Follow-up to Nonfatal Opioid Overdoses

Richard E. Moon; Jennifer V.F. Potter

doi:10.7326/L16-0110

Letters |6 September 2016

Follow-up to Nonfatal Opioid Overdoses

Richard E. Moon, MD; Jennifer V.F. Potter, MD

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TO THE EDITOR:

Gregg's editorial (1) outlines many sensible strategies for approaching the recent plethora of opioid overdoses causing hypoventilation, hypoxia, and often death. We suggest 1 additional long-term strategy that deserves consideration: identification of phenotypes at high risk for opioid-induced respiratory depression (OIRD). Clinical observation has identified some of these—including conditions leading to chronic hypercapnia, such as severe obstructive lung disease and obesity hypoventilation syndrome (2). Another group at high risk for OIRD includes long-term opioid users who have developed tolerance to the analgesic effects of these drugs. Animal studies and human observations have revealed that tolerance to respiratory depression develops slowly or not at all (3); thus, persons who develop tolerance to opioid analgesia and therefore tend to use increasingly higher doses are at risk, especially during sleep (4).

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2016 American College of Physicians

Letters |6 September 2016

Follow-up to Nonfatal Opioid Overdoses

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Letters |6 September 2016

Follow-up to Nonfatal Opioid Overdoses

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