Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose

TLDR

Naloxone reverses opioid overdose and can prevent death, and while usually given by injection, it can also be administered via intranasal spray. In August 2006 the Boston Public Health Commission authorized a public‑health program that trained bystanders through non‑medical needle‑exchange staff to use intranasal naloxone. Over 15 months the program trained 385 participants, who reported 74 successful overdose reversals with few problems, demonstrating the feasibility of intranasal naloxone distribution.

Abstract

Administering naloxone hydrochloride (naloxone) during an opioid overdose reverses the overdose and can prevent death. Although typically delivered via intramuscular or intravenous injection, naloxone may be delivered via intranasal spray device. In August 2006, the Boston Public Health Commission passed a public health regulation that authorized an opioid overdose prevention program that included intranasal naloxone education and distribution of the spray to potential bystanders. Participants were taught by trained nonmedical needle exchange staff. After 15 months, the program provided training and intranasal naloxone to 385 participants who reported 74 successful overdose reversals. Problems with intranasal naloxone were uncommon. Overdose prevention education with distribution of intranasal naloxone is a feasible public health intervention to address opioid overdose.