One of CanadaÂ?s leading experts on suicide told a coronerÂ?s jury Tuesday he believes Kimberly Rogers stockpiled hundreds of prescription pills because she contemplated ending her own life over an extended period of time.
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Dr. Isaac Sakinofsky, head of suicide studies at the University of Toronto, testified Rogers stockpiled so many pills in the weeks after a conviction for welfare fraud because she was considering ending her life.
Due to numerous factors, including being pregnant and under house arrest without any means of support, Rogers took Â?13 times the lethal dosageÂ? of amitriptyline to kill herself, said Sakinofsky.
Suggestions she took so many pills to try and get some sleep during a blistering heat wave or because she was addicted to this particular medication donÂ?t make sense, said Sakinofsky.
No high
Â?She wouldnÂ?t take 13 times the dose to get some sleep,Â? he said. Â?And no one becomes addicted to this particular drug.Â?
You donÂ?t get a high off this drug. and there are numerous serious side effects such as irregular heartbeat, dry mouth, weight gain and risk of seizure, he said.
Â?In my view, she did not take the drug to go to sleep or because she was addicted,Â? he said. Â?She took it to harm herself and perhaps end her life.Â?
Almost immediately from the time Rogers was sentenced for welfare fraud on April 25, 2001, she started stockpiling amitriptyline, he testified.
Contemplating suicide isnÂ?t simply a matter of Â?yes or no, but includes shades across the spectrumÂ?.
ItÂ?s his opinion Rogers was putting in place a series of events in which she could commit suicide if things didnÂ?t improve in her life.
Extensive studies have shown only seven per cent of people who commit suicide Â?leave no doubt they want to die and their methods are fool proofÂ?, said Sakinofsky.
About 70 per cent who contemplate suicide by overdose Â?hope to go to sleep and hope three or four days laterÂ? they will be revived and their problems will be solved, he said.
About 20 per cent are in Â?such a head space they donÂ?t give a damn whether they live or dieÂ?if they die, so what.Â?
Several witnesses at the inquest have testified they donÂ?t believe Rogers was suicidal in the weeks before she died because she was in good spirits and very much looking forward to having her baby.
Studies show more than 70 per cent of people who end their own lives donÂ?t inform their doctors or loved ones about their suicidal ideology in any way in the weeks before they commit the act, said Sakinofsky.
A survey of 10,000 homes in Ontario indicates 11 per cent of people between the ages of 15 and 64 or more than 750,000 at one or more times in their life strongly consider suicide, he testified.
There are 26 serious suicide attempts for every person who ends their life, he said.
The inquest has heard Dr. Robert Clendenning prescribed Rogers a 300 milligram daily dosage in late May or 10 weeks before she died.
This is the maximum daily dosage allowed and from his experience only the most seriously ill patients hospitalized for depression are prescribed this amount, said Sakinofsky.
In Britain, the suicide rate has declined markedly after physicians started prescribing addictive medications in small packages that canÂ?t be automatically refilled in a short period of time, he said.
Â?Changing prescribing methods and availability can dramatically reduce the suicide rate,Â? he testified. Â?Doctors should chose the less dangerous drugs first.Â?
Because Rogers is gone, no one will ever know her full intent in taking so many pills, he said.
Â?What was her intent and focusÂ?thatÂ?s a very complex question,Â? he said.
Studies show 90 per cent of all people who commit suicide suffer from at least one confirmed psychological diagnosis and the percentages increase when you have multiple disorders like Rogers did, he said.
Common factors for most people who are considering suicide include being in an untenable position, suffering a serious loss be it a failed career opportunity or loved one, anger at people who they believe havenÂ?t helped them and unbearable physical pain, he said.
All of the above could apply to Rogers, he said.
In earlier testimony, a prominent Hamilton-based family medicine expert told the jury she studied the case and doesnÂ?t know if Rogers committed suicide or accidentally overdosed.
After reading numerous doctorÂ?s reports, pharmacology reports and police statements, Dr. Nancy Fowler testified the cause of death remains a mystery to her.
It would be Â?very surprisingÂ? for a woman who seemed in such good spirits and talked so positively to family members, friends and social workers about becoming a mother to commit suicide, said Fowler, identified as an expert witness in family medicine.
However, when asked by coroner Dr. David Eden if itÂ?s possible for a woman diagnosed with depression, who showed no signs of being suicidal, to suddenly suffer a breakdown and consider ending her life, Fowler said Â?yes, that has happenedÂ? to clients sheÂ?s treated.
Fowler said itÂ?s obvious Rogers presented a complex number of issues for her family physician.
Â?She struck me as someone using quite a lot of medication,Â? she said. Â?She was someone who misused and abused prescription medication.Â?
Amitriptyline is no longer prescribed commonly to battle depression, but is much more commonly used to prevent the onset of migraine headaches and can help in battling insomnia, said Fowler.
Newer, less powerful prescription medications such as Prozac and Paxil are now favoured by doctors to prescribe to patients to battle depression, said Fowler.
Amitriptyline is considered safe to use by pregnant woman and can treat numerous conditions at one time and thatÂ?s why she strongly endorsed ClendenningÂ?s decision to prescribe it for Rogers, said Fowler.
Â?I see Dr. ClendenningÂ?s decision as quite reasonable to be quite honest,Â? she said.
However, she didnÂ?t agree Rogers should have been allowed to stockpile hundreds of pills in such a short time period or with the 300 milligram daily dosage Clendenning prescribed from late May until Rogers died, said Fowler.
In her many years as a doctor, sheÂ?s never heard of any physician prescribing a 300 milligram daily dosage of amitriptyline, said Fowler.
Â?That would be out of my comfort zone as a family doctor,Â? she said.
The inquest has heard Rogers increased her daily dosage on her own from 150 milligrams to 250 milligrams per day.
Clendenning didnÂ?t see any adverse affects and agreed to allow the maximum allowable dosage of 300 milligrams per day when Rogers visited him May 22, 2001. Clendenning testified he warned Rogers repeatedly not to exceed the daily dosage and she clearly understood.
Â?I would see a red flagÂ? if a patient were to increase medication on their own, said Fowler.
However, as a caring physician, you want to maintain a strong alliance and relationship with the patient without risking prescribing medications which could hurt more than help, she said.
As a physician, she would not want any patient of hers to have to endure the circumstances Rogers had to deal with during the final few months of her life, she testified.
