Intranasal Mucosal Atomiser Devices: A Novel Harm Reduction Intervention

INTRODUCTION: Factors associated with diminished peripheral vein access, including age, prolonged history of injecting drug use and coadministration with other substances, are all increasing among people who inject drugs in Australia. This exposes individuals to increased risk of injecting related complications, including skin and soft tissue infection, neurovascular injury and deep vein thrombosis. CASE PRESENTATION: Case 1 is a 48-year-old man with a 30-year history of injecting drug use who presents with recurrent skin and soft tissue infections requiring hospitalisation, surgery and extensive wound care. Case 2 is a 40-year-old woman who has been injecting heroin since her teens, predominantly into the femoral vein. She has developed significant chronic venous insufficiency and severe venous ulcers. Both consumers were motivated to reduce their injecting-related harms and were offered the use of an intranasal atomiser for heroin administration and reported both a positive use experience and an intention to continue to utilise the device. DISCUSSION AND CONCLUSIONS: Intranasal administration of heroin via atomising device may be an effective harm reduction intervention. The efficacy of these devices is supported by evaluation within heroin-assisted treatment programs, where they are associated with high rates of treatment retention, a favourable user experience and 50% fewer injection episodes. Harm reduction benefits of these devices require further evaluation but are likely to include reduced rates of infection and overdose. Given the potential benefits, as supported by the two cases reported here, intranasal atomisers should be further evaluated for inclusion within community harm reduction programs.