Improvised Nasal Naloxone Devices Less Effective Than Narcan, Study Finds

By Lindsey Weedston 04/04/19
Narcan is a better choice across the board for reversing opioid overdose.
narcan nasal spray
Photo via Flickr/TomWolf

A recent study conducted by the National Institute on Drug Abuse (NIDA) found that improvised nasal naloxone devices (INNDs) are significantly less effective at administering high enough doses of the overdose-reversing medication than the FDA-approved Narcan.

Naloxone is the drug that can reverse opioid overdoses that kill tens of thousands of people in the U.S. every year. Efforts to make it available, particularly in the form of Narcan, are a part of the national fight against the deadly opioid epidemic.

INNDs, according to Psych Congress, consist “of a prefilled naloxone syringe attached to a mucosal atomization device,” and have been used by first responders and others to successfully reverse overdoses for 25 years.

However, the study, first reported on by NIDA on March 15, found that Narcan does a better job of delivering high enough doses of naloxone to be maximally effective. 

“Scientists found that the approved naloxone devices deliver higher blood levels of naloxone than the improvised nasal devices,” the report reads. “In fact, levels in the plasma concentration of naloxone are considerably lower when improvised devices are used. The FDA-approved 4-mg dose nasal spray produced the highest blood level of naloxone of all the products tested.”

Speed and plasma concentration of naloxone are especially important, as overdoses of the highly potent synthetic opioid, fentanyl, have skyrocketed in the past few years. Data from the Centers for Disease Control and Prevention (CDC) found that fentanyl-related overdose deaths doubled each year from 2013 to 2016.

The fastest way to administer naloxone to counter an opioid overdose is with an IV, but first responders might not have access to the equipment they need to give a naloxone IV when time is of the essence.

Narcan is a simple nasal spray that does not require assembly and can be administered in one nostril while the patient is lying on their back. Members of the public, including people with opioid use disorders, can be easily trained to administer Narcan, and it is  available to anyone without a prescription. Health insurance may even cover some or all of the cost.

“Using the FDA-approved nasal Narcan spray is a great choice for average consumers, who will likely keep only one or two devices on hand,” said NIDA’s Dr. Philip A. Krieter. “It is smaller, easier to use, and doesn't require much if any training to use properly. The Narcan spray is a ready-to-use device; the improvised device needs assembly, and laypersons may not able to use it correctly in a panic situation.”

However, according to TIME, a Narcan kit with two doses costs around $135 without insurance, which may be prohibitively expensive for some.

Another option is the auto-injection device Ezvio, which has also been approved by the FDA. According to Dr. Krieter, a generic version of Ezvio will become available “later this year for some purchasers.”

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Lindsey Weedston is a Seattle area writer focused on mental health and addiction, politics, human rights, and various social issues. Her work has appeared in The Establishment, Ravishly, ThinkProgress, Little Things, Yes! Magazine, and others. You can find her daily writings at Twitter: