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Undetected Respiratory Depression in People with Opioid Use Disorder
B Tas1, N J Kalk2, M Lozano-García3
1National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Addictions Department, King's College, London SE5 8BB, UK.
Drug and Alcohol Dependence
|March 20, 2022
Summary
Respiratory depression is common in Opioid Use Disorder (OUD) patients, even those without chronic obstructive pulmonary disease (COPD). This finding highlights potential risks associated with opioid agonist treatment (OAT) and overdose susceptibility.
Area of Science:
- Pulmonary Medicine
- Addiction Medicine
- Critical Care
Background:
- Opioid-related deaths are a growing global concern, with respiratory complications being a significant factor.
- Understanding individual susceptibility to opioid overdose is crucial, particularly for individuals with Opioid Use Disorder (OUD).
- The interplay between OUD, underlying respiratory conditions like chronic obstructive pulmonary disease (COPD), and respiratory depression (RD) requires further investigation.
Purpose of the Study:
- To investigate the prevalence of respiratory depression (RD) in patients undergoing Opioid Use Disorder (OUD) treatment.
- To compare the prevalence of RD in OUD patients with that of patients suffering from chronic obstructive pulmonary disease (COPD) of similar severity.
- To explore the influence of opioid agonist treatment (OAT) dosage and type on the occurrence of RD.
Main Methods:
- Four participant groups were studied: OUD with COPD, OUD without COPD, opioid-naïve COPD patients, and healthy controls.
- Continuous physiological monitoring included pulse oximetry, end-tidal CO2, transcutaneous CO2, respiratory airflow, and parasternal muscle electromyography.
- Respiratory depression was defined by specific thresholds for SpO2, ETCO2, TcCO2, and respiratory pauses.
Main Results:
- All participants with OUD (n=20) exhibited at least one indicator of respiratory depression (RD).
- In contrast, RD episodes were observed in only 2/7 healthy controls and 2/13 COPD patients (p < 0.05).
- The prevalence of RD was similar between OUD patients receiving methadone (n=6) and buprenorphine (n=12).
Conclusions:
- Undetected respiratory depression (RD) is prevalent in Opioid Use Disorder (OUD) cohorts receiving opioid agonist treatment (OAT).
- RD in OUD patients is significantly more severe compared to opioid-naïve individuals.
- Objective measures can effectively assess RD, and further research is needed to link RD to overdose risk.
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