Follow-up to Nonfatal Opioid Overdoses
Authors: Richard E. Moon, Jennifer V.F. Potter
Journal: Annals of Internal Medicine (2016)

Letters6 September 2016Follow-up to Nonfatal Opioid OverdosesRichard E. Moon, MD and Jennifer V.F. Potter, MDRichard E. Moon, MDFrom Duke University Medical Center, Durham, North Carolina, and University of Virginia, Charlottesville, Virginia.Search for more papers by this author and Jennifer V.F. Potter, MDFrom Duke University Medical Center, Durham, North Carolina, and University of Virginia, Charlottesville, Virginia.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0110 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail 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 ...References1. Gregg J. Follow-up to nonfatal opioid overdoses: more of the same or an opportunity for change? [Editorial]. Ann Intern Med. 2016;164:62-3. [PMID: 26720852]. doi:10.7326/M15-2687 LinkGoogle Scholar2. Nelson JA, Loredo JS, Acosta JA. The obesity-hypoventilation syndrome and respiratory failure in the acute trauma patient. J Emerg Med. 2011;40:e67-9. [PMID: 18757156] doi:10.1016/j.jemermed.2007.12.022 CrossrefMedlineGoogle Scholar3. White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999;94:961-72. [PMID: 10707430] CrossrefMedlineGoogle Scholar4. Potter JV, Moon RE. Commentaries on Viewpoint: Why do some patients stop breathing after taking narcotics? Ventilatory chemosensitivity as a predictor of opioid-induced respiratory depression. J Appl Physiol (1985). 2015;119:420-2. [PMID: 25792710] doi:10.1152/japplphysiol.00034.2015 CrossrefMedlineGoogle Scholar5. Bates ML, Farrell ET, Eldridge MW. Abnormal ventilatory responses in adults born prematurely [Letter]. N Engl J Med. 2014;370:584-5. [PMID: 24499235] doi:10.1056/NEJMc1311092 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Duke University Medical Center, Durham, North Carolina, and University of Virginia, Charlottesville, Virginia.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L16-0110. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoFollow-up to Nonfatal Opioid Overdoses: More of the Same or an Opportunity for Change? Jessica Gregg Follow-up to Nonfatal Opioid Overdoses Mitchel L. Galishoff Metrics 6 September 2016Volume 165, Issue 5Page: 377-378KeywordsAnalgesicsHypercapniaHypoxiaLungsObesityObservational studiesOpioidsPhenotypesPregnancySleep ePublished: 6 September 2016 Issue Published: 6 September 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...