Innovation in harm reduction: Experimenting with a spray to atomise psychoactive substances through the mucous membranes

Background
The experiential approach indicates that some individuals who engage in sniffing practices may experience harm, such as nosebleeds, epistaxis, blocked noses, pain, or lesions. Despite these potential health risks, sniffing currently lacks support for harm reduction. Furthermore, the intravenous injection of psychoactive substances (PAS) carries various risks and pathologies, including risks of HCV and HIV contamination, as well as abscesses and septicaemia.
Since 2021, SAFE and Psychoactif NGOs have been experimenting with the distribution of MAD® (mucosal atomization device). It is a spray designed to deliver PAS in fine drops onto the nasal mucous membranes, providing an alternative for PWUD to sniffing or injecting.

Method
The MAD® kit was developed by members of PsychoActif, users of the remote harm reduction programme, and SAFE professionals. The kit comes with instructions for use, including explanatory documents and a video.
To assess the kit, two questionnaires were created: one for users and another for professionals. The trial involved 171 CAARUD (Support Centres for the Reduction of Drug-related Harms) and CSAPA (addiction centres), and the nasal spray was evaluated by 228 PWUD and 28 professionals.

Results
68% of users used the nasal spray kit as a replacement for sniffing, while over a third (33.8%) used it as a replacement for intravenous injections and 10.1% used it as a replacement for inhalation. Finally, 9.2% of the respondents tested the nasal spray kit as an alternative to other modes of consumption, such as oral ingestion, intramuscular injection, and rectal administration. The kit was tested with 43 substances, primarily cocaine (42.5%), followed by heroin (31.1%), 3-MMC (16.7%), Subutex (13.6%), methamphetamine (7.9%), ketamine (7.5%), and Skénan© (3.9%).
The majority of users (74.1%) expressed a desire to continue using the nasal spray kit. Additionally, 65.8% of respondents reported improvements in their health. Some users noted a decrease in cravings, longer-lasting effects, and a stronger perceived impact.
Professionals highlighted the advantages of MAD® as an alternative to sniffing and injecting, and the harm reduction benefits they offer. They also highlighted the advantage of achieving stronger effects while using less product.

Conclusion
The study found that the nasal spray kit was positively received by the surveyed users. Most participants expressed interest in using the nasal spray if it were distributed. Additionally, almost two-thirds of participants reported improvements in their health since using the MAD®, indicating that it could be a viable alternative to sniffing and injecting. However, it is important to note that the study had limitations, including a small sample size (n=30) for responses regarding prolonged use of the MAD®. Continuing the follow-up over the longer term (one year of use) is important to assess the acceptability of the tool and the positive effects associated with the use of MAD®.