A coroner has instructed a chemist group to make changes after a young Suffolk mother died from an overdose after becoming addicted to drugs while working as a pharmacist.

On Tuesday, the inquest of Katherine Legg, known to her loved ones as Kate, was heard at Suffolk Coroners’ Court. Ms Legg died at her home in Carlton Colville on October 1 last year, at the age of 34.

In a statement read before the court, Ms Legg’s partner said that she was kind and compassionate and would always “go the extra mile” to support those she cared for. The couple had been together for six years and shared a young child.

Ms Legg qualified as a pharmacist at the University of East Anglia. Since June 2022, she was employed as a locum by the Hayden Chemist, and worked as a pharmacist in their branches, most often in Victoria Road. Lowestoft.

Ms Legg struggled for several years with drug addiction. This was a problem she battled to overcome by herself; she told her partner that she felt that she was in a ‘Catch 22’ situation, wanting to seek help but fearful that she would be struck off if she did so.

Giving evidence was the group’s superintendent pharmacist, Kanwardeep Dhanoa. He told the court that he liked and respected Ms Legg.

“The Kate I knew was an exceptional pharmacist,” he said. “Her ethics, her knowledge and her ability – she was brilliant.”

Mr Dhanoa only became aware of Ms Legg’s struggles after her death, and never had any concerns about her professional conduct.

The court heard Ms Legg had amassed a large quantity of discarded medication. While controlled drugs needed to be prescribed by two people and recorded on a balance sheet, the same prescription could be returned to the pharmacy, such as when the recipient has passed away, but would be received by only one person.

“The legislation around returned medication is lacking,” Mr Dhanoa told the court. He said that, since Ms Legg’s death, improvements have been made.

Controlled drugs are now recorded at the point that they come into the pharmacy, and a witnessed register is kept so that a record is held of all medication kept in the secure cupboard.

The presiding coroner Dr Daniel Sharpstone instructed Mr Dhanoa that in future, a weekly total of controlled, stored drugs awaiting destruction must be kept.

However, he said that closing all loopholes to fully safeguard people suffering addiction would be difficult.

“Sadly, people who are addicted to opiates tend to find any way they can of getting around systems,” he said.

Ms Legg’s family in court said that they would like to see current procedures become still more rigorous. For example, they suggested that returned drugs could be destroyed daily, or that secure drop-off points could be installed outside pharmacies.

“I cannot believe the law is as relaxed as it is and it comes to individual people to tighten it up,” said Ms Legg’s sister. She expressed hope that others would take further action, such as writing to their MP about the issue.

Coroner Sharpstone advised them that would require national backing.

He concluded that Ms Legg was a registered pharmacist who died of a morphine overdose. The morphine was acquired during her role as a registered pharmacist.

He ended proceedings by offering his own condolences to Ms Legg’s family.