Abstract 15476: Methadone-Related Sudden Death in the Community

Abstract

Introduction: Non-toxic levels of methadone have been associated with ventricular dysrhythmias and sudden death, but current community-based data are lacking. We studied demographics and resuscitation circumstances at the time of cardiac arrest in these individuals. Methods: We prospectively ascertained all residents of Multnomah Co., OR (2002-18) and Ventura Co., CA (2015-21) who suffered out-of-hospital cardiac arrest and had toxicology reports available. We excluded individuals under age 18 or with evidence of recreational drug use or drug overdose. Methadone levels were captured on toxicology reports from the medical examiner and resuscitation variables were obtained from emergency medical services. We used logistic regression to compare demographics and resuscitation features in those with and without methadone. Results: Of the 789 subjects who met criteria, the mean (SD) age was 49 (13) years, 34% were females, and 85 (11%) had therapeutic levels of methadone (Table). After adjusting for age, females were 2.26 times more likely to have methadone on their toxicology report (1.42-3.57; p-value=0.0005). Subjects with methadone-related deaths were younger and 3.5 times more likely to suffer cardiac arrest in a home setting compared to those without methadone. Although the prevalence of night-time arrest was similar in those with and without methadone, those with methadone were more likely to have an unwitnessed event or no resuscitation attempted. When resuscitation was attempted, 97% of those with therapeutic methadone levels had a non-shockable presenting rhythm. Conclusion: Although males account for 66% of overall sudden death events, females were twice as likely to have a methadone-related sudden death compared to males. Methadone-related cardiac arrests are difficult to resuscitate. These findings highlight the need to enhance primary prevention of methadone-related sudden deaths, and a renewed investigative focus on higher risk in women.