Report finds higher-dose opioid overdose spray didn’t save more lives

A new, higher-dose nasal spray for reversing opioid overdoses did not save more lives than the previous standard dose, but it did cause side effects, researchers wrote in a recently published study.

The 8-milligram naloxone spray — twice as potent as the highest dose previously available — was approved two years ago after pressure from experts and patient advocates who noted lower-dose antidotes often were being given multiple times to people suffering overdoses.

The study, which was limited to more rural parts of New York state, was published by the Centers for Disease Control and Prevention, but the federal health agency was not involved in the research.

The higher-dose “did not provide added benefit,” the authors wrote.

“What was really remarkable was the survival was the same, but the amount of withdrawal symptoms was significantly larger in the people that got the 8-milligram dose,” said one of the authors, Dr. Michael Dailey of Albany Medical College.

The researchers worked with New York State Police. Three troops in eastern New York were given 8-milligram sprays. Eight troops based farther away from Albany were stocked with 4-milligram doses. The study results were based on 354 instances in which police administered naloxone from late March 2022 to mid-august 2023.

In cases where overdose patients were still alive when police arrived, 99% survived after getting naloxone, no matter which dose was given.

People who got 4-milligram sprays usually got more than one dose — 1.67 doses on average, equivalent to 6.7 milligrams. But so, too, did those treated with the 8-milligram sprays, who got 1.58 doses, or 12.6 milligrams, on average.

But other problems were more common in the patients who got higherdose sprays. About 38% had signs and symptoms of withdrawal, including vomiting, abdominal pain and diarrhea. Only 19% of those getting the lower dose had those issues.

That’s a concern because it could actually contribute to future overdose deaths, said Dr. Alexander Walley, a Boston Medical Center addiction specialist.