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. 2022 Aug:106:103751.
doi: 10.1016/j.drugpo.2022.103751. Epub 2022 May 26.

Patient perceptions of higher-dose naloxone nasal spray for opioid overdose

Justin C Strickland  1 , Katherine R Marks  2 , Kirsten E Smith  3 , Jennifer D Ellis  4 , J Gregory Hobelmann  5 , Andrew S Huhn  5
Affiliations

Patient perceptions of higher-dose naloxone nasal spray for opioid overdose

Justin C Strickland et al. Int J Drug Policy. 2022 Aug.

Abstract

Background: Higher-dose formulations of naloxone were recently approved by the FDA for the treatment of opioid overdose. These products were developed based on projected saturation of high-potency fentanyl analogues in the illicit marketplace although the evidence base for their necessity is still under scrutiny. Concern has been raised that unintended reductions in patient acceptance of naloxone may occur due to increased precipitated withdrawal risk associated with higher naloxone doses. A well-founded and time-sensitive call for representation of people who use drugs in this decision-making process has been made. This study provides the first data on patient perceptions of higher-dose formulations to inform this scientific debate and distribution efforts.

Methods: Patients (N=1152) entering treatment for opioid use disorder at one of 49 addiction treatment facilities located across the United States completed a preference assessment of naloxone nasal spray formulations. Patients selected a formulation preference across three scenarios (administration for self, administration to others, community responder administration).

Results: A majority of respondents that had been administered naloxone previously reported that their most recent overdose reversal included two or more naloxone administrations (59.9%). Most respondents either had no preference (48.4%) or preferred a higher-dose formulation (35.9%) if personally experiencing an overdose. Similar preference distributions were observed for administration to others and by community responders. Relative to standard-dose preference, respondents preferring higher-dose formulations had a greater odds of recent suspected fentanyl exposure.

Conclusions: These data inform patients, advocates, and policy-makers considering distribution and utilization of naloxone formulations by reporting perspectives of patients with opioid use and overdose experience. Limited evidence for widespread avoidance of higher-dose formulations was found. As real-world evidence of acceptability and effectiveness emerges, either supporting or refuting the widespread need for higher-dose naloxone formulations, it is the responsibility of the scientific and public health community to be responsive to those data.

Keywords: Fentanyl; Harm reduction; Naloxone; Opioid; Overdose; Prevention.

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Conflict of interest statement

Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

    1. Abdelal R, Banerjee AR, Carlberg-Racich S, Darwaza N, Ito D, & Epstein J (2022). The need for multiple naloxone administrations for opioid overdose reversals: A review of the literature. Substance Abuse, 43(1), 774–784. - PubMed
    1. American Medical Association, 2021. Higher-dose naloxone nasal spray (Kloxxado) for opioid overdose. JAMA, 326(18),1853–1854. - PubMed
    1. American Society of Addiction Medicine, 2016. Public policy statement on the use of naloxone for the prevention of opioid overdose deaths. Available at https://www.asam.org/docs/default-source/public-policy-statements/use-of.... Accessed on 20 Feb 2022.
    1. Bell A, Bennett AS, Jones TS, Doe-Simkins M, Williams LD Amount of naloxone used to reverse opioid overdoses outside of medical practice in a city with increasing illicitly manufactured fentanyl in illicit drug supply. Substance Abuse. 2019;40(1):52–55. - PubMed
    1. Bennett AS, Freeman R, Des Jarlais DC, & Aronson ID (2020). Reasons people who use opioids do not accept or carry no-cost naloxone: Qualitative interview study. JMIR Formative Research, 4(12), e22411. - PMC - PubMed

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