A new study published by the Centers for Disease Control and Prevention (CDC) in rural parts of New York state reveals that a higher-dose nasal spray for reversing opioid overdoses does not provide added benefits compared to the standard-dose spray. The research, which is considered the first to provide real-world data on the differences between the two sprays, also highlights that the higher-dose spray causes more side effects, including vomiting and withdrawal symptoms.

The 8-milligram naloxone spray, which is twice as potent as the previously available dose, was approved two years ago in response to pressure from experts and patient advocates who observed that lower-dose antidotes were often administered multiple times to individuals experiencing overdoses. However, the study demonstrated that the higher-dose spray did not lead to a higher survival rate compared to the standard dose.

Dr. Michael Dailey of Albany Medical College, one of the authors of the study, noted that while the survival rates were similar, individuals who received the 8-milligram dose experienced significantly more withdrawal symptoms. The study did not provide a definitive endorsement for either product, but it emphasized the importance of recognizing the potential for increased side effects with the higher-dose spray.

The study, conducted in collaboration with the New York State Police, focused on emergency responses in rural areas and along highways. Troopers were divided into two groups, with one group administering 8-milligram sprays and the other using 4-milligram doses. The results were based on 354 instances of naloxone administration between late March 2022 and mid-August 2023.

Surprisingly, regardless of the dose given, 99% of overdose patients who were still alive when troopers arrived ultimately survived after receiving naloxone. However, individuals who received the lower dose typically required more than one dose, averaging 1.67 doses equivalent to 6.7 milligrams. Similarly, those treated with the higher-dose spray received an average of 1.58 doses, totaling 12.6 milligrams.

Although both doses were effective in reversing the overdose, the study highlighted that patients treated with the higher-dose sprays experienced more problems. Approximately 38% of individuals in this group reported signs and symptoms of withdrawal, including vomiting, abdominal pain, sweating, shaking, and diarrhea. In comparison, only 19% of those administered the lower dose experienced such issues.

Dr. Alexander Walley, an addiction specialist at Boston Medical Center, expressed concerns regarding the higher incidence of withdrawal symptoms. He explained that these symptoms could impact future overdose deaths, as individuals may associate the pain and discomfort with naloxone rescue and subsequently avoid seeking help when using drugs in the future.

Although the study has limitations in the randomization process for assigning doses, Dr. Walley considers it to be good-quality evidence. He emphasized that a more potent naloxone is not necessarily the solution to combating a more potent illicit drug supply. Instead, he advocates for having individuals who use drugs to be witnessed by someone who can administer naloxone and call for help.

This study serves as a valuable contribution to understanding the efficacy and side effects of different naloxone doses for opioid overdose reversal. Further research is needed to explore the broader implications and potential advancements in overdose response strategies.