Nasal spray could reverse opioid and heroin overdoses

New research suggests the injectable drug naloxone can be administered just as effectively with an easy-to-use nasal spray.

The drug naloxone is a standard part of a first responder’s toolkit, and is also kept on hand by opioid users themselves. If administered in time, it can save the life of someone experiencing an overdose from opioids or heroin. Naloxone is typically injected, but efforts are underway to find easier delivery methods. One is a nasal spray, which a newly released study has found can deliver the drug just as effectively, at least in healthy people. The delivery method has yet to be studied in opioid users, who may absorb it differently due to damaged nasal membranes or obstruction from vomit during an overdose. Still, the results leave the researchers behind the study optimistic that the spray could provide a life-saving alternative to injections. We spoke with study authors John Strang and Rebecca McDonald of King's College London to learn more.

ResearchGate: How long has naloxone spray been around, and what does it do?

Strang and McDonald: Naloxone nasal spray has been tested since the early 1990s, but concentrated formulations, which can be used to administer a clinically meaningful dose of naloxone, have only become available recently.

Just like naloxone for injection, concentrated naloxone nasal spray can be used to reverse overdose from heroin and other opioids. It blocks opioid receptors in the brain and restores regular breathing. In the opioid overdose emergency, where breathing becomes very shallow or even stops, timely administration of naloxone is essential to save the life of the overdose victim.

RG: Who typically uses it?

Strang and McDonald: Recent World Health Organization guidelines recommend that anyone likely to witness an opioid overdose should have access to naloxone and know how to use it. Most commonly, naloxone nasal spray is distributed to opioid users themselves, but family members, staff at hostels and drug treatment services, and first responders can use naloxone nasal spray to reverse overdose and potentially save someone’s life.

RG: Why is a spray preferable to alternative delivery methods?

Strang and McDonald: A spray offers several advantages compared to giving naloxone as an injection. Giving a spray does not require training in needle-and-syringe assembly and may be less intimidating for layperson emergency responders to use compared to giving an injection. In addition, the nasal spray removes any risk of needle-stick injury. Finally, injectable medications are often subject to prescription-only medication status, whereas nasal sprays may be made available over the counter.

RG: What were you investigating in your study?

Strang and McDonald: In our study, the central aim was to identify a nasal dose that would deliver early naloxone exposure equivalent to a 0.4mg intramuscular injection, which is the current standard reference in clinical practice.

We found that among the three doses of nasal naloxone spray tested (1mg, 2mg, 4mg) the 2mg dose provides early exposure comparable to a 0.4 mg intramuscular naloxone, following the 0.4 mg intramuscular curve closely in the first 10 minutes post-dosing and maintaining blood levels above twice the intramuscular reference for the next two hours.

RG: Do you think having naloxone spray on hand could make opioid abusers more likely to overdose?

Strang and McDonald: This is an interesting question. Do EpiPens make people with peanut allergy more likely to eat peanuts? While the potential existence of a “safety net effect” is a commonly cited concern, there is no data to suggest that opioid users change their drug use patterns as a result of having been provided a naloxone spray for emergency use.

Featured image courtesy of Be.Futureproof.