Study: Nasal Spray Naloxone Easiest to Use for Untrained Individuals

Nasal sprays are the quickest and easiest means to delivering naloxone to an individual experiencing an opioid overdose for untrained community members, according to a new study published in Pharmacotherapy.¹

Access to naloxone is crucial to reducing the opioid-related deaths. There are 3 types of FDA-approved naloxone forms–injectable, auto-injector, and nasal spray–and all 3 currently require a prescription. However, naloxone may be distributed through pharmacies and community distribution for use by individuals with or without medical training.

The study aimed to determine how easily and effectively individuals without prior medical training could administer naloxone in the event of an opioid overdose.  

For the study, 207 participants were randomly assigned to administer naloxone using a nasal spray device, an intramuscular (IM) kit, or an improvised nasal atomizer kit. Participants were instructed to administer the device to a high-fidelity mannequin in a public environment with distractions to mimic those that may be present in an actual overdose. No device instructions were provided and participants were evaluated using a standardized tool.

Related: Opioids: The Pharmacist’s Role

Successful administration was defined as administration within 7 minutes and without critical errors. According to the results, use of the nasal spray (66.7%, p<0.001) and IM (51.5%, p<0.001) devices had higher rates of successful administration than the improvised nasal atomizer device (2.9%).

Additionally, individuals administered the nasal spray device more quickly (median 16 seconds) compared with the IM device (median 58 seconds, p<0.001) or improvised nasal atomizer device (median 113 sec, p=0.012). The nasal spray device was also the easiest to use, according to the study.

Still, the researchers noted that success rates overall for untrained individuals administering naloxone was much lower than a previously-conducted study of individuals who were provided video demonstrations.²

“People may not realize how important it is to provide training on how to administer naloxone,” study author William Eggleston, clinical assistant professor at Binghamton University, said in a press release about the findings.² “But when someone is not breathing, every second counts. If naloxone becomes available over the counter, our study highlights the importance of training resources, like pharmacists, public health campaigns, and community resources. It also shows that the nasal spray product is the most intuitive to use and easiest to use quickly.”

Currently, the FDA is working on making naloxone more widely available in pharmacies as an approved OTC product.

References:

• Eggleston W, Calleo V, Kim M. Naloxone administration by untrained community members. Pharmacotherapy. 2019. Doi: https://doi.org/10.1002/phar.2352.

• Research Shows Nasal Spray Antidote Is Easiest to Give for Opioid Overdose [news release]. Binghamton University’s website. https://www.binghamton.edu/news/story/2230/research-shows-nasal-spray-antidote-is-easiest-to-give-for-opioid-overdose. Accessed January 13, 2020.