Researchers at St. Michael’s Hospital call for a new approach to solving the opioid crisis

By Anna Wassermann

Greater research attention should be paid to the way opioids affect breathing in order to develop safer pain therapies with reduced side effects, suggests a paper written by scientists at the Keenan Research Centre for Biomedical Science (KRCBS) and recently published in CHEST Journal.

Between 2016 and 2018, more than 11,500 people died of an opioid overdose in Canada. Overdoses occur when high amounts of opioids inhibit the part of the brain responsible for breathing, but little is known about the mechanisms by which this occurs.

Co-authors Dr. Gaspard Montandon and Dr. Arthur Slutsky have studied breathing disorders for years and say there’s a serious knowledge gap in our understanding of the ways opioids affect breathing.

“Much of the research aimed at addressing the opioid crisis has been focused on trying to reduce addiction, which is an important aspect,” said Dr. Slutsky, a scientist in the Critical Illness and Injury Research Centre in the KRCBS. “But the main problem isn’t addiction — it’s what happens to the brain during an overdose.”

“We know that certain parts of the brain are more sensitive to opioids, but that’s about it,” said Dr. Montandon, a scientist in the KRCBS. “It’s unclear which parts of the brain are affected, and we don’t know how opioids inhibit the cells responsible for breathing.”

In their paper, Drs. Montandon and Slutsky suggest that scientists should focus their attention on determining which cells, proteins or molecules are inhibited by opioids. If successful, they say this would enable scientists to develop new drugs that provide pain relief without the effects on breathing.

The challenge, said Dr. Montandon, is that the circuits responsible for pain relief and breathing overlap, which makes them difficult to study. This hasn’t deterred Dr. Montandon, however, who’s leading a research program at St. Michael’s to address the mechanisms of opioid-induced respiratory depression and analgesia.

With few other scientists investigating these mechanisms in Canada and globally, the authors say they hope their paper will motivate basic scientists to take a different approach to solving the opioid crisis.

“It’s no longer working to focus only on treatments for addiction,” said Dr. Montandon. “It’s time we to turn our attention to developing safer opioid pain therapies without the respiratory side-effects responsible for overdose.”

• More information about opioid research at St. Michael’s Hospital

This paper is an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.