Norway is facing an unexpected health crisis as a staggering 700,000 people have found themselves tangled in the grip of addiction — not to illegal substances, but to over-the-counter nasal sprays, a common remedy for nasal congestion.
As per the Norwegian Institute of Public Health (FHI), the sales of over-the-counter nasal sprays have exhibited a consistent upward trend in recent years. Between 2018 and 2022, there has been a staggering 36 percent surge in sales. In 2022 alone, the total number of packs sold for mucosa-decongestant nasal spray reached a notable 8.8 million.
The addiction is very expensive and disruptive for individuals like Gulla, a 22-year-old who shared her struggles with Kvinner og Klær magazine, the oldest women’s health publication in Norway. She describes a claustrophobic, suffocating feeling if she fails to use the spray consistently throughout the day and night. The damage done to her mucous membranes means that she is unable to breathe properly without constant relief from the spray.
Sverre Steinsvåg, a senior physician at the hospital of southern Norway and professor of ear, nose, and throat diseases at the University of Bergen, has been paying close attention to this recent phenomenon. He has researched the effects of nasal sprays and why people are becoming addicted. He estimates that around 700,000 Norwegians abuse them, referring to the crisis as a “huge problem for public health.”
The addiction to nasal sprays is not exclusive to Norway, but the sprays are acquired without a prescription, making it difficult to record how many are buying them, and there have not been many studies outside Norway focusing on the number of individuals addicted. Yet doctors in the United States estimate that the number approaches the 10 million mark.
According to Medical News Today, physicians across the world are criticizing the industry for taking advantage of their addictive nature to keep business booming as it is a “well-regarded fact that chemical nasal sprays can be as addictive as Morphine.”
What causes the addiction?
The rising popularity of these nasal sprays has prompted questions about the reasons behind their addictive nature. The active ingredients, oxymetazoline or xylometazoline, attack mucous membranes, slowing down the blood supply. Acting as topical decongestants and vasoconstrictor medications, they cause the nasal tissues to shrink, reducing swelling and congestion. They provide quick relief for nasal congestion associated with conditions like colds or allergies.
However, symptoms return after a few hours when the blood supply reaches the nasal membranes again, causing them to swell. Rather than treat the underlying cause of congestion, these nasal sprays only mask the symptoms for a short period.
Steinsvåg’s research warns against the prolonged use of mucosal decongestant nasal sprays, revealing the risk of rebound congestion. This phenomenon occurs when nasal passages become more congested when the medication is discontinued. If the spray is used every day for more than 10 consecutive days, an inflammation of the nasal mucosa will occur and the user will become dependent.
Researchers explain that withdrawal must be done gradually — it takes six to eight weeks and is very distressing for patients. CEGLA Medizintechnik, a medical technology manufacturer in Germany, suggests a method of diluting the nasal spray for a few days with saline solution, thus weaning gradually.
Without the spray, Gulla feels unable to function; she has difficulty talking, eating, and doing physical activity. She has been addicted to nasal sprays since she was 10 years old, having tried and failed multiple times to quit.
What is the solution?
Faced with this troubling phenomenon, doctors in Norway have been researching solutions. Alternative nasal sprays such as saline sprays are used to thin mucus while corticosteroid sprays reduce inflammation without causing drug tolerance that leads to dependency.
Professor Steinsvåg is therefore conducting a study with 200 Norwegian patients to compare the effects of a hypertonic solution of undiluted seawater that will reduce the swelling of the nasal mucosa more effectively than a simple saline solution. The objective is to provide patients with a withdrawal process that is more manageable than saline sprays that Gulla has attempted to stop using without success and continues to face functional challenges without the nasal spray.
Correction March 6th: The article has been revised to quote Professor Steinsvåg for the estimate of Norwegians abusing the nasal spray, and to clarify the withdrawal suggestion.
