A Victorian coroner has recommended that the Therapeutic Goods Administration review the safety and therapeutic value of the peptides Richard Norton was using before his death. David Ryan said he was not satisfied the drugs should remain available for medical practitioners to prescribe.
Norton, 75, went into cardiac arrest in March 2025 after injecting prescribed but unapproved CJC1295 and ipamorelin. Ryan found the peptides had been prescribed by a doctor, then concluded it was not clear how their safe use could be clinically justified given the acknowledged uncertainty around their benefit and risks.
The recommendation is being searched now because it is the first formal regulatory move to follow a death tied to these injections. Ryan urged the Therapeutic Goods Administration to examine whether the peptides should stay in schedule 4, where prescription-only drugs sit, or be shifted to schedule 10, which would confine them to clinical trials or other experimental use.
That matters because the case is not only about one patient. If the review leads to restriction, it could change how the peptides are accessed by patients who are offered them outside standard approved treatment. Norton had approached Dr Jerzy Muchnicki in March 2025 wanting peptide therapy, and the pair discussed its experimental nature, possible risks and the lack of other approved alternatives before treatment began.
The record also shows how quickly confidence in the therapy changed into disaster. Norton signed an informed consent form that covered the treatment, its benefits and risks, including anaphylaxis, and a series of blood tests was done before he was prescribed the injections on 19 March. A week later, he said he was feeling good and that the peptide therapy was improving his symptoms.
That makes the coroner’s findings harder to read as a simple cautionary tale. A man who appeared to think the treatment was helping him later suffered a fatal cardiac arrest after using it, and Ryan’s recommendation now puts the Therapeutic Goods Administration under pressure to decide whether these peptides should remain prescribable at all. The next step is a review, but the outcome could narrow their use to research settings only.
