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

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 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.