher, Prisons and Probation Ombudsman, said: "We found that although SMS staff at Altcourse trained Mr Yates in the use of naloxone, they did not offer Mr Yates a naloxone kit when he was released from prison.

"We asked the Deputy Head of Healthcare at Altcourse why this was, but she was unable to provide an explanation as it was standard practice to issue naloxone to prisoners with a history of opiate use."

The ombudsman noted "the failure to offer Mr Yates a naloxone kit appears to have been an error".

The report said: "As Altcourse has a policy in place, we do not make a recommendation but bring this to the attention of the Head of Healthcare."

Mr Usher added: "We are satisfied that Mr Yates’ probation practitioner put appropriate measures in place to address his substance misuse issues when he was released from prison.

"This included arranging a release appointment with the local substance misuse agency and adding licence conditions for Mr Yates to comply with any requirements relating to addressing his substance misuse issues."

A spokesperson for G4S Care and Rehabilitation Services, who managed HMP Altcourse at the time, said: "Our thoughts remain with the family and friends of Mr Yates.

"We review all Prisons and Probation Ombudsman (PPO) reports carefully and take on board recommendations where applicable."