What is Respiratory Depression?

Methadone toxicity often manifests itself-- causing death by something called respiratory depression or central nervous system depression. Respiration is controlled principally through the part of the brain called the medullary respiratory center with peripheral input from chemoreceptors and other sources. We all understand that breathing is something that is involuntary-- like blinking ones eyes or beating one's heart. We don't "make ourselves breathe." Rather, chemoreceptors in the carotid arteries measure CO2 levels and transmit that information to the brain, which then directs the diaphragm and intercostals/lungs to "breathe." Thank goodness for this process. It would be difficult to sleep if we had to worry about making our bodies breathe. Opioids like methadone inhibit the chemoreceptors via mu opioid receptors and in the medulla via mu and delta receptors. While there are a number of neurotransmitters mediating the control of respiration, glutamate and GABA are the major excitatory and inhibitory neurotransmitters, respectively. So, a simpler way to understand this is to say that methadone interferes with the messages the chemoreceptors send to the brain. Methadone desensitizes the medulla, making the brain unaware of the need for the lungs to breathe. The result is respiratory depression. Families report that the son or daughter feels really sleepy, falls asleep and , the lucky families report that the child is difficult to awaken during the respiratory depression process. The unlucky mother tells me that she heard her son snoring heavily, and found him dead the next morning. Phyllis Lile-King

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