How Opioids Overdoses and Breathing Are Connected
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[Applause]
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ah
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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
it
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