{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T06:59:24Z","timestamp":1780988364965,"version":"3.54.1"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,3,11]],"date-time":"2020-03-11T00:00:00Z","timestamp":1583884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2020,3,11]],"date-time":"2020-03-11T00:00:00Z","timestamp":1583884800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Globally, more than 100\u2009000 people die annually from opioid overdose. Opportunities to study physiological events in at\u2010risk individuals are limited. This study examined variation of opioid dose and impact on respiratory depression in a chronic injecting heroin user at separate time\u2010points during his long\u2010term diamorphine maintenance treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A single\u2010subject study over 5\u00a0years during which participant underwent experimental studies on diamorphine\u2010induced respiratory depression, at changing maintenance doses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>A clinical research facility.<\/jats:p>\n                    <jats:p>Participant<\/jats:p>\n                    <jats:p>Male subject on long\u2010term injectable diamorphine (pharmaceutical heroin) maintenance treatment for heroin addiction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>\n                      Physiological measures of oxygen saturation (SpO\n                      <jats:sub>2<\/jats:sub>\n                      ), end\u2010tidal carbon dioxide (ETCO\n                      <jats:sub>2<\/jats:sub>\n                      ) and respiratory rate (RR) were used to indicate severity of respiratory depression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      (1) After diamorphine injection, respiratory regulation became abnormal, with prolonged apnoea exceeding 20\u00a0sec (maximum 56\u00a0sec), elevated ETCO\n                      <jats:sub>2<\/jats:sub>\n                      (maximum 6.9%) and hypoxaemia (minimum SpO\n                      <jats:sub>2<\/jats:sub>\n                      80%). (2) Abnormalities were greater with highest diamorphine dose: average SpO\n                      <jats:sub>2<\/jats:sub>\n                      was 89.3% after 100\u00a0mg diamorphine versus 93.6% and 92.8% for the two 30\u2010mg doses. (3) However, long apnoeic pauses and high levels of ETCO\n                      <jats:sub>2<\/jats:sub>\n                      % were also present after lower doses.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>With marked inter\u2010session variability, these findings corroborate observations of inconsistent relationships between opioid dose and overdose risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.15014","type":"journal-article","created":{"date-parts":[[2020,2,14]],"date-time":"2020-02-14T06:35:34Z","timestamp":1581662134000},"page":"1954-1959","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Heroin\u2010induced respiratory depression and the influence of dose variation: within\u2010subject between\u2010session changes following dose reduction"],"prefix":"10.1111","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3137-7631","authenticated-orcid":false,"given":"Basak","family":"Tas","sequence":"first","affiliation":[{"name":"King's College London National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline J.","family":"Jolley","sequence":"additional","affiliation":[{"name":"King's College London Centre for Human and Applied Physiological Sciences  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3820-9243","authenticated-orcid":false,"given":"Nicola J.","family":"Kalk","sequence":"additional","affiliation":[{"name":"King's College London National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience  London UK"},{"name":"South London and Maudsley NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rob","family":"van der Waal","sequence":"additional","affiliation":[{"name":"South London and Maudsley NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Bell","sequence":"additional","affiliation":[{"name":"King's College London National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5413-2725","authenticated-orcid":false,"given":"John","family":"Strang","sequence":"additional","affiliation":[{"name":"King's College London National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience  London UK"},{"name":"South London and Maudsley NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,11]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"United Nations Office on Drugs and Crime (UNODC).World Drug Report 2018. Vienna Austria: UNODC;2018 pp.161\u2013190."},{"key":"e_1_2_7_3_1","unstructured":"Centers for Disease Control (CDC).Multiple Cause of Death 1999\u20132017 on CDC Wide\u2010ranging Online Data for Epidemiologic Research (CDC WONDER). 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Global Initiative for Chronic Obstructive Lung Disease (GOLD).2019. Available at:www.goldcopd.org(accessed 27 February 2020)."},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60349-2"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2011.06.001"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000375260"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0810635"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2017.02.027"}],"container-title":["Addiction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fadd.15014","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.15014","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/add.15014","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.15014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T06:03:06Z","timestamp":1780984986000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/add.15014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,11]]},"references-count":20,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1111\/add.15014"],"URL":"https:\/\/doi.org\/10.1111\/add.15014","archive":["Portico"],"relation":{},"ISSN":["0965-2140","1360-0443"],"issn-type":[{"value":"0965-2140","type":"print"},{"value":"1360-0443","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,11]]},"assertion":[{"value":"2019-12-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-02-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-03-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}