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

Justin C. Strickland, Katherine R. Marks, Kirsten E. Smith, Jennifer D. Ellis, J. Gregory Hobelmann, Andrew S. Huhn

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Article number103751
JournalInternational Journal of Drug Policy
Volume106
DOIs
StatePublished - Aug 2022

Bibliographical note

Funding Information:
Support for Dr Strickland was provided by grant R03DA054098 from the National Institute on Drug Abuse. Support for Dr Smith was provided by that National Institute on Drug Abuse Intramural Research Program. Support for Dr Hobelmann was provided by Ashley Addiction Treatment. Support for Dr Ellis was provided by grant T32DA07209 from the National Institute on Drug Abuse. Support for Dr Huhn was provided by grant UG3DA048734 from the National Institute on Drug Abuse.

Funding Information:
Support for Dr Strickland was provided by grant R03DA054098 from the National Institute on Drug Abuse . Support for Dr Smith was provided by that National Institute on Drug Abuse Intramural Research Program . Support for Dr Hobelmann was provided by Ashley Addiction Treatment . Support for Dr Ellis was provided by grant T32DA07209 from the National Institute on Drug Abuse . Support for Dr Huhn was provided by grant UG3DA048734 from the National Institute on Drug Abuse .

Publisher Copyright:
© 2022

Keywords

  • Fentanyl
  • Harm reduction
  • Naloxone
  • Opioid
  • Overdose
  • Prevention

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

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