Findings suggest that national estimates of opioid overdose rates could 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 estimates for overdose mortality may be substantially underestimated. A brief research report will be 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 the primary classifications of intoxications and whether intoxications were prescribed for each death examined. After toxicology and autopsy, the researchers found that more than one in six deaths attributed to OHCA were actually due to overdose. Most occult overdose OHCA deaths involved multiple medications, including opioids, and about half of intoxications were prescribed by a physician.
These findings have nationally important implications because the age-adjusted age-related mortality of San Francisco is almost identical to the national median overdose mortality rate. As such, published estimates for national mortality based on recognized overdoses can significantly underestimate the true burden, because occult overdose deaths mask if sudden cardiac deaths are missed without postmortem toxicology analysis. According to the researchers, their findings confirm the need for ongoing efforts to combat the opioid epidemic and for policymakers to consider naloxone in selected OHCA resuscitations.
Reference: August 10, 2020, Annals of Internal Medicine.
DOI: 10.7326 / M20-0977
