Opioid Overdose Deaths May Be Grossly Underestimated: Many Found to Be Misclassified As Sudden Heart Attacks

Coroner Dead Body

Findings suggest that national estimates of opioid overdose burden may be grossly underestimated.

A 7-year comprehensive study of deaths attributed to out of hospital cardiac arrest (OHCA) in San Francisco found that more than one in six of those deaths were actually from occult overdose. These findings suggest that published national overdose mortality estimates may be substantially underestimated. A brief research report is published in Annals of Internal Medicine.

Researchers from the University of California, San Francisco conducted a case-series analysis of the POST SCD (POstmortem SysTematic Investigation of Sudden Cardiac Death) Study, to compare the characteristics of occult overdose OHCA deaths with all other causes of OHCA deaths and to classify primary intoxicants and whether intoxicants were prescribed for each death investigated. After toxicology and autopsy, the researchers found that more than one in six deaths attributed to OHCA were really due to overdose. Most occult overdose OHCA deaths involved multiple drugs, including opioids, and approximately one-half of intoxicants were prescribed by a physician.

These findings have important implications nationally, as San Francisco’s age-adjusted overdose mortality rate is nearly identical to the national median overdose mortality rate. As such, published national mortality estimates based on recognized overdoses may significantly underestimate its true burden because occult overdose deaths masquerading as sudden cardiac deaths are missed without postmortem toxicology analysis. According to the researchers, their findings affirm the need for continued efforts to combat the opioid epidemic and for policymakers to consider naloxone in selected OHCA resuscitations.

Reference: ”

Occult Overdose Masquerading as Sudden Cardiac Death: From the POstmortem Systematic InvesTigation of Sudden Cardiac Death Study” by Robert M. Rodriguez, MD; Juan Carlos C. Montoy, MD; Daniel Repplinger, MD; Shiktij Dave, BA; Ellen Moffatt, MD and Zian H. Tseng, MD, MAS, 11 August 2020, Annals of Internal Medicine.
DOI: 10.7326/M20-0977

American College of Physicians

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