An inquest has found that the cause of death of a Lisbellaw man who died in September, 2019, was poisoning by cocaine, fentanyl, pregabalin and diazepam.

Held at Laganside Court last Thursday, February 10, the inquest heard from the deceased's mother, the friend in whose house he was found, a police officer who attended the scene, the pathologist who carried out an autopsy, the deceased's doctor, and a consultant psychiatrist at the Tyrone and Fermanagh Hospital (T&F).

Robert Smyth (32) died on September 14, 2019, after being found unresponsive on the sofa of a friend's house in Coleshill Park, Enniskillen, despite efforts to resuscitate him at the scene.

Caroline Higgins, the deceased's mother, told the inquest how she had seen her son the day before his death at his home.

She described him as in good form, but his speech was slurred, and she suspected he had taken something. He said he had only taken his medication. Other than that, there had been nothing untoward or unusual to raise concerns.

In his evidence to the inquest, Mark Suttle, in whose home Mr. Smyth was found, said he was called by Mr. Smyth at around 10pm on September 13 asking him to come over.

He described Mr. Smyth as sounding "rubbered". When Mr. Smyth arrived, his speech was slurred and he was unsteady on his feet. He told Mr. Suttle to "give me a hug, a proper one".

Mr. Smyth showed Mr. Suttle a cut on his arm where he had self-harmed.

They sat in the living room chatting for about 90 minutes. He said while they watched television, Mr. Smyth lay back on the sofa and it looked as if he had fallen asleep.

Mr. Suttle said he watched television for a little bit, and then tried to rouse Mr. Smyth, but couldn’t.

He checked for a pulse and couldn’t find one, so started CPR. In a state of panic, he tried to call friends to help, including a friend – Mr. Jim Lunney – who he asked to come and help him. He then telephoned an ambulance shortly after, and thought at this time that Mr. Smyth was already dead.

Constable Jason McGowan, who attended the scene and checked Mr. Smyth's pockets, said he found Pregabalin tablets and an empty foil wrapper from a 75mg Fentanyl patch. He saw no evidence of drug or alcohol use, or of anything untoward.

Dr. Simon Forster confirmed to the inquest that Mr. Smyth had never been prescribed Fentanyl patches, but he was on several other medications.

Dr. Stephen Moore, Consultant Psychiatrist, who was in charge of Mr. Smyth’s care on his last admission to Tyrone and Fermanagh Hospital, also gave evidence to the inquest.

He said Mr. Smyth had been admitted as a voluntary patient following assessment at South West Acute Hospital's A&E.

Continuing, he explained Mr. Smyth, on admission, had said he wanted to stop taking all his currently prescribed benzodiazepine medications, and admitted self-harm by superficial cutting.

He reported “Lucifer” wanting him to do this. He described the recent breakdown of his last relationship.

Mr. Smyth told them of his drug use over the previous four to five days, including using cocaine.

He discussed wishing to harm his father and discontinuing his anti-psychotic and anti-depressant medications two weeks previously, and reported increased auditory hallucinations.

He reported some thoughts of life being not worth living, but denied any intent to act on these and thoughts of self-harm.

Dr. Moore told how on September 10 a review of Mr. Smyth noted he was engaging well, and was pleasant, and he reported feeling better than the previous days.

Mr. Smyth discussed being willing to stay in hospital until the following Monday. He reported no thoughts of life being not worth living, and had no plans or wish to harm his father.

Dr. Moore said the deceased left the following day, contrary to medical advice, saying his mental health had improved and he was keen for discharge.

He denied any thoughts of life being not worth living, and specifically denied any homicidal or suicidal ideation and hallucinations. On assessment, Mr. Smyth did not meet the grounds for detention.

During his evidence, pathologist Professor Jack Crane said a partially translucent fragmented pharmaceutical patch was located in the deceased's stomach, and on removing his clothing items, he found a pink pill; however, he did not find any patch on his body.

Professor Crane was of the opinion that it was principally the effects of the cocaine and fentanyl which were responsible for Mr. Smyth's death, although the pregabalin and diazepam would have caused some degree of central nervous system depression, thereby contributing to the fatal outcome.

He was of the opinion that death was due to poisoning by drugs.

The fact that the fentanyl patch had been found in the stomach was highly suggestive it had been ingested, and it was likely the cocaine had been snorted.

Prof. Crane said the effects of the fentanyl patch would be much more severe in cases of ingestion.

In her findings from the inquest, the coroner, Anne-Louise Toal, said: "I find that Mr. Smyth, who had an extensive history of drug misuse, at some stage prior to midnight on September 13, 2019, ingested a Fentanyl patch and took cocaine and temazepam.

"I find that he also had taken a number of his prescription medications, including pregabalin, diazepam, venlafaxine, mirtazapine and olanzapine.

"I find that he was under the influence of drugs when he attended Coleshill Park. The effect of the combination of these drugs was to cause central nervous system and respiratory depression, leading to a progressive loss of consciousness.

"This caused Mr. Smyth to appear to fall asleep, and resulted in his inability to be roused. I find that Mr. Smyth, although having a history of self-harm and suicidal ideation, did not intend to take his own life," concluded the coroner.