Heroin‐induced respiratory depression and the influence of dose variation: within‐subject between‐session changes following dose reduction

Background and aims Globally, more than 100 000 people die annually from opioid overdose. Opportunities to study physiological events in at‐risk individuals are limited. This study examined variation of opioid dose and impact on respiratory depression in a chronic injecting heroin user at separate t...

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Vydané v:Addiction (Abingdon, England) Ročník 115; číslo 10; s. 1954 - 1959
Hlavní autori: Tas, Basak, Jolley, Caroline J., Kalk, Nicola J., Waal, Rob, Bell, James, Strang, John
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England Blackwell Publishing Ltd 01.10.2020
Predmet:
Addictions
Analgesics, Opioid - pharmacology
Anatomical systems
Apnea
Carbon dioxide
Clinical research
Depression
Dosage
Dose-Response Relationship, Drug
Drug addiction
Drug overdose
Drug Tapering
HAT
Heroin
Heroin - pharmacology
Heroin Dependence - drug therapy
Heroin Dependence - physiopathology
Humans
Hypoventilation
Male
Mental depression
Middle Aged
Narcotics
opioid
Opioids
Overdose
Oxygen
Pauses
Physiology
Respiration
respiratory
Respiratory Insufficiency - chemically induced
Saturation
overdose
Depression
HAT
heroin
respiratory
opioid
ISSN:0965-2140, 1360-0443, 1360-0443
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Shrnutí:Background and aims Globally, more than 100 000 people die annually from opioid overdose. Opportunities to study physiological events in at‐risk individuals are limited. This study examined variation of opioid dose and impact on respiratory depression in a chronic injecting heroin user at separate time‐points during his long‐term diamorphine maintenance treatment. Design A single‐subject study over 5 years during which participant underwent experimental studies on diamorphine‐induced respiratory depression, at changing maintenance doses. Setting A clinical research facility. Participant Male subject on long‐term injectable diamorphine (pharmaceutical heroin) maintenance treatment for heroin addiction. Measurements Physiological measures of oxygen saturation (SpO2), end‐tidal carbon dioxide (ETCO2) and respiratory rate (RR) were used to indicate severity of respiratory depression. Findings (1) After diamorphine injection, respiratory regulation became abnormal, with prolonged apnoea exceeding 20 sec (maximum 56 sec), elevated ETCO2 (maximum 6.9%) and hypoxaemia (minimum SpO2 80%). (2) Abnormalities were greater with highest diamorphine dose: average SpO2 was 89.3% after 100 mg diamorphine versus 93.6% and 92.8% for the two 30‐mg doses. (3) However, long apnoeic pauses and high levels of ETCO2% were also present after lower doses. Conclusions With marked inter‐session variability, these findings corroborate observations of inconsistent relationships between opioid dose and overdose risk.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:0965-2140
1360-0443
1360-0443
DOI:10.1111/add.15014