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Heroin‐induced respiratory depression and the influence of dose variation: within‐subject between‐session changes following dose reduction
Addiction ( IF 5.2 ) Pub Date : 2020-03-11 , DOI: 10.1111/add.15014
Basak Tas 1 , Caroline J Jolley 2 , Nicola J Kalk 1, 3 , Rob van der Waal 3 , James Bell 1 , John Strang 1, 3
Affiliation  

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 30 seconds (maximum 56 seconds), elevated ETCO2 (maximum 6.9%) and hypoxaemia (minimum SpO2 80%). (2) Abnormalities were greater with highest diamorphine dose: average SpO2 was 89% after 100mg diamorphine versus 94% and 93% for the two 30mg 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.

中文翻译:

海洛因引起的呼吸抑制和剂量变化的影响:剂量减少后受试者内部的会话间变化

背景和目标 在全球范围内,每年有超过 100,000 人死于阿片类药物过量。研究高危个体生理事件的机会是有限的。本研究检查了慢性注射海洛因使用者在长期二吗啡维持治疗期间的不同时间点阿片类药物剂量的变化及其对呼吸抑制的影响。设计 一项为期 5 年的单受试者研究,在此期间,参与者在改变维持剂量的情况下接受了关于二吗啡诱导的呼吸抑制的实验研究。设置临床研究机构。参与者 接受长期注射二吗啡(药物海洛因)维持治疗海洛因成瘾的男性受试者。测量氧饱和度 (SpO2) 的生理测量,呼气末二氧化碳 (ETCO2) 和呼吸频率 (RR) 用于指示呼吸抑制的严重程度。结果(1)注射地吗啡后,呼吸调节异常,呼吸暂停时间延长超过30秒(最长56秒),ETCO2升高(最高6.9%),低氧血症(最低SpO2 80%)。(2) 最高二吗啡剂量时异常更严重:100mg 二吗啡后平均 SpO2 为 89%,而两个 30mg 剂量为 94% 和 93%。(3) 然而,在较低剂量后也存在长时间的呼吸暂停暂停和高水平的 ETCO2%。结论由于显着的会话间变异性,这些发现证实了阿片类药物剂量与过量风险之间不一致关系的观察结果。呼吸暂停超过 30 秒(最长 56 秒)、ETCO2 升高(最高 6.9%)和低氧血症(最低 SpO2 80%)。(2) 最高二吗啡剂量时异常更严重:100mg 二吗啡后平均 SpO2 为 89%,而两个 30mg 剂量为 94% 和 93%。(3) 然而,在较低剂量后也存在长时间的呼吸暂停暂停和高水平的 ETCO2%。结论由于显着的会话间变异性,这些发现证实了阿片类药物剂量与过量风险之间不一致关系的观察结果。呼吸暂停超过 30 秒(最长 56 秒)、ETCO2 升高(最高 6.9%)和低氧血症(最低 SpO2 80%)。(2) 最高二吗啡剂量时异常更严重:100mg 二吗啡后平均 SpO2 为 89%,而两个 30mg 剂量为 94% 和 93%。(3) 然而,在较低剂量后也存在长时间的呼吸暂停暂停和高水平的 ETCO2%。结论由于显着的会话间变异性,这些发现证实了阿片类药物剂量与过量风险之间不一致关系的观察结果。低剂量后也出现长时间的呼吸暂停暂停和高水平的 ETCO2%。结论由于显着的会话间变异性,这些发现证实了阿片类药物剂量与过量风险之间不一致关系的观察结果。低剂量后也出现长时间的呼吸暂停暂停和高水平的 ETCO2%。结论由于显着的会话间变异性,这些发现证实了阿片类药物剂量与过量风险之间不一致关系的观察结果。
更新日期:2020-03-11
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