Use of naloxone nasal spray 4 mg in the community setting: a survey of use by community organizations

Abstract

Objective: Naloxone hydrochloride, an opioid antagonist, has been approved as a concentrated 4 mg dose intranasal formulation for the emergency treatment of known or suspected opioid overdose. This new formulation is easier to use and contains a higher dose of naloxone compared with earlier, unapproved kits. A survey of first responders and community-based organizations was conducted to understand initial real-world experiences with this new formulation for opioid overdose reversal.

Methods: In August 2016, 152 US organizations known to have received units of the approved 4 mg dose/unit naloxone nasal spray (Narcan^®1 nasal spray 4 mg; NNS) were surveyed regarding experiences using this formulation and availability of recorded data on these cases. Descriptive statistics were calculated based on the number of responses received for each item.

Results: Eight first-responder or community-based organizations provided case report data on 261 attempted overdose reversals using NNS, with survival reported for 245 cases. Successful overdose reversals were reported in 98.8% (242/245) of cases; most cases (73.5%; 125/170) reported a time to response of ≤5 minutes after NNS administration. Heroin was the substance reportedly involved in a majority (95.4%; 165/173) of these cases; fentanyl was reported to be involved in 5.2% (9/173) of the cases. Many reversals (97.6%; 248/254) involved administration of ≤2 units of NNS. Three deaths were reported (NNS was reported to have been administered too late for two cases [the individuals were deceased prior to NNS administration]; details were not provided for the third case). The most commonly reported observed events were “withdrawal” (14.3%; 28/196); “nausea”, “vomiting”, or “gagging/retching” (10.2%; 20/196); and “irritability” or “anger” (8.7%; 17/196).

Conclusion: This survey of data provided by first-responder and community-based organizations indicated that NNS was successful at reversing the effects of opioid overdose in most reported cases.

Keywords:

• Opioid overdose reversal
• naloxone formulation
• naloxone nasal spray
• opioid overdose

Notes

Transparency

Declaration of funding

Survey data collection and medical writing/editorial support were provided by Synchrony Medical Communications LLC, West Chester, PA, USA, and sponsored by Adapt Pharma Inc., Radnor, PA, USA.

Author contributions: conception and design: G.K.A., P.F., S.M., D.K., V.H., P.H.; analysis and interpretation of the data: G.K.A., P.F., S.M., D.K., V.H., P.H.; drafting of the paper or revising it critically for intellectual content: G.K.A., P.F., S.M., D.K., V.H., P.H.; final approval of the version to be published: G.K.A., P.F., S.M., D.K., V.H., P.H.; all authors agree to be accountable for all aspects of the work: G.K.A., P.F., S.M., D.K., V.H., P.H.

Declaration of financial/other relationships

G.K.A. has disclosed that he has received payment from Adapt Pharma Inc. for consultant work. P.F. has disclosed that he has received honoraria (through his institution) from Adapt Pharma Inc. for participation in this survey. S.M., D.K. and V.H. have disclosed that they have no significant relationship with or financial interest in any commercial company related to this study or article. P.H. has disclosed that she is an employee of Synchrony Medical Communications LLC.

CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.

Acknowledgements

Survey data collection and medical writing/editorial support were provided by Synchrony Medical Communications LLC, West Chester, PA, USA, and sponsored by Adapt Pharma Inc., Radnor, PA, USA.

Notes

1 Narcan is a registered trade name of Adapt Pharma Inc., Radnor, PA, USA