What happens inside your brain when it comes to breathing? This is the question Christopher has spent years researching. By starting with the brain’s role in breathing, he uses this talk to give listeners a new insight into how opioids work. Opioids are powerful drugs that, when used properly under medical supervision, can work wonders for those suffering from constant, intractable pain. When used recreationally or outside of sound medical controls, the scourges of addiction and overdose are high. Christopher explains the how’s and why’s of both sides of opioids and the brain, in a talk that makes the science accessible to all. Christopher Wyatt is originally from Manchester, England. He has a PhD in Neuropharmacology and for the last thirty years has researched the neuronal control of breathing with particular interest in how disease states and medicines alter breathing. He has over fifty publications on the control of breathing and his laboratory has been funded by NIH, The American Heart Association, and the pharmaceutical industry. Chris lives in Yellow Springs, is married to Karen, and has two teenage sons: Bob and Morris. To relax during this pandemic, he walks his two crazy little Patterdale Terriers: Betty and Archie. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at
Ah we rarely think about one of the most important things that we do breathing it’s a mostly involuntary mechanism but the average human being can voluntarily hold their breath for approximately one minute and that’s something i’d like to try now so when i tell you and if you’re able i’d like you to take a deep breath and hold it okay you ready take a
Deep breath and hold it while you’re holding your breath several things are happening your body is continuing to consume oxygen and so the oxygen in your blood is falling simultaneously the body’s producing carbon dioxide and so the carbon dioxide in your blood is rising this is an unsustainable situation and your body’s going to have to do something about
It so you’ll start to feel an increase in the drive to breathe can you feel it can you feel it now okay you can carry on breathing i don’t want people fainting for the last 30 years i’ve researched the neuronal control of breathing specifically looking at the mechanisms that underpin the drive to breathe when oxygen falls in the blood and carbon dioxide
Rises it stimulates two little organs in your neck called the carotid bodies they’re about the size of a grain of rice in man and when stimulated these fire nervous signals to your brain forcing you to breathe and the oxygen goes back up again and the carbon dioxide goes back down it’s a really powerful homeostatic mechanism in fact you can’t commit suicide
By holding your breath even if you’re incredibly stubborn you’ll hold your breath faint full on the floor and carry on breathing again now my laboratory is particularly interested in disease states that change the control of breathing such as sudden infant death syndrome and sleep apnea but we’re also really interested in medicines that change the way we
Breathe and one of the classes of medicine that i’m particularly interested in are the opioids now you’ve probably heard about the fact that regionally and nationally the usa has a problem with opioid abuse but what you probably don’t know is that opioids kill you by suppressing your breathing now in my teaching of students in the laboratory and also in the
Classroom it quickly became apparent that the students didn’t know that opioids suppress breathing but it went much deeper than that the students didn’t really know very much about opioids at all some of my students thought that if they went for surgery and were prescribed opioids to help with the recovery they’d end up as junkies now opioids are some of our
Best pain killing medication and yes they are addictive but they help people living in terrible pain to lead a relatively normal life and so for that reason today i’d like to talk a little bit about what happens to your brain when you take an opioid now most of us are aware that in our bodies we have a natural opioid system the endorphins the endorphins
Are responsible for the runners high and also for why spicy food can be so addictive but the endorphins do so much more than that they’re responsible for how we perceive happiness and also sense reward after we’ve done a job well they’re involved in our gut motility they’re involved in modulating our breathing and regulating our body temperature in fact
Endorphins are involved in a host of normal physiological and psychological processes so what happens then if we have surgery and we’re prescribed an opioid well the same thing that happens if you take an opioid simply to get high it feels good in high doses opioids produce euphoria and they help us manage the pain that we’re in but not just physical pain
Psychological pain as well the stresses and strains of everyday life fade away when you take an opioid it’s one of the reasons why they’re so addictive then what happens if we continue taking this dose of opioid well our brain begins to change the receptors on the nerves in the brain that the opioids act on start to be removed from the nerve membranes they
Get fewer and fewer and fewer and this has significant consequences now the dose of opioid that we’re taking doesn’t kill as much pain and it doesn’t produce the high that we’re expecting we’ve become tolerant to the opioid now following surgery this is fine because as we develop tolerance to the opioids we’re actually healing and so we need less drug anyway
And so we can safely take the opioids away and there’ll be very few side effects which is great news but if you have a more severe pain condition say like bone cancer or you’re chasing that high you’re going to have to start taking more opioid and our brains continue to change those receptors are taken out of the nerves until we have so few receptors in
Our brains for the opioids that even though we’re taking a high dose of opioid it just makes us feel normal and if at that point we stop taking the opioid we’ll go into withdrawal we are dependent on that opioid now let’s think a little bit back about what happens with our endogenous or natural opioid the endorphins help us feel happiness and reward and
Are involved in a host of physiological mechanisms but in withdrawal we don’t have any of that we’ve got virtually no receptors in the brain for the opioids we’ve completely suppressed our endogenous or natural opioids we enter a painfully abnormal state diarrhoea cramping we can’t control temperature anxiety it’s a horrible situation but at the same time
Our brain is recovering and those receptors are starting to be put back into the nerves and this is a really really dangerous period of time it varies from individual to individual and the time that these receptors get put back in but why is it dangerous well we’re in withdrawal and it’s awful and the fastest way to get back to being normal is to take more
Opioid but if we take the same amount of opioid that we were taking before we went into withdrawal we’ll massively over stimulate all of these new receptors that have been put back into the brain and will suppress our drive to breathe from our carotid bodies and from the brain and we’ll stop breathing and we’ll die now this is extremely unlikely to happen
With cancer patients their medications are well managed and monitored but with a recreational opioid user it’s incredibly likely that it’s going to happen so what can we do to stop the overdose well we can take narcan or naloxone and what narcan does is it sits on all these receptors in the brain and it stops them from functioning and it will reverse the
Overdose the drive to breathe will come back and will survive but what narcan doesn’t do is cure an addiction indeed my friend shawnee overdosed and was brought back more than 10 times if you take an addict that’s overdosed and you recover them with narcan and then you put them back in the same environment where they overdosed then it’s incredibly likely
That they’ll overdose again they’ll take opioid again why well they’re in withdrawal and it’s awful and the opioid is a shortcut back to normality so what can we do well we can treat them like human beings we can provide skilled therapists to help them root out the causes of addiction we can provide them with social services to help with difficult family
Situations and we can even give them a sense of reward by helping them get a job long-term treatment is essential for rehabilitating opioid addicts my friend shawnee she’s been clean for years now and this morning she saved someone’s life in a car park by administering narcan now what have i hoped to do with this talk well i’ve hoped that you understand
Now that opioids can be safe and effective medicine when used correctly and yes they’re addictive and now you know a little bit more about why they’re addictive and yes they’re dangerous and now you know a little bit more about why they’re dangerous and i truly believe that we can treat opioid addicts better it’s going to take more time more money more
People and an awful lot more compassion is it worth it oh absolutely it’s worth it i’ve spent the last 30 years of my life focused on keeping people breathing and i’m not going to lose that focus now you
Transcribed from video
How Opioids, Overdoses, and Breathing Are Connected | Christopher Wyatt, PhD | TEDxDayton By TEDx Talks