The Queensland coroner has reopened an investigation into the death of a 22-year-old Brisbane man who committed suicide just days after starting medication to quit smoking.
Timothy Oldham left a box of anti-smoking drug Champix next to his suicide tape recording when he died in 2013.
He began taking the drug just eight days prior to taking his life.
As part of an investigation, the Queensland coroner has now begun reviewing all suicides in Australia where the person had taken Champix.
Oldham’s mother, Phoebe Morwood-Oldham, launched a campaign for warnings to be included on packets which highlight its link to suicide and other psychiatric problems.
Ms Morwood-Oldham started a Change.org petition which at the time of writing had more than 19,000 signatures advocating a so-called “black box” warning on Champix.
She said the following night was even worse.
“I went to bed and I got up and he’s sitting at his door on a cushion with my electric chainsaw plugged in, telling me there are people coming to get him,” she told 7.30.
When asked whether he had ever done anything like this before, she replied: “No, never”.
“That was so far out of the scale of things that I expected,” she said.
Timothy had been a strong school student and champion tennis player, but had suffered anxiety after two difficult incidents in 2006: the family’s house burned down and then he was beaten up in a shopping centre.
But Ms Morwood-Oldham said what happened to him after taking Champix was something entirely different.
“If I can make an analogy with numbers, his behaviour of his anxiety disorder would be 10 per cent, his behaviour with Champix went to 100 per cent and ended his life.”
Ms Morwood-Oldham said her son had never mentioned or attempted suicide before.
It was only after he died that she discovered the link between Champix and suicide had been made before in the US.
Dr Diana Zuckerman is a former policy advisor to Hillary Clinton who runs America’s National Centre for Health Research.
The centre was one of five peak health advocacy groups, including the National Physicians Alliance, which in October last year petitioned the Food and Drug Administration (FDA) to have the “black box” warning on Champix — called Chantix in the US.
“It seems very clear that people who would never have thought about suicide before, when they are taking this drug, they start thinking about it,” Dr Zuckerman told 7.30.
“And sometimes they act on those thoughts and actually try to kill themselves or they do kill themselves.”
‘Black box’ warning not used in Australia
The FDA in the US first implemented its so-called “black box” warning on Champix packets in 2009, and recently strengthened it, after a huge class action involving 3,000 litigants was settled by pharmaceutical manufacturer Pfizer.
But Australia’s Therapeutic Goods Administration (TGA) does not require a “black box” warning and Champix currently does not contain consumer medical information inside the box either.
The risk you take by putting a big warning on [Champix] is that people will not take it and smokers die from it. From smoking.
Respiratory physiologist Renee Bittoun
“We’ve been very concerned about the drug because it has so many more adverse reactions that have been reported than pretty much any other drug,” Dr Zuckerman said.
But the response to Champix in Australia by health professionals and the TGA has been markedly different.
“The TGA continually reviews the adverse events and we believe that Champix PMI and CMI contains the appropriate information to assist in its safe and effective use,” a TGA spokeswoman said.
“This includes appropriate warnings on neuropsychiatric-adverse events, such as self-harm and suicidal tendencies.
“People taking this medicine [and their family or carer] need to pay special attention to your mood, behaviour and thinking while you are taking Champix.”
Champix was first introduced to the Australian market in 2007 and by 2010, 900,000 prescriptions had been filled.
In that time, the TGA had more than 200 reports of suicide-related events for Champix patients.
But Australian health professionals say large population studies in places like Sweden and the UK showed it was coming off nicotine, not Champix, that caused psychiatric problems.
Respiratory physiologist Renee Bittoun started one of the world’s first “quit smoking” clinics in Sydney.
“The risk you take by putting a big warning on [Champix] is that people will not take it and smokers die from it. From smoking,” Associate Professor Bittoun said.
“One in two smokers dies from their smoking. We don’t actually view [suicide and mental health problems] as a symptom or a side-effect of the drug per se. It may be a side-effect of not having nicotine in your brain.
“That’s often manifested as depression or anxiety. We have seen a lot of this way before the advent of Champix.”
“We have seen it for decades. I’ve seen it for decades.”
Warning to enable patient monitoring
Associate Professor Bittoun said now that cigarette addiction is at a historic low, the cohort that still smoke have a higher rate of mental illness.
“About 50 per cent of smokers today in Australia that we know about have a mental health component,” she said.
But Dr Zuckerman maintained that having the “black box” warning enables care-givers and families to monitor patients, so if they appear to be in trouble, they can be taken off Champix before it is too late.
“If you pretend this isn’t happening, people are going to get really hurt,” Dr Zuckerman said.
“I think the most important thing for physicians and other practitioners to understand is that some patients may do well with this drug, and other patients can die from it.”