Death of 17-year-old girl in Blackpool sparks call for change over prescribed medication

According to the National Poisons Information Service (NPIS), 172 people intentionally overdosed using the drug in 2022/23

Blackpool Victoria Hospital

The death of Blackpool teenager Imogen Heap has prompted a coroner to call for change amid fears over the “underappreciated” danger of her prescribed medication.

Imogen was aged just 17 when she ingested an amount of Propranolol in a bid to take her own life. She quickly changed her mind after taking the tablets but although she called for help within hours, the drug had already begun its fatal effect.

Concerns had previously been raised over the safety of the beta blocker in 2019, when the death of a 24-year-old woman who overdosed using her prescription medication prompted a national investigation.

Fears were raised over the “under recognised toxicity” of the drug, which is primarily used to treat heart conditions and migraines but is also frequently given to help patients deal with symptoms of anxiety.

The Healthcare Safety Investigation Branch (HSIB, now HSSIB) launched a probe and while guidance was introduced warning over its usage in treating anxiety, little changed practically.

According to the National Poisons Information Service (NPIS), 172 people intentionally overdosed using the drug in 2022/23, of which 108 were on prescriptions to manage anxiety.

Tragically, 12 of those people died.

In Blackpool, Imogen had been given the medication to help treat anxiety and depression and as those conditions took hold last October, she made the tragic decision to take a “very high quantity” of the medication, along with smaller amounts of two others.

Within a very short space of time, she regretted her decision and decided to call for help - it would take almost four fours for an ambulance to arrive and after calling at 6.10pm she wasn’t taken to Blackpool Victoria Hospital until 8.30pm.

The backlog of ambulances queuing outside meant she still couldn’t go in but almost an hour later, while still in the ambulance she began vomiting and her blood pressure dropped. It wasn’t until 10.13pm when she began to have seizures that she was taken into the A&E department where she received advanced life support and was transferred to the Intensive Treatment Unit.

Despite extensive efforts from healthcare workers, Imogen continued to deteriorate and suffered cardiac arrest. The following afternoon “an unexpected and unusual reaction to extubation” accelerated her deterioration and Imogen died.

An inquest into her death was held at Blackpool Town Hall in July and heard from two consultants who agreed Propranolol is widely prescribed and often to relatively young people reporting symptoms of anxiety, but that there can be an under-appreciation of how toxic it can be at elevated levels.

Concluding the inquest, senior coroner Alan Wilson said: “At a time when she was low in mood, Imogen Heap ingested a very large quantity of tablets, mostly prescribed propranolol medication, with a view to ending her life. Within a period of around 2.5 hours of beginning to ingest the medication, she decided to telephone for help, but by that time the extent of the overdose was going to prove fatal.”

After hearing the evidence and reviewing the HSSIB investigation, Mr Wilson said he remains concerned that further such tragedies could occur if further action does not take place.

When that investigation was published in 2020, National Institute for Health and Care Excellence (NICE) responded by saying it does not recommend the use of propranolol in anxiety and that it would add a footnote to its headache guidance to warn the drug may worsen depression. It continued to say it would discuss the issue with the British National Formulary (BNF) and the NHS.

Issuing a Prevention of Future Deaths report which legally requires either action or an explanation why it is felt action is not needed, Mr Wilson warned there is still an underappreciation of the level of risk posed by an elevated level of propranolol medication.

He wrote: “It is recommended that the National Institute for Health and Care Excellence reviews and updates guidance on the use of propranolol in the treatment of anxiety and migraine, with particular reference to the toxicity of propranolol in overdose.”

In response, a NICE spokesperson told The Blackpool Lead: “NICE can confirm we have received the coroner’s prevention of future deaths report in relation to Imogen Heap. We will consider the issues raised by the report and respond to the coroner directly.

“We follow an established process when making sure our published guidelines are current and accurate and take a proactive approach to responding to events (with an assessment of priority) that may impact on our recommendations.”