CANNABIS-INDUCED psychosis has been a concern within the Health Department “for some time” about , an inquest has heard – though a prescriber has denied a link with the death of a patient.
David Keith Morgan died on 4 August 2025 at his home at Lord Coutanche Court in Seaton Place, of carbon monoxide poisoning with a secondary cause of starvation due to him being malnourished.
However, throughout his inquest, which has been held over a period of three days, evidence has been heard as to the affect that a medical prescription of cannabis may have had on his mental health in the lead-up to his death.
Earlier this week, Mr Morgan’s family raised questions about the increasing doses he was receiving in the months before his death, stating his behaviour had become “erratic”, that he was writing on walls at his home and making threats to family members.
Yesterday, Dr Steffen Osbelt appeared via videolink. He said he had first spoken to Mr Morgan on 30 September 2024 on behalf of Windsor CBPM Clinic, though he mostly worked for Medicann at the time.
At the time, Dr Osbelt lived in Guernsey and travelled to Jersey around three times a year and typically spoke to patients – including Mr Morgan – by telephone. When he worked in Jersey, he saw up to around 1,000 patients per year through two Jersey cannabis clinics, Windsor CBPM and Medicann.
Asked why he did not use a video call, he said the technology had not been available to him. Previously, Mr Morgan’s GP, Dr Lisa Clynes, had told the inquest that her patient appeared frail, and that face-to-face consultations were a “cornerstone” of general practice, using factors like eye contact and general presentation to make an assessment.
She had said she had concerns from the outset about Mr Morgan being prescribed cannabis and that she wrote to Windsor CBPM after growing increasingly concerned about his behaviour.
Dr Osbelt said that it was now “standard practice to do telemedicine”. He said he did not recall if he was aware of Mr Morgan’s agoraphobia and depression, and added that when he spoke to Mr Morgan “everything had been going really smoothly, really well”.
Though the clinic sent letters to the GPs of patients who were prescribed cannabis, Dr Osbelt said this was generated automatically after his consultation and did not include details of the strength and dosage prescribed.
“I think the sharing of that information will have very, very limited benefit for the GP,” he said.
Advocate David Wilson, representing Mr Morgan’s family, said: “The GP may not be specialised in relation to cannabis, but what the GP is specialised in is knowledge of the patient. The GP in this case has a long history of dealing with David, you had a 15-minute telephone conversation, that is it.”
Dr Osbelt replied that the initial appointment was 30 minutes long and that he had Mr Morgan’s full medical history “so I did know what a GP knows”.
Asked by Advocate Matt Berry, sitting as coroner, how he was remunerated, Dr Osbelt said it was “a mixture”.
“I got paid per patient that I saw… and I got paid per prescription that I personally generated.”
Dr Osbelt suggested that the increase in dosage had not been large enough to be a concern or for him to alert the GP and he denied that patients can experience psychosis once the cannabis has worn off.
He said the psychosis symptoms could have come from Mr Morgan having gone “cold turkey” from the anxiety medication pregablin.
Asked by Advocate Heidi Heath, representing the Health Department, about his record-keeping and “the need for accurate, full and thorough contemporaneous notes on your behalf”, Dr Osbelt said: “Yes, that is something I will take home from here, that it is better to have closer note-keeping.”
Meanwhile, pharmacist Katherine Delargy appeared yesterday and said that psychosis was an “unusual” symptom of pregabalin withdrawal.
Health managing director Andy Weir, who was director of mental health at the time, personally authored a Serious Incident Report into Mr Morgan’s care.
In his conclusions, he found that there should be better communications between agencies including prescribers of cannabis and that Adult Protection Notices made by police were “not escalated” despite reaching the threshold of three notices in 30 days.
Appearing in the inquest yesterday, Mr Weir said: “This case is not an isolated incident. This is not the first time there have been concerns about [prescribed medicinal cannabis].”
He was shown a recent Times article referring to increased concerns about medicinal cannabis use in Jersey and said: “This is very much a concern for inpatient mental health services and has been for some time,” adding that psychosis is “predominantly the main concern is psychosis as a result of cannabis use”.
A finding is expected to be delivered on Tuesday.
