No evidence midazolam used to kill thousands of patients in April 2020

1 December 2022
What was claimed

There was an unprecedented increase of out of hospital doctor’s prescriptions of midazolam to the over-65s in March 2020.

Our verdict

There was a large increase in out of hospital prescriptions of the drug for use as a sedative and analgesic in April 2020. We don’t know details of the patients it was given to, but it is likely they were older as the drug is used in palliative care.

What was claimed

The sudden spike in deaths during the pandemic was largely the result of lethal midazolam and morphine injections.

Our verdict

We can find no evidence to support this. Deaths with Covid-19 listed as a cause on the death certificate did spike in April 2020, when midazolam prescriptions also rose, but this was likely because the drug is used to make patients comfortable at the end of their lives and many people were dying—not because the drug was being used to end their lives.

A video on YouTube with tens of thousands of views makes several claims about the rise in the use of the drug midazolam during the Covid-19 pandemic, including that a 2020 spike in deaths was caused by “lethal midazolam and morphine injections”.

We can find no evidence to support this. Midazolam is often used to make patients comfortable at the ends of their lives, including those who are dying of Covid-19. A spike in midazolam prescriptions during one of the worst months of the pandemic is therefore not unexpected.

While it is possible that midazolam could have been used incorrectly and caused death in some cases, the evidence we have certainly does not show that the drug was used to kill thousands of people.

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What is midazolam?

Midazolam is a drug with a number of uses including treating seizures and conscious sedation for medical procedures. It’s also used in palliative care to make patients comfortable at the end of their lives, particularly for those experiencing ‘terminal agitation’, or “anxious, restless and unsettled behaviour” at the end of their life. 

The National Institute for Health and Care Excellence specifically lists midazolam in its guidance for treating patients with Covid-19 experiencing anxiety or agitation at the end of their life.

Like many drugs, if used incorrectly it can cause harm, which is why there are detailed guidelines on how to use it, including in palliative care.

Since former health secretary Matt Hancock started participating in the ITV reality TV show ‘I'm a Celebrity... Get Me Out of Here!’, we have seen multiple people referring to him as “Midazolam Matt”, apparently a reference to the increase in prescriptions of the drug at the start of the pandemic when he was a minister.

Midazolam prescriptions did increase in April 2020

The YouTube video includes footage it claims shows Matt Hancock “under oath before the House of Commons Inquiry into Covid-19”. The footage is actually from oral evidence the then-health secretary gave before the Health and Social Care Committee in April 2020. (Two Covid-19 inquiries are planned: one from the UK Government and another from the Scottish Government.)

First, the YouTube video shows Dr Luke Evans MP asking Matt Hancock if the country had enough syringe drivers, which are battery-powered pumps that continually deliver medication through a needle. Mr Hancock responded by saying there were enough.

The video then claims: “Four weeks before Hancock made those statements under oath before the House of Commons Inquiry into COVID-19, there was an unprecedented increase in out of hospital doctor’s prescriptions of Midazolam to the over 65’s.”

The English Prescribing Dataset tells us how many times midazolam was prescribed in England (and dispensed in England, Wales, Scotland or the Crown Dependencies). 

There was a jump in prescriptions of midazolam for “sedative or analgesic” purposes in April 2020, the same month Mr Hancock gave evidence to the select committee, as opposed to “four weeks before”, as claimed. (Prescriptions of midazolam as an antiepileptic drug are counted separately, and these figures did not increase in April 2020.)

While in 2019, there were an average of around 17,500 midazolam prescriptions for sedative or analgesic purposes a month, in April 2020 it increased to 38,582. 

This data does not include hospital prescriptions, as the video correctly states, or private prescriptions. While the data doesn’t include any information on the patient, for example their age, as the video claims, as it is used in a palliative setting it’s likely that many recipients would be over 65. 

Another source of prescription data—the Prescription Cost Analysis monthly administrative data for April 2020—shows a similar level of prescribing. It appears that the video has used the English Prescribing Dataset, as another graph at the end of the video lists that as the source. 

No evidence spike in deaths was caused by midazolam used in “lethal doses”

The video claims that midazolam as well as morphine were prescribed in greater quantities, and used to deliberately kill elderly patients.

The increase in midazolam prescriptions in April 2020 was covered by the Daily Mail and the Sun in July 2020, though both newspapers said they could not verify claims that the drug was being used to speed up deaths.

As evidence the video says there was a spike in deaths among elderly people coinciding with the increased prescribing of midazolam. 

The video goes on to claim: “It is grievously logical to deduce that the sudden spike in deaths, which was used to justify the UK government’s COVID policies, was largely the result of lethal Midazolam and Morphine [another drug used in palliative care to treat pain] injections.”

The number of deaths did increase in April 2020, at the point at which midazolam prescriptions increased (though the video is wrong to claim both happened in March 2020). 

But a correlation between midazolam prescriptions and death figures is not proof one caused the other, and this ignores the main reason deaths were increasing in April 2020: Covid-19 itself. In April 2020, there were 29,377 deaths in England (and 33,854 in the UK) where that person’s death certificate would go on to list Covid-19 as one of the causes.

The founder of the charity Compassion in Care, Eileen Chubb, told the Daily Mail that a number of care home workers had told her sedatives were used too freely during the pandemic, according to the Mail in 2020. The Association for Palliative Medicine also told the Mail: “I can understand why people are raising concerns, but when prescribed and used appropriately, midazolam will not hasten or prolong someone’s death—it will just give comfort”.

It is possible that midazolam may sometimes not be used appropriately, but we can find no evidence that this happened on a large scale in April 2020.

Why did midazolam prescriptions increase?

The Care Quality Commission, which is England’s health and adult social care regulator, noted in a report on controlled substances that overall prescriptions of midazolam were up 23% between 2019 and 2020, saying: “This is [sic] might be linked to the community based treatment of people with COVID-19 at the end of their lives.”

Morphine is also specifically used to treat the feeling of breathlessness in certain dying patients with Covid-19, so like midazolam, it wouldn’t be surprising for prescriptions to increase during a rise in fatal Covid-19 infections.

In response to claims that Full Fact checked last year, that elderly people were “culled” with midazolam, the Department of Health and Social Care told us: “These claims are deeply misleading. The government’s top priority throughout this pandemic has always been doing everything possible to save lives.”

Image courtesy of Danie Franco

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