The main reason people die after using opioids is that they have trouble breathing.
In the UK, there were 140,863 adults who went to treatment for opioid use in 2020/21. Opioid use is still a major cause of early death, as it was a factor in 3,726 drug-related deaths last year. Opioid abuse kills through suffocating.
According to new research published in The Journal of Physiology, a novel treatment for respiratory depression caused by opioid use involves administering electrical pulses to the back of the neck, which can help patients regain respiratory function after high-dose opioid use. This could be a viable alternative to pharmacological treatments, which can result in withdrawal symptoms, cardiac difficulties, and adverse effects on the central nervous system.
Because opioids desensitize the brain stem to increases in carbon dioxide, breathing issues can emerge following opioid usage or post-operative complications from anaesthesia. This can result in respiratory failure, which is potentially fatal. Current therapies for breathing issues caused by opiate use, such as manual lung expansion and medicine, can help in the short term, but enabling patients to breathe independently remains a struggle. As a result, this new study, which uses epidural electrical stimulation (EES), provides a non-pharmacological therapeutic option.
EES activates a network of neurons in the brainstem that stimulates and coordinates respiratory muscles, improving breathing rate and depth. It is administered at the cervical spinal cord, which is positioned at the back of the neck.
Researchers from the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), USA, looked at the sensory-motor circuits in the cervical spinal cord of 18 people with degenerative spine diseases who were put to sleep for surgery. For no more than 90 seconds, they continually delivered 30 Hertz of EES to the cervical spinal cord.
They discovered that short bursts of low-intensity EES not only enhanced breath volume but also actively controlled frequency and rhythm during opioid-induced breathing difficulties. In the presence of strong doses of opioids, the rhythmic breathing pattern was momentarily prolonged after the EES ceased.
Professor and vice chair of neurosurgery at UCLA and lead author Dr. Daniel Lu says:
The findings of the study, according to Professor and vice chair of neurosurgery at UCLA and lead author Dr. Daniel Lu, “provide proof of principle that cervical EES could improve respiration following opioid use. We can compare the human body to a car, our goal is to jump start the body so it can run by itself without periodic pushes.”
The study authors “hope to use EES to provide novel approaches to restore breathing for healthcare providers as we are now using defibrillation devices for restoring cardiac activities.”
Future human trials with bigger cohorts will be done to further investigate the practical applicability and impact of EES in acute pathological situations such as OIRD, stroke, and traumatic brain, brain stem, or spinal cord damage to see if EES can lessen or eliminate the requirement for ventilator support. To further study the role of individual neurons in response to EES, mice will be subjected to experiments.
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