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Can nasal spray be addictive?

Sniffles? Blocked nose? Difficulties breathing? In such cases, we often use nasal spray to clear our noses. But some people turn into virtual nasal-spray junkies, with some unpleasant side effects.

Many of us will use decongestant nasal sprays  for a week or two to help us breathe more easily when we have a stuffy nose from a cold. And according to ENT specialists, this is perfectly OK. It is a great relief when the nose is no longer blocked so we can finally breathe freely and inflammatory secretions can flow out of the sinuses. Nasal sprays are a popular and effective treatment — as long as we don't overdo it.

Smooth transition

Nasal spray reduces swelling in mucous membranes during colds and sniffles. "The nasal conchae have vessels that are strongly supplied with blood. The nasal sprays have an effect on these," says Thomas Deitmer from the German Society of Oto-Rhino-Laryngology.  "The vessels constrict; the swelling of the conchae goes down. This frees up the path for air to pass through the nose." He says common sprays contain adrenaline-like substances but are not addictive drugs that have an impact on the psyche. 

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Wanting more, getting less

Most nasal sprays contain mainly xylometazoline  or oxymetazoline.  These belong to the so-called sympathomimetic drugs.  Such substances cause the blood vessels to contract, reducing the unpleasant swelling and allowing us to breathe more freely.

But our mucous membranes quickly get used to a daily dose of this spray. This can lead to a vicious circle: The more often we use nasal spray, the faster the effect diminishes, and the faster we need a new dose. At some point, however, even this no longer helps, and we can end up with a chronic case of nasal congestion with dried-out mucous membranes that are very difficult to keep moist.

A lot of people use nasal spray at least three times a day to treat their symptoms, many probably without giving it much thought. After all, nasal spray is not listed among the addictive substances and drugs. 

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Just a habit or already addicted?

The feeling that our nose is completely blocked disappears when we use nasal spray. But if its effect decreases, we resort to another dose. This can lead to a never-ending story. If you use increasing amounts of nasal spray, you will not do yourself or your nose any good in the long run. The nose gets used to the pleasant effect and wants more and more of it.

The boundaries between pure habit and dependence are often blurred, says Heino Stöver from the Institute for Social Science Addiction Research at the University of Applied Sciences  in Frankfurt (ISFF). "Nasal sprays have a pleasant effect and clear our heads, so to speak, and we can get very used to that," he says.

Stöver knows what he is talking about: He can draw on his own experience. "When I was young, I also used nasal sprays in excess for years: two to three blasts of spray every day for about two years. This gave me dry nasal mucous membranes. They have not recovered to this day," says the now 64-year-old. 

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He says that at the time when he was using nasal sprays, there was no awareness of the problems they can cause and that people had been rather naive in their approach. Today, we know that using them for more than two weeks at a time can have a range of negative effects. "But I would still tend to place nasal sprays at the lower end of the danger scale and not say that they have a huge addictive potential," says Stöver.

The substance alone does not create addiction, he says. However, although the constant use of nasal sprays is not considered an addiction, it is a borderline case, according to Stöver.

"These drugs have nopsychoactive effect, like with cocaine, cannabis or even alcohol. Rather, they lose their effect", explains ENT physician Deitmer. "This means that people end up spraying their noses not just three times a day, but perhaps eight times."

When it really stinks

The effect of nasal spray gradually decreases until there is none at all. What remains are dry mucous membranes that can no longer fulfill their protective function. Our nasal mucous membranes are there to ward off germs and they need to be moist for this. 

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It becomes quite unpleasant when a so-called stinky nose develops

The continuous use of nasal spray makes the nasal mucous membrane so thin that the nose can no longer properly moisten the air we breathe. Yet this is exactly what our nose is there for: to warm, clean and humidify the air we breathe. "If it can no longer do this, dried crusts grow in the nose, which then tend to become bacterially infected," says Deitmer.

This can lead to so-called ozena, also known as stinky nose or chronic atrophic rhinitis.  The bacteria that get into the nose cause a foul odor, Deitmer explains. The nose stinks. People who are affected usually don't smell it themselves, but the people in their immediate environment do. And here, nasal sprays are not the remedy, but the cause.

From habituation to weaning

Stöver says that people can get so used to using nasal spray in their everyday lives that they begin to feel uncomfortable or unwell without it. For many, he says, it can lead to real despair if there is no nasal spray at hand.

One strategy for weaning oneself off nasal spray is to gradually reduce its use, to become more aware of using it and to decrease the doses. Stöver says that if necessary, a log can be kept to record when the last dose was taken, and whether there were any signs of illness at all or whether it was taken just out of habit. He says there is no official therapy such as inpatient treatment in a clinic, so people have to deal with the problem on their own. 

It could get worse

Sprays containing sea salt, a natural substance, are also a very good way to wean oneself.

While trying to reduce their use of nasal sprays, many patients suffer repeatedly from blocked and dry noses. But before reaching for the bottle again, it is advisable to see a doctor. 

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This is because dry nasal mucosa can be an indication of serious diseases that are not necessarily as harmless as a cold. "One must try to find out why patients have a blocked nose. It may be that there are mucous membrane polyps in their nose. We might then be able to remove them surgically," Deitmer says. "But it is also possible that the patient has an allergic illness that is causing the nose to become blocked." He says allergy tests could then be carried out to find an appropriate therapeutic approach.

A crooked nasal septum can also cause a nose to be constantly blocked. Surgeons can straighten this surgically. At worst, tumors in the nose can occur, but this is extremely rare, says Deitmer.

He admits that a constantly blocked nose is a great hindrance for those affected, causing a dry mouth, snoring and problems sleeping. However, introducing nasal spray into our olfactory organ several times a day is obviously not a solution, and certainly not when it is done in large quantities.

The physician and natural scientist Paracelsus,  writing some 500 years ago, already summed it up: "What is there that is not poison? All things are poison and nothing is without poison. Solely the dose determines that a thing is not a poison." 

This article was translated from German

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