Nasal Spray Harm Reduction Framework Proposed for Snorting Cocaine, MDMA and Ketamine

Intranasal use of psychoactive substances such as cocaine, MDMA and ketamine is linked to a well-documented range of nasal and sinonasal complications. According to a rationale article published in Harm Reduction Journal, these injuries arise from at least three distinct but interacting mechanisms: mechanical trauma from powder particles, vasoconstriction-induced mucosal ischaemia that is primarily relevant for cocaine, and chemical irritation from adulterants. The paper argues that harm reduction programmes, which have traditionally concentrated on hygiene, shared equipment and product testing, have paid little formal attention to the form of the substance itself, whether a solid powder or an aqueous solution.

The proposed intervention is a volumetric dilution nasal spray, abbreviated VDNS, in which the substance is dissolved in sterile saline and delivered through a calibrated spray device. The author describes this as a low-barrier, low-cost approach that is coherent with existing national and international harm reduction frameworks. Because the substance is dissolved rather than snorted as dry powder, the method eliminates mechanical mucosal trauma from powder particles and delivers the drug in a hydrated vehicle that is compatible with the physiology of the nasal mucosa.

A second practical effect concerns dosing. Snorting typically involves uncontrolled line-based dosing, in which the amount consumed depends on the size of a line and the vigour of insufflation. Dissolving a known quantity in a defined volume of saline and delivering it with a calibrated spray converts this practice into a quantifiable per-spray unit. The article presents this shift from an uncontrolled line to a measurable spray dose as a central feature of the framework, grounded in the pharmacokinetics of intranasal absorption.

To build the rationale, the paper draws on pharmaceutical nasal delivery science, existing harm reduction resources from community organisations, and field feedback from harm reduction professionals. Pharmaceutical nasal sprays are an established technology, and the author uses that body of knowledge to explain how a dissolved substance can be delivered to the nasal mucosa in a controlled manner. The framework is explicitly described as covering cocaine, MDMA and ketamine, three substances commonly used intranasally in recreational settings.

The biological reasoning rests on the known pathophysiology of snorting-related nasal damage. Powder particles striking the mucosa cause mechanical injury, while cocaine additionally constricts blood vessels and can starve the mucosal tissue of oxygen through ischaemia. Adulterants mixed into street powders add chemical irritation on top of these effects. By dissolving the substance in sterile saline, the VDNS approach addresses the particulate mechanism directly and, by hydrating the mucosa rather than drying it, is designed to work with mucosal physiology rather than against it.

The article also situates the method within the principles of non-normative harm reduction, a tradition that accepts that people will continue using substances and seeks to reduce the harms of that use without demanding abstinence. In this framing, a nasal spray is presented as a practical tool that community organisations and outreach workers could integrate alongside existing measures such as drug checking and safer snorting guidance. The paper describes the rationale, practical implementation, limitations and field integration of the approach for the three substances it covers.

Importantly, the author does not claim that the intervention has been tested. The conclusion states that formal evaluation of the acceptability of VDNS and of its impact on nasal morbidity is still needed. Pending such data, the article supports dissemination of the method by harm reduction professionals in community settings on the basis of biological plausibility and field practice, rather than on the results of a clinical trial or an observational study.

This distinction matters for readers weighing the proposal. The published work is a framework and rationale, not an efficacy study, and it reports no measured outcomes on nasal health, dosing accuracy or user behaviour. Its claims are mechanistic: removing particles removes particulate trauma, a hydrated saline vehicle is gentler on mucosa than dry powder, and a calibrated spray makes each dose countable. Whether these theoretical advantages translate into reduced nasal complications in real-world use remains an open question that the paper itself flags for future research.

The article was published open access on 30 October 2026 and is marked as an early-release, peer-reviewed accepted version that remains citable and carries a permanent DOI, subject to further edits before the final version of record appears. For harm reduction workers, the practical takeaway is a concrete, low-cost technique that can be discussed and, where appropriate, demonstrated in community settings. For researchers, the paper defines a clear evaluation agenda: testing whether volumetric dilution nasal sprays are acceptable to people who snort substances and whether they measurably reduce the nasal and sinonasal damage associated with intranasal cocaine, MDMA and ketamine use.

Subject of Research: A proposed volumetric dilution nasal spray framework as a harm reduction strategy for intranasal cocaine, MDMA and ketamine use.

Article Title: Volumetric dilution nasal spray as a harm reduction strategy for intranasal psychoactive substance use: a practical framework and rationale

Article References: Delforge, A. (2026). Volumetric dilution nasal spray as a harm reduction strategy for intranasal psychoactive substance use: a practical framework and rationale. Harm Reduction Journal. https://doi.org/10.1186/s12954-026-01567-y

Image Credits: AI Generated

DOI: 10.1186/s12954-026-01567-y

Keywords: harm reduction, nasal spray, volumetric dilution, cocaine, MDMA, ketamine, intranasal drug use, nasal mucosa, saline, pharmacokinetics, community health, drug policy