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What Is Opioid-Induced Respiratory Depression?

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Opioid-induced respiratory depression (OIRD) is the main cause of death for people who overdose.[1]

Take too much of an opioid like Vicodin or fentanyl, and you will overwhelm your opioid receptors, which decreases your body’s natural drive to breath, leading to respiratory depression and overdose.

In 2020, more than 56,000 people died due to synthetic opioid misuse .[2] If you misuse opioids, the risk of overdose is real.

There are medications that can reverse and overdose. Naloxone (Narcan) is one such medication. If you or someone you know misuses opioids, make sure you have a Narcan prescription with you at all times and know how to use it.

What Is Opioid-Induced Respiratory Depression?

Opioids have a tendency to reduce the body’s respiratory drive or our brain’s natural tendency to keep us breathing. This is called respiratory depression or sometimes respiratory suppression.

Opioid medications bind to the cells of the brain called the brainstem that are responsible for stimulating our respiratory drive. Opioids suppress the brainstem so that the body “forgets” to breathe. 

Risk Factors for Opioid-Induced Respiratory Depression

Anyone who misuses opioids is at risk for OIRD. But some factors increase your chances of respiratory distress.

Those risk factors include the following:[3]

  • Tolerance adjustments: Stop taking opioids, and your body will lose tolerance. Doses that once seem small can overwhelm your body and cause an overdose. 
  • Medication changes: If your supplier gives you a stronger drug (like fentanyl) instead of the substance you typically take, you may overdose. 
  • Mixing substances: Adding another sedating substance (like alcohol or benzodiazepines) to your opioids can cause an overdose. 
  • Poor health: A weak immune system, heart problems, unhealthy lungs, or liver damage could all increase your overdose risk. 
  • Prior issues: If you've overdosed in the past, you're at risk for a repeat.

Remember that anyone who takes opioids can overdose, including people who don't have these risk factors. But if you do have one of the issues on this list, you must be especially careful. 

Reducing Your OIRD Risk 

The best way to ensure that you don't overdose is to stop taking opioids altogether. If you must take them, you can lower your overdose risks.

There are ways to minimize the risk of opioid-induced respiratory depression. Here are a few:

  • Lower your dose. The higher the dose of opioids consumed, the greater your risk of respiratory depression. 
  • Use as directed. Only take opioids as prescribed by your doctor. 
  • Steer clear. Don't combine opioids with other medications that cause sedation, drowsiness, or similar decreases in respiratory drive like muscle relaxers, certain antidepressants, or benzodiazepines. 
  • Ask for help. Take opioids around other people who can watch for signs of sedation and get you help if needed. 
  • Stock up on overdose reversal meds. Narcan should always be prescribed to patients on opioids and available to use in case of an emergency. You should know how to use Narcan and how to instruct others around you to use it in case of emergency. 

Treating Opioid-Induced Respiratory Depression

Naloxone (brand name Narcan) is a prescription medication capable of reversing opioid-induced respiratory depression. Naloxone works by binding to opioid receptors instead of the opioid itself, quickly reversing the opioid’s effects and stopping the subsequent respiratory depression that the opioid causes.

Naloxone is remarkably effective, and take-home programs that put the medication in the hands of people with drug issues can save lives.[4]

If you have naloxone with you and you are concerned someone is overdosing, you should immediately administer Narcan and then call 911.

Once an ambulance arrives, people who overdosed may be awake after a naloxone dose. But they may need additional help. Doctors can use respiratory stimulant drugs in a hospital setting to restart their system and get them breathing normally again.[5]

While reversal medications like this can save lives, experts warn that some people experience such profound respiratory depression that they can't be saved even with Narcan administration.[6]

If you're misusing opioids, an overdose might be a wake up call that you need additional help. Reach out to your doctor, or use here at Bicycle health for more information.

Sources

  1. Neural Basis of Opioid-Induced Respiratory Depression and Its Rescue. Proceedings of the National Academy of Sciences of the United States of America. https://www.pnas.org/doi/10.1073/pnas.2022134118. February 2021. Accessed June 2022.
  2. Overdose Death Rates. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates. January 2022. Accessed June 2022.
  3. Opioid Overdose Risk Factors. Commonwealth of Massachusetts. https://www.mass.gov/service-details/opioid-overdose-risk-factors. Accessed June 2022.
  4. Naloxone Effectiveness: A Systematic Review. Journal of Addictions Nursing. https://journals.lww.com/jan/Abstract/2018/07000/Naloxone_Effectiveness__A_Systematic_Review.6.aspx. 2018. Accessed June 2022.
  5. Opioid-Induced Respiratory Depression: Reversal by Nonopioid Drugs. F1000 Prime Reports. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173639/. 2014. Accessed June 2022. 
  6. Opioid-Induced Respiratory Depression in Humans: A Review of Pharmacokinetic-Pharmacodynamic Modelling of Reversal. British Journal of Anaesthesia. https://www.sciencedirect.com/science/article/pii/S000709121930008X. June 2019. Accessed June 2022.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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