NARCAN Nasal Spray appears to be the best life-saving antidote that family members and other bystanders can administer to save a loved one from overdosing on opioids, a new study has found.
The study’s conclusions may bode well for potentially decreasing drug overdose fatalities in the United States, where more than 700,000 Americans have died from all drug overdoses between 1999-2017, according to the Centers for Disease Control and Prevention (CDC).
“Using NARCAN Nasal Spray should increase the likelihood that nonmedical personnel correctly deliver naloxone in time-critical, high-stress opioid overdose rescue situations,” conclude the authors in a Pain and Therapy journal article published last month.
According to the CDC, almost 70 percent of the roughly 70,200 U.S. drug overdose deaths in 2017 involved an opioid, including those that are prescription, as well as illegal opioids like heroin and illicitly manufactured fentanyl.
On average, 130 Americans die every day from an opioid overdose, the CDC reports.
Such a drastic rise in opioid overdose fatalities has led to the development of training initiatives for non-medical first responders and bystanders on when and how to administer the opioid reversal agent naloxone prior to the arrival of emergency medical services (EMS) personnel.
“Opioid overdose reversal is often dependent upon non-medical first responders or bystanders to intervene,” said Peter Sneeringer, research director at Design Science Consulting Inc. and an analyst for the recently released study.
For more than a decade, first responders and the general public have been able to treat suspected opioid overdoses using an improvised nasal naloxone device constructed from a prefilled syringe attached to a mucosal atomization device — what’s known as a naloxone PFS-NA, or prefilled syringe with nasal atomizer.
And in recent years, the U.S. Food and Drug Administration (FDA) also approved NARCAN Nasal Spray for the emergency treatment of a known or suspected opioid overdose.
“The need for nonmedical personnel to appropriately deliver naloxone during opioid overdoses is well known and increasing,” the scientists wrote in “Comparative Human Factors Evaluation of Two Nasal Naloxone Administration Devises: NARCAN Nasal Spray and Naloxone Prefilled Syringe with Nasal Atomizer.”
“However, the safety of lay prehospital naloxone administration has not been established and standardized medication administration training programs are limited,” according to the study. “Additionally, the naloxone PFS-NA was recalled by the FDA in 2016 because the nasal atomizer was not reliably converting the fluid medication into a spray.”
Nevertheless, increased public access to naloxone already has resulted in a reduction in opioid fatalities, according to Sneeringer and his colleagues, who also added that such “inexperienced users are at the highest risk of incorrectly administering naloxone.”
Sneeringer and his colleagues determined that NARCAN requires fewer steps and is easier to administer than a PFS-NA, according to the study, which compares and evaluates how easy both delivery methods are for naloxone.
“Prior usability research found that no untrained, and only 40 percent to 60 percent of trained, users were able to successfully administer a full dose of naloxone using a PFS-NA, whereas more than 70 percent of untrained users were able to successfully administer a full dose using NARCAN Nasal Spray,” the scientists wrote. “These studies provide information about lay users’ ability to administer naloxone but do not provide insights on why users commit more errors when using a PFS-NA.”
Specifically, the scientists found that the FDA-approved naloxone devices deliver higher blood levels of naloxone than the improvised nasal devices. In fact, levels in the plasma concentration of naloxone were considerably lower when improvised devices were used, according to the study.
The scientists noted that while there are many variables associated with the successful use of naloxone, quickly reaching an adequate plasma concentration is particularly important when treating overdoses involving highly potent opioids like fentanyl.
The outcomes of their study suggest that the approved nasal spray technology has the potential to save more lives than improvised devices.
“The opioid epidemic has become an increasingly prevalent public health crisis,” said Mary Yovanoff, an associate engineer at Design Science who also was involved in the study. “If delivered in time, naloxone is able to reverse the effects of an overdose.”
The study’s data, she said, contributes “further evidence that NARCAN Nasal Spray is a preferred formulation of naloxone.”
The research was funded by scientists at the National Institute on Drug Abuse, which is part of the National Institutes of Health, while the comparative analysis — initiated in October 2018 by Design Science — also included funding for the technical evaluation from Adapt Pharma Inc.
Emergent BioSolutions Inc. officially acquired Adapt Pharma and its flagship product NARCAN that same month.
“The awareness and access of affordable overdose-reversing drugs is a critical element to combat the opioid crisis,” said Doug White, senior vice president and head of the Devices Business Unit at Emergent BioSolutions, at the time. “With the acquisition of Adapt Pharma and NARCAN Nasal Spray, the leading community use emergency treatment for opioid overdose, Emergent is proud to be part of the solution to address this public health emergency.”