Sweden expands use of spray that reverses opoid overdose

The Swedish government says it will move quickly to make naloxone, a spray that rapidly reverses an opioid overdose, widely available outside the healthcare system to save more lives.

In Sweden, mortality from overdoses and poisonings surpass 900 cases a year, higher than the death rate from road accidents at just 227 in 2022.

In a bid to combat this, along with creating a new knowledge-based policy on drugs focusing on life and health, Jakob Forssmed, Christian Democrat and Sweden’s Minister for Social Affairs, received the report “We can do better!” from a state investigation.

It contains a number of proposals for extensive actions to prevent addiction, support addicts, and increase harm reduction – with the overreaching goal of reducing the high number of drug-related deaths in Sweden by 20% in five years.

If implemented, the proposals will signal a historic change in Swedish drug policy “with less political ideology and more pragmatism”, according to doctors.

One of the main new measures would be to make the opioid antidote nasal spray naloxone available outside healthcare facilities – and free of charge to those affected.

“It’s been frustrating not to have a system in place to make naloxone available to people overdosing. I am happy that we now have such a proposal to save lives, and we will treat it with great urgency”, Forssmed told the media.

Today, only doctors and nurses can prescribe naloxone, which can help someone with an opioid overdose within seconds.

Many addicts’ lives can be saved as, according to the European Monitoring Centre for Drugs and Drug Addiction, almost 90% of all overdoses in Sweden are opioid-related.

“Today, healthcare workers can prescribe naloxone, but they can’t reach people they don’t come into contact with, and naloxone is not available in places where there is a high risk of poisonings and opioid overdoses”, Thomas Lindén, the state chief physician in Sweden and department chief at the National Board of Health and Welfare, said at the press conference.

He suggests a new Swedish law would be a solution.

Naloxone, he proposes, should be available for first responders, such as police officers and staff at shelters for homeless people.

Some of the 21 Swedish regions have already piloted naloxone projects, distributing the medication to patients through addiction medicine clinics.

“The projects have been shown to work, and there are no signs of misuse”, Dag Larsson, a senior expert at Life, the Association for the research-based pharmaceutical industry in Sweden, said in a comment to Euractiv.

Tobias Eriksson, the chief physician at the addiction medicine clinic of the university hospital Akademiska Sjukhuset in Uppsala, has led a similar project for patients since 2018.

“When given a naloxone-kit, the patients can be ready to help when other addicts overdose”, he told Euractiv.

“People surviving from overdoses also get cognitive problems because of the lack of oxygen to the brain. But, if naloxone is used, this effect disappears fast”, Tobias Eriksson said, adding that the reform is very much needed, but “legal obstacles today prevent a wider use, outside clinics in Sweden”.

Naloxone use in Europe

The WHO has also highlighted the importance of naloxone. This summer, Dr Tedros Adhanom Ghebreyesus, WHO Director-General, in a speech in the US, said:

“Medicines like naloxone and methadone are deemed essential by WHO to prevent and respond to drug overdoses and to treat drug use disorders”.

In March this year, the US Food and Drug Administration approved a naloxone opioid antidote as an over-the-counter product (OTC product).

Now, not only Sweden but also other European countries are waking up and pushing for policies to stop drug-related deaths and make naloxone more accessible.

France stands out as naloxone has been an OTC product for several years. But Greece has also expanded access to naloxone to more healthcare staff at prevention centres and drug consumption rooms.

Also, Norway is a forerunner, according to Nina Måsvaer, the marketing manager at the Norwegian pharmaceutical company DNE Pharma, which manufactures Respinal, a nasal spray with naloxone that is sold in Sweden.

This is one of two sprays being sold in Europe. The other one is Nyoxid, from Mundipharma, a British pharmaceutical company.

“Our spray has marketing authorisations in twelve European countries. But it is only sold as an OTC product in France”, she told Euractiv.

But, according to Thomas Lindén, there seem to be legal problems in making naloxone sprays OTC products in Sweden.

However, Nina Måsvaer told Euractiv that the DNE Pharma is now preparing to apply for an OTC stamp for Respinal after talks this summer with the Swedish Medical Products Agency.

“But even if they say yes, we believe that the most efficient way to administer naloxone is at prevention centres, syringe exchanging centres, or by police officers and firefighters,” she said.

The Swedish centre-right government will now consider the proposals in the report from the drug investigation.

[By Monica Kleja – Edited by Vasiliki Angouridi | Euractiv.com]

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