Positive Feedback From Communities Using Naloxone Nasal Spray

Pauline Anderson

March 22, 2017

ORLANDO — Naloxone nasal spray effectively reverses the effects of opioid overdose, with response times similar to those reported for intramuscular administration of naloxone, results of a new survey suggest.

"Looking at the results of this survey, believe me, I was very pleasantly surprised with what I saw," said lead researcher, George K. Avetian, DO, senior medical advisor for Delaware County, Media, Pennsylvania.

"People in my county are seeing phenomenal results with this product," he told Medscape Medical News. "We're going to continue to use it because it's very effective, it's safe, efficient and fast-acting."

Approved by the US Food and Drug Administration (FDA) in February 2016 for the emergency treatment of a known or suspected opioid overdose, the product (Narcan, Adapt Pharma) is an intranasal form of naloxone. It comes in a package of two doses of 4 mg each. Adapt Pharma provided funding for the survey.

Conducted in August 2016, researchers surveyed 152 of the 216 community organizations in the United States that had received a total of 57,882 units of the nasal spray. Community organizations included health departments, emergency medical services, law enforcement, and others.

The findings were reported here at the American Academy of Pain Medicine (AAPM) 2017 Annual Meeting.

Successful Outcomes

Of the 152 organizations contacted for the survey, 8 provided data, which were collected and documented on 261 attempted opioid overdose reversals using the nasal spray. Heroin was presumed to be involved in the majority of overdose cases.

Of the 261 cases, outcomes were reported for 245, and of these, 242 were successful.

"That's a 98% survival rate," commented Dr Avetian.

Of the 170 cases for which time to success after nasal administration was reported, 74.1% reported a response time of 5 minutes or less (19.9%, <1 minute; 33.5%, 1 to 3 minutes; 27.7%, 3 to 5 minutes).

Fast response is extremely important to preventing respiratory distress, which can lead to brain death and cardiac death in patients who have overdosed on opioids, said Dr Avetian.

"If you can get a response in 5 minutes, number 1, you're saving heart and brain, and number 2, you're giving the police officer or whoever is administering it time for paramedics to arrive and take more advanced life support measures."

The response time observed in the survey is consistent with what has been found for the naloxone intramuscular formulation, said Dr Avetian.

Biggest Concern

Opioid withdrawal was initially the biggest concern with the nasal spray, said Dr Avetian. But the survey found that there was no event in 62% of cases, with opioid withdrawal symptoms being reported in 14.3% of cases with successful overdose reversal. Such symptoms included nausea, vomiting, irritability, dizziness, and cold sweats.

"These are relatively insignificant when you look at the option, which is death," said Dr Avetian. "I would much rather deal with withdrawal than have to deal with the coroner."

Three deaths were reported. In two of these cases, the nasal spray was reported to have been administered after the period during which naloxone would be expected to be effective. Details on the third case were not provided. 

Like other areas across the country, Delaware County is experiencing an "epidemic" of opioid overdoses, said Dr Avetian. He added that his county is taking "a very proactive approach" to the problem.

"To make this effective, you need four pieces of the equation. You have to have leadership convinced and engaged, the medical community has to buy into the process, law enforcement has to buy into the process, and the general public has to be involved. We are fortunate; all four pieces of the equation are there."

The county also has a multidisciplinary heroin taskforce, said Dr Avetian. "Many other jurisdictions have come to see what we do."

When asked to comment, Miroslav Backonja, MD, a neurologist and pain specialist in Seattle, Washington, said the success of the naloxone nasal spray "totally makes sense."

The nasal route of administration is fairly efficient, with relatively fast access to the cerebrovasculature, and rapid absorption, said Dr Backonja.

However, he questioned how the spray could be administered if the patient has suffered trauma and has a blockage of the nasal passage.

Even though this is a survey, not a randomized controlled trial, "it was encouraging to see such a high rate of success with the intervention and the number of lives saved," said Steve Stanos, DO, a pain medicine specialist at Swedish Medical Center, Seattle, and new president of the American Academy of Pain Medicine.

"It helps to show that surveys can offer valuable insights."

This poster, which was an award winner at the AAPM meeting, is important given the ongoing prescription opioid, heroin, and illicit fentanyl overdose crisis, said Dr Stanos.

"Besides providing injectable and nasal naloxone to first responders, these medications are also being prescribed to patients who are on very high doses of opioids, have other risk factors for abuse or overdose, or have ongoing substance abuse or addiction problems.  Family members are trained in how to recognize overdose and how to administer the medication."

Survey data collection and medical writing/editorial support were provided by Synchrony Medical Communications  LLC and sponsored by Adapt Pharma Inc. Dr Avetian has disclosed no relevant financial relationships.

American Academy of Pain Medicine (AAPM) 2017 Annual Meeting. Late Breaking Poster # LB001.  

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