Occult Overdose Masquerading as Sudden Cardiac Death: From the POstmortem Systematic InvesTigation of Sudden Cardiac Death Study
Authors: Robert M. Rodriguez, Juan Carlos C. Montoy, Daniel Repplinger, Shiktij Dave, Ellen Moffatt, Zian H. Tseng
Journal: Annals of Internal Medicine (2020)

Letters1 December 2020Occult Overdose Masquerading as Sudden Cardiac Death: From the POstmortem Systematic InvesTigation of Sudden Cardiac Death StudyRobert M. Rodriguez, MD, Juan Carlos C. Montoy, MD, Daniel Repplinger, MD, Shiktij Dave, BA, Ellen Moffatt, MD, and Zian H. Tseng, MD, MASRobert M. Rodriguez, MDUniversity of California, San Francisco, San Francisco, California (R.M.R., J.C.M., D.R., S.D., Z.H.T.), Juan Carlos C. Montoy, MDUniversity of California, San Francisco, San Francisco, California (R.M.R., J.C.M., D.R., S.D., Z.H.T.), Daniel Repplinger, MDUniversity of California, San Francisco, San Francisco, California (R.M.R., J.C.M., D.R., S.D., Z.H.T.), Shiktij Dave, BAUniversity of California, San Francisco, San Francisco, California (R.M.R., J.C.M., D.R., S.D., Z.H.T.), Ellen Moffatt, MDOffice of the Chief Medical Examiner, City and County of San Francisco, San Francisco, California (E.M.), and Zian H. Tseng, MD, MASUniversity of California, San Francisco, San Francisco, California (R.M.R., J.C.M., D.R., S.D., Z.H.T.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-0977 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Overdose deaths have increased dramatically in the past decade to become the leading cause of injury-related death nationally (1). Although many overdose cases are obvious, with history of ingestion or evidence of drug use at the scene, others may present occultly as out-of-hospital cardiac arrest (OHCA), with an emergency medical services (EMS) primary impression of cardiac arrest but no history or overt signs of overdose. Recognition and characterization of these occult deaths are critical for accurate estimates of overdose mortality and to inform public health measures, especially in the context of the ongoing opioid epidemic.Objective: To characterize occult ...References1. Scholl L, Seth P, Kariisa M, et al. Drug and opioid-involved overdose deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep. 2018;67:1419-1427. [PMID: 30605448] doi:10.15585/mmwr.mm675152e1 CrossrefMedlineGoogle Scholar2. Tseng ZH, Olgin JE, Vittinghoff E, et al. Prospective countywide surveillance and autopsy characterization of sudden cardiac death: POST SCD study. Circulation. 2018;137:2689-2700. [PMID: 29915095] CrossrefMedlineGoogle Scholar3. Rudd RA, Seth P, David F, et al. Increases in drug and opioid-involved overdose deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65:1445-1452. [PMID: 28033313] doi:10.15585/mmwr.mm655051e1 CrossrefMedlineGoogle Scholar4. California Opioid Overdose Surveillance Dashboard. Welcome to the California Opioid Overdose Surveillance Dashboard. Accessed at https://discovery.cdph.ca.gov/CDIC/ODdash/ on 9 December 2019. Google Scholar5. National Center for Health Statistics, Centers for Disease Control and Prevention. NCHS data on drug-poisoning deaths. Accessed at www.cdc.gov/nchs/data/factsheets/factsheet-drug-poisoning.htm on 9 December 2019. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of California, San Francisco, San Francisco, California (R.M.R., J.C.M., D.R., S.D., Z.H.T.)Office of the Chief Medical Examiner, City and County of San Francisco, San Francisco, California (E.M.)Grant Support: By grant R01 HL102090 from the National Heart, Lung, and Blood Institute, National Institutes of Health, to Dr. Tseng.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-0977.Reproducible Research Statement: Study protocol and Statistical code: Not available. Data set: Analytical data set available from Dr. Tseng (e-mail, [email protected]ucsf.edu).Corresponding Author: Zian H. Tseng, MD, MAS, Section of Cardiac Electrophysiology, Division of Cardiology, University of California, San Francisco, 500 Parnassus Avenue, MUE-433, Box 1354, San Francisco, CA 94143-1354; e-mail, [email protected]ucsf.edu.This article was published at Annals.org on 11 August 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMultiple substance use and blood pressure in women experiencing homelessnessImplementation of a Leave-behind Naloxone Program in San Francisco: A One-year ExperienceFactors Affecting Yield of Genetic Testing of Sudden Deaths in Young IndividualsAntemortem and Post-Mortem Characteristics of Lethal Mitral Valve Prolapse Among All Countywide Sudden DeathsNAloxone CARdiac Arrest Decision Instruments (NACARDI) for targeted antidotal therapy in occult opioid overdose precipitated cardiac arrestOpioid Deaths Undercounted 1 December 2020Volume 173, Issue 11Page: 941-944KeywordsAddictionAutopsyDrugsEmergency medical servicesHeartMortalityOpioidsPlagueSudden cardiac deathToxicology ePublished: 11 August 2020 Issue Published: 1 December 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...