How Opioids Overdoses and Breathing Are Connected

[Music]

[Applause]

[Music]

we rarely think about one of the most

important things that we do

breathing it’s a mostly involuntary

mechanism

but the average human being can

voluntarily hold their breath

for approximately one minute and that’s

something i’d like to try now

so when i tell you and if you’re able

i’d like you to take a deep breath and

hold it okay

you ready take a deep breath and hold it

while you’re holding your breath several

things are happening your body is

continuing to consume oxygen

and so the oxygen in your blood is

falling simultaneously

the body’s producing carbon dioxide and

so the carbon dioxide in your blood is

rising

this is an unsustainable situation and

your body’s going to have to do

something about it

so you’ll start to feel an increase in

the drive to breathe

can you feel it

can you feel it now okay you can carry

on breathing i don’t want people

fainting

for the last 30 years i’ve researched

the neuronal control of breathing

specifically looking at the mechanisms

that underpin the drive to breathe

when oxygen falls in the blood and

carbon dioxide rises

it stimulates two little organs in your

neck called the carotid bodies they’re

about the size of a grain of rice in man

and when stimulated these fire nervous

signals to your brain

forcing you to breathe and the oxygen

goes back up again

and the carbon dioxide goes back down

it’s a really

powerful homeostatic mechanism in fact

you can’t commit suicide by holding your

breath even if you’re incredibly

stubborn

you’ll hold your breath faint full on

the floor

and carry on breathing again

now my laboratory is particularly

interested in

disease states that change the control

of breathing

such as sudden infant death syndrome and

sleep apnea

but we’re also really interested in

medicines that change the way we breathe

and one of the classes of medicine that

i’m particularly interested in

are the opioids now you’ve probably

heard about

the fact that regionally and nationally

the usa has a problem with opioid abuse

but what you probably don’t know is that

opioids kill you

by suppressing your breathing

now in my teaching of students in the

laboratory and also in the classroom

it quickly became apparent that the

students didn’t know that opioids

suppress breathing

but it went much deeper than that the

students

didn’t really know very much about

opioids at all

some of my students thought that if they

went for surgery and were prescribed

opioids to help with the recovery

they’d end up as junkies

now opioids are some of our best pain

killing medication

and yes they are addictive

but they help people living in terrible

pain

to lead a relatively normal life and so

for that reason today

i’d like to talk a little bit about what

happens to your brain

when you take an opioid now most of us

are aware

that in our bodies we have a natural

opioid system the endorphins

the endorphins are responsible for the

runners high

and also for why spicy food can be so

addictive

but the endorphins do so much more than

that

they’re responsible for how we perceive

happiness and also sense reward after

we’ve done a job well

they’re involved in our gut motility

they’re involved in modulating our

breathing and regulating our body

temperature

in fact endorphins are involved in a

host

of normal physiological and

psychological processes

so what happens then if we have surgery

and we’re prescribed an opioid well

the same thing that happens if you take

an opioid simply to get high

it feels good

in high doses opioids produce euphoria

and they help us manage the pain that

we’re in but not just

physical pain psychological pain as well

the stresses and strains of everyday

life fade away

when you take an opioid it’s one of the

reasons why they’re so addictive

then what happens if we continue taking

this dose of opioid

well our brain begins to change

the receptors on the nerves in the brain

that the opioids act on

start to be removed from the nerve

membranes

they get fewer and fewer and fewer and

this has significant consequences

now the dose of opioid that we’re taking

doesn’t kill as much pain

and it doesn’t produce the high that

we’re expecting

we’ve become tolerant to the opioid

now following surgery this is fine

because as we develop tolerance to the

opioids

we’re actually healing and so we need

less drug anyway

and so we can safely take the opioids

away

and there’ll be very few side effects

which is great news

but if you have a more severe pain

condition say like bone cancer

or you’re chasing that high you’re going

to have to start taking

more opioid and our brains

continue to change those receptors are

taken

out of the nerves until we have so few

receptors in our brains for the opioids

that even though we’re taking a high

dose of opioid

it just makes us feel normal

and if at that point we stop

taking the opioid we’ll go into

withdrawal

we are dependent on that opioid

now let’s think a little bit back about

what happens

with our endogenous or natural opioid

the endorphins help us feel happiness

and reward

and are involved in a host of

physiological mechanisms

but in withdrawal we don’t have any of

that

we’ve got virtually no receptors in the

brain for the opioids

we’ve completely suppressed our

endogenous or natural

opioids we enter a painfully abnormal

state

diarrhoea cramping we can’t control

temperature

anxiety it’s a horrible situation

but at the same time our brain is

recovering

and those receptors are starting to be

put back

into the nerves and this is a really

really dangerous period of time

it varies from individual to individual

and the time that these receptors get

put back in but why is it dangerous

well we’re in withdrawal and it’s awful

and the fastest way to get back to being

normal

is to take more opioid

but if we take the same amount of opioid

that we were taking before we went into

withdrawal

we’ll massively over stimulate all of

these new receptors that have been put

back into the brain

and will suppress our drive to breathe

from our carotid bodies and from the

brain

and we’ll stop breathing and we’ll die

now this is extremely unlikely to happen

with cancer patients

their medications are well managed and

monitored

but with a recreational opioid user it’s

incredibly likely that it’s going to

happen

so what can we do to stop the overdose

well we can take narcan or naloxone

and what narcan does is it sits on all

these receptors in the brain

and it stops them from functioning and

it will reverse the overdose

the drive to breathe will come back and

will survive

but what narcan doesn’t do is cure an

addiction

indeed my friend shawnee overdosed

and was brought back more than 10 times

if you take an addict that’s overdosed

and you recover them with narcan and

then you put them back in the same

environment where they overdosed

then it’s incredibly likely that they’ll

overdose again

they’ll take opioid again why well

they’re in withdrawal

and it’s awful and the opioid is a

shortcut back to normality

so what can we do well we can treat them

like human beings

we can provide skilled therapists to

help them root out

the causes of addiction we can provide

them

with social services to help with

difficult family situations

and we can even give them a sense of

reward by helping them get a job

long-term treatment is essential for

rehabilitating opioid addicts

my friend shawnee she’s been clean for

years now and this morning she saved

someone’s life in a car park

by administering narcan

now what have i hoped to do with this

talk

well i’ve hoped that you understand now

that opioids can be

safe and effective medicine when used

correctly

and yes they’re addictive and now you

know a little bit more about why they’re

addictive

and yes they’re dangerous and now you

know a little bit more about why they’re

dangerous

and i truly believe that we can treat

opioid addicts

better it’s going to take more time

more money more people and an awful lot

more compassion

is it worth it oh absolutely it’s worth

i’ve spent the last 30 years of my life

focused on keeping people breathing

and i’m not going to lose that focus now

you