ArticleHarm reduction journal2022
Real-world study of multiple naloxone administration for opioid overdose reversal among bystanders.
Article in Harm reduction journal, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 37 citations in OpenAlex.
- 'If you've ever experienced it, you'd feel differently': Exploring willingness and skepticism toward using higher dose naloxone products among people who use drugs in Maryland, United States.Addiction (Abingdon, England) · 2026Article
- A wearable acoustofluidic patch for rapid reversal of opioid overdose.Nature communications · 2026Article
- Formulation considerations in enhancing olfactory mucosal deposition for nose-to-brain drug delivery.Drug delivery and translational research · 2026Review
- Usability of Mixed Reality for Naloxone Training: Iterative Development and Field Testing of ReviveXR.Healthcare (Basel, Switzerland) · 2025Article
- Predictors of non-transport by emergency medical services after a nonfatal opioid overdose: a national analysis.Health affairs scholar · 2025Article
- Naloxone dosing by non-medical first-responders at opioid overdoses: findings from a qualitative interview study.Harm reduction journal · 2025Article
- Agent-Based Model of Combined Community- and Jail-Based Take-Home Naloxone Distribution.JAMA network open · 2024Article
- An autonomous implantable device for the prevention of death from opioid overdose.Science advances · 2024Article
- Fentanyl, Heroin, Methamphetamine, and Cocaine Analyte Concentrations in Urine Drug Testing Specimens.JAMA network open · 2024Article
- Monoclonal Antibodies Engineered with Fc Region Mutations to Extend Protection against Fentanyl Toxicity.Journal of immunology (Baltimore, Md. : 1950) · 2024Article
- Fentanyl harm reduction strategies among Latinx communities in the United States: a scoping review.Harm reduction journal · 2024Article
- An Autonomous Implantable Device for the Prevention of Death from Opioid Overdose.bioRxiv : the preprint server for biology · 2024Article
- Article
- Development ofPharmaceutics · 2024Review
- Naloxone distribution programs in the emergency department: A scoping review of the literature.Journal of the American College of Emergency Physicians open · 2024Article
- Virtual opioid poisoning education and naloxone distribution programs: A scoping review.PLOS digital health · 2024Article
- Overdose responses among rural people who use drugs: A multi-regional qualitative study.Harm reduction journal · 2024Article
- High-dose naloxone formulations are not as essential as we thought.Harm reduction journal · 2024Review
- Adverse Effects After Prehospital Administration of Naloxone by Bystanders: A Preliminary Study.Prehospital and disaster medicine · 2024Article
- Comparison of Administration of 8-Milligram and 4-Milligram Intranasal Naloxone by Law Enforcement During Response to Suspected Opioid Overdose - New York, March 2022-August 2023.MMWR. Morbidity and mortality weekly report · 2024Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe increasing prevalence of highly potent, illicitly manufactured fentanyl and its analogues (IMF) in the USA is exacerbating the opioid epidemic which has worsened during the COVID-19 pandemic. Narcan® (naloxone HCl) Nasal Spray has been approved by the US Food and Drug Administration as a treatment for opioid-related overdoses. Due to the high potency of IMF, multiple naloxone administrations (MNA) may be needed per overdose event. It is essential to determine the patterns of naloxone use, including MNA, and preferences among bystanders who have used naloxone for opioid overdose reversal.
methodsA cross-sectional web-based survey was administered to 125 adult US residents who administered 4 mg Narcan® Nasal Spray during an opioid overdose in the past year. The survey asked about the most recent overdose event, the use of Narcan® during the event and the associated withdrawal symptoms, and participant preferences regarding dosages of naloxone nasal spray. An open-ended voice survey was completed by 35 participants.
resultsParticipants were mostly female (70%) and white (78%), while reported overdose events most frequently occurred in people who were males (54%) and white (86%). Most events (95%) were successfully reversed, with 78% using ≥ 2 doses and 30% using ≥ 3 doses of Narcan® Nasal Spray. Over 90% were worried that 1 Narcan® box may not be enough for a successful future reversal. Reported withdrawal symptoms were similar in overdose events where 1 versus ≥ 2 sprays were given. Eighty-six percent of participants reported more confidence in an 8 mg versus a 4 mg naloxone nasal spray and 77% reported a stronger preference for 8 mg over 4 mg.
conclusionsMNA occurred in most overdose events, often involving more sprays than are provided in one Narcan® nasal spray box, and participants predominantly expressed having a stronger preference for and confidence in an 8 mg compared to a 4 mg nasal spray. This suggests the need and desire for a higher dose naloxone nasal spray formulation option. Given that bystanders may be the first to administer naloxone to someone experiencing an opioid overdose, ensuring access to an adequate naloxone supply is critical in addressing the opioid overdose epidemic.
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Registered trials
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