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'''Respiratory depression''' is a common physical side effect of many central nervous system [[depressants]] such as [[opioids]], [[GHB]], [[benzodiazepines]] (in combination with other [[depressants]]) and [[alcohol]]. This effect is manifested as a reduced urge to breathe and can cause a "sighing" pattern of breathing which can be described as deep breaths separated by abnormally long pauses. [[Sedation]] increases along with drug-induced respiratory depression. Breathing is controlled in the brain by the medulla oblongata, and when the activity of it is suppressed by drugs it decreases the ability to ventilate.<ref> Opioids and the control of respiration | https://academic.oup.com/bja/article/100/6/747/303263/Opioids-and-the-control-of-respiration</ref>
'''Respiratory depression''' can be described as a reduced urge to breathe that be fatal depending on its intensity. At relatively safe levels, this effect typically causes a "sighing" pattern of breathing which can be described as deep breaths separated by abnormally long pauses. At higher levels, however, an individual may cease breathing entirely in a manner which is rapidly fatal without immediate treatment.


This effect can be potentially life-threatening when depressants are taken in large doses or when combined with one another. In an overdose situation, an individual may cease breathing entirely (go into respiratory arrest) which is rapidly fatal without treatment.
This effect is capable of manifesting itself across the x different levels of intensity described below:


Substance induced respiratory depression can be broken down into 4 separate levels of intensity which progressively intensify proportional to dosage:
#'''Minimal respiratory depression:''' At the lowest level, respiratory depression is typically subtle enough to be unnoticeable and is accompanied by mild [[sedation]].
#'''Moderate respiratory depression:''' At this level, the person becomes aware of the sensation that they are taking fewer breaths per minute than usual. This level of respiratory depression is not uncomfortable and does not result in any shortness, struggling, or impairment of breath.
#'''Severe respiratory depression:''' At this level, a person's rate of breathing becomes noticeably slowed down by a significant margin which results in the person feeling that they are breathing abnormally, are short of breath, and cannot breathe in enough air. This forcibly redirects the person's focal point of attention towards manually regulating their own breathing in order to not feel extremely uncomfortable. At this point, extreme [[sedation]] is usually also present and if sleep occurs the person can potentially wake up struggling and gasping for air. Confusion, panic, and [[anxiety]] often occur at this level, further increasing the strong sensation that one's breathing will stop completely due to sleep or a lack of attention.
#'''Respiratory failure:''' At this point, the person's oxygen and carbon dioxide levels become dangerously impaired. The person will fall into a semi-conscious state, lose consciousness completely, slip into a coma, or stops breathing completely. The skin, fingernails, or lips may also have a blue-ish colour to them. This level of respiratory failure will likely be fatal without immediate medical attention.<ref>What Is Respiratory Failure? | https://www.nhlbi.nih.gov/health/health-topics/topics/rf/</ref> Opioids, in overdose or combined with other depressants, are notorious for such fatalities.


#'''Minimal respiratory depression:''' Minimal respiratory depression occurs on low doses of depressants. This effect is unnoticeable and is accompanied by mild [[sedation]].
Respiratory depression is often accompanied by other coinciding effects such as [[sedation]] and [[sleepiness]]. It is most commonly induced under the influence of [[dosage#heavy|heavy]] [[dosage|dosages]] of [[depressant]] compounds, particularly [[opioids]] such as [[heroin]] and [[fentanyl]] or [[GABAergic|GABAergics]] such as [[alcohol]] and [[GHB]]. However, it is worth noting that otherwise safe dosages of these compounds can become fatal when combined with even small amounts of other classes of depressant. For example, [[benzodiazepine|benzodiazepines]] combined with [[opioids]] are an extremely common cause of fatal respiratory depression. It is therefore strongly discouraged to combine these depressants at any dosage range.  
#'''Moderate respiratory depression:''' As the dose increases, feelings of [[sedation]] intensify from moderate to high levels. One becomes aware of the sensation that the breath is slowed down mildly to moderately or that one is taking less breaths per minute than usual. This level of respiratory depression is not uncomfortable and does not result in any shortness, struggling, or impairment of breath.
#'''Severe respiratory depression:''' Severe respiratory depression is impairing and occurs at dangerously high doses of [[depressants]]. At this level, a person's breathing rate becomes noticeably slowed down significantly which results in the feeling that one is not adequately moving air in and out of the body. Severe respiratory depression induces a powerful and overwhelming focus point of attention on one's breathing rate. In terms of how this feels physically, it can be described as the feeling that you are breathing abnormally, are short of breath, cannot breathe in enough air, and/or are forced to breathe manually in a conscious effort to feel that you are taking in enough air. Extreme [[sedation]] is present and if sleep occurs one may potentially wake up struggling and gasping for air. In cases of [[GHB]] overdoses, many reportedly experience an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea. Confusion and [[Anxiety|anxiety]] often occur at this level of heightened awareness, increasing the strong sensation that one's breathing will stop completely due to sleep or a lack of attention.
#'''Respiratory failure:''' At this point, a person's oxygen and carbon dioxide levels become dangerously impaired. The person goes into a  semi-conscious state, loses consciousness completely, slips into a coma, and/or stops breathing completely (respiratory arrest). The skin, fingernails, or lips may have a blue-ish color to them. This level of respiratory failure can be fatal without immediate medical attention.<ref>What Is Respiratory Failure? | https://www.nhlbi.nih.gov/health/health-topics/topics/rf/</ref> Opioids, in overdose or combined with other depressants, are notorious for such fatalities.
===Treatment===
===Treatment===
To prevent death, it is recommended to contact emergency medical services immediately in case of severe respiratory depression. If caused by an opioid overdose, an opioid antagonist, such as [[naloxone]], should be administered. Many harm reduction organizations provide naloxone to users for free or it can be bought at pharmacies (including Walgreens and CVS in the U.S.). Naloxone will rapidly reverse the respiratory depression unless complicated by other [[depressants]]. For other drug-induced respiratory depression, hospitalization and the assistance of a mechanical breathing machine may be necessary.
To prevent death, it is recommended to contact emergency medical services immediately in case of severe respiratory depression. If caused by an opioid overdose, an opioid antagonist, such as [[naloxone]], should be administered. Many harm reduction organizations provide naloxone to users for free or it can be bought at pharmacies (including Walgreens and CVS in the U.S.). Naloxone will rapidly reverse the respiratory depression unless complicated by other [[depressants]]. For other drug-induced respiratory depression, hospitalization and the assistance of a mechanical breathing machine may be necessary.

Revision as of 00:59, 12 March 2018

Respiratory depression can be described as a reduced urge to breathe that be fatal depending on its intensity. At relatively safe levels, this effect typically causes a "sighing" pattern of breathing which can be described as deep breaths separated by abnormally long pauses. At higher levels, however, an individual may cease breathing entirely in a manner which is rapidly fatal without immediate treatment.

This effect is capable of manifesting itself across the x different levels of intensity described below:

  1. Minimal respiratory depression: At the lowest level, respiratory depression is typically subtle enough to be unnoticeable and is accompanied by mild sedation.
  2. Moderate respiratory depression: At this level, the person becomes aware of the sensation that they are taking fewer breaths per minute than usual. This level of respiratory depression is not uncomfortable and does not result in any shortness, struggling, or impairment of breath.
  3. Severe respiratory depression: At this level, a person's rate of breathing becomes noticeably slowed down by a significant margin which results in the person feeling that they are breathing abnormally, are short of breath, and cannot breathe in enough air. This forcibly redirects the person's focal point of attention towards manually regulating their own breathing in order to not feel extremely uncomfortable. At this point, extreme sedation is usually also present and if sleep occurs the person can potentially wake up struggling and gasping for air. Confusion, panic, and anxiety often occur at this level, further increasing the strong sensation that one's breathing will stop completely due to sleep or a lack of attention.
  4. Respiratory failure: At this point, the person's oxygen and carbon dioxide levels become dangerously impaired. The person will fall into a semi-conscious state, lose consciousness completely, slip into a coma, or stops breathing completely. The skin, fingernails, or lips may also have a blue-ish colour to them. This level of respiratory failure will likely be fatal without immediate medical attention.[1] Opioids, in overdose or combined with other depressants, are notorious for such fatalities.

Respiratory depression is often accompanied by other coinciding effects such as sedation and sleepiness. It is most commonly induced under the influence of heavy dosages of depressant compounds, particularly opioids such as heroin and fentanyl or GABAergics such as alcohol and GHB. However, it is worth noting that otherwise safe dosages of these compounds can become fatal when combined with even small amounts of other classes of depressant. For example, benzodiazepines combined with opioids are an extremely common cause of fatal respiratory depression. It is therefore strongly discouraged to combine these depressants at any dosage range.

Treatment

To prevent death, it is recommended to contact emergency medical services immediately in case of severe respiratory depression. If caused by an opioid overdose, an opioid antagonist, such as naloxone, should be administered. Many harm reduction organizations provide naloxone to users for free or it can be bought at pharmacies (including Walgreens and CVS in the U.S.). Naloxone will rapidly reverse the respiratory depression unless complicated by other depressants. For other drug-induced respiratory depression, hospitalization and the assistance of a mechanical breathing machine may be necessary.

Psychoactive substances

Compounds within our psychoactive substance index which may cause this effect include:

... further results

See also

References

  1. ↑ What Is Respiratory Failure? | https://www.nhlbi.nih.gov/health/health-topics/topics/rf/
Responsible drug use index
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