Opioid Overdose Reversal With Nalmefene Nasal Spray: A Case Report

Despite the recent FDA approval of intranasal (IN) nalmefene, there is a lack of published evidence regarding its utilization, namely regarding concerns about its potential for precipitate withdrawal. In this case report, two physician investigators independently reviewed Oakland County (Michigan) Sheriff's Office (OCSO) bodycam footage, OSCO dispatch report, and the Alliance of Coalitions for Healthy Communities interview data conducted 72 hours post-overdose of a patient who received IN nalmefene following an opioid overdose, to describe clinical signs and symptoms before, during, and after administration. An increase in oxygen saturation up to 98% occurred within approximately 2.5 minutes after the initial dose. The patient also showed a marked improvement in mental status. The patient exhibited no evidence of precipitated withdrawal. This case study provides data to support that IN nalmefene can produce a rapid and effective reversal of opioid overdose. Additional studies will be important in establishing the role of IN nalmefene in the treatment of opioid overdose by first responders as well as its impact on clinical outcomes once patients arrive at the accepting medical facility.