When Uma Thurman's character OD’d by sniffing heroin in Pulp Fiction, she was brought back to life with a shot of adrenaline stabbed straight through her sternum into her heart. But since 1961, doctors have actually used a much more effective drug to combat opioid overdoses. Called naloxone, it bonds with opioid receptors in your brain more effectively than illicit drugs, so it effectively washes heroin out of your brain to wake up your system. It’s remarkably cheap and can be delivered without a needle, right up someone's nose.
But there’s a catch. Naloxone is still impractical to administer in real-world conditions—the sort of foggy, stressful environment where a drug overdose is taking place—because it requires you assemble a seven-part kit of components, first. Simply put, there's no EpiPen of the naloxone world.
As heroin use is on the rise, Jonathan Grossman, industrial designer at the global design firm Frog, became preoccupied by the state of affairs at San Francisco’s methadone clinics. He learned just how flawed naloxone administration is today, and in turn, despite that his passion had no client, he proposed to his team that he begin working on a better method. The syringe-shaped atomizer used now seems like a perfect low-tech solution at first glance. It squeezes liquid through a tiny tube, so small it turns the drug into a mist that can shoot into someone’s nasal cavity. But problems arise from how the atomizers are purchased and distributed.
They’re passed out by social service agencies in a Frankensteinian kit of parts, as each component must be acquired from a different arm of the medical industry. The plunger comes from one factory. The tip another. If you were to assemble it ahead of time, it would be like carrying a leaking syringe through life. Because it’s designed not to be built in advance and ready to go in an emergency, but to be pieced together as a nurse might, casually, in a hospital setting for immediate use.
"There are too many caps," says Grossman. "Each component has a cap that covers the end, and in an emergency situation you have to pry off caps and nibs. And there’s a really precise collection to make between the atomizer cap and body. If it goes in at an angle, it’s common that the medicine sprays out the side."
He spotted other usability errors, too. People building the syringe often would hold the drug-filled glass vile in their mouth, which could crack it. And once the whole system was assembled, the drug itself presented another challenge: It must be carefully squirted in through the nose, half up one nostril, half up the other, at just the right angle to be effective.
Nothing about the process is impossible, but it requires the user to assemble seven distinct pieces, when "not everyone is in the right state of mind," Grossman says. "People are freaking out. It’s a scary situation."
So Grossman began exploring new forms for naloxone administration. He started with reexamining the syringe. What if it came preassembled? What if it didn’t even need a package? What if a lid on the front and back allowed it to live, ready to go, in someone’s backpack? What if it was designed symmetrically, so its angle of attack wasn’t so important? They were all good ideas, playing out in a series of sketches and renderings Grossman produced and shared with colleagues.
But then he had a breakthrough. What if there were two connected syringes, so you could administer the drug up both nostrils at the same time? He checked with Frog’s resident doctor. Was there a physiological reason that no one was doing this? No. And so Grossman tested out his own hypothesis as a lab rat: He taped two syringes together, filled them both with water, aimed them up his own nose, and squeezed.
"It was totally fine," he says, laughing. "You feel like you have a sore throat for a minute, and then it goes away."
Over several iterations of design, Grossman combined all of his best ideas, and then some. The final product is still an atomizing syringe—so nothing about the core mechanism of drug delivery has changed. But a forking head fills both nostrils at once. Plunger and tip lids allow it to be tossed into someone’s bag, like an EpiPen, without a second thought. And in a very clever bit of design, while the main body is a plastic, the plunger lid is constructed of a ridged rubber. Remove it, and the plunger shares the same material and finish.
This rubbery material begs to be touched, and it serves as a subconscious cue to the drug’s administrator: This is the part of the syringe that you’ll want to push down. So even if someone doesn't cognitively know what they're doing in an emergency, they'll intrinsically understand how to use the device.
Frog admits that were this to come to market—and the company is currently looking for the right partners to make that happen, so get in touch!—there would probably be many tiny adjustments that would still have to be made for regulatory reasons and unforeseen use cases. But the fact that a dual-nasal-atomizer doesn’t exist seems almost unbelievable, given that atomizers can be used as a needle alternative to all sorts of drugs beyond naloxone.
"A lot of times, stuff gets created with very little thought about the context it’ll be used. That’s not just in health care. There are a lot of things we use on a regular basis, and we wonder, why doesn't it work like this?" Lindsey Mosby, Frog's executive strategy director and health care practice lead, says. "That disconnect between, here’s what we can make, and here’s what we should make, happens a lot. I don’t want to say anything that belittles how important the way we do our work is, but I think anyone can think the way we do. However, it requires you get in the shoes of someone you’re designing for. And if you don’t do that, you get what we have today: a kit of parts without any sort of empathy or consideration of how this is used."
And now, with the biggest problem of naloxone administration more or less solved by Frog, maybe we can all focus on the other big problem of the drug—that with a new surge of demand, Big Pharma appears to be jacking up its price.
All Images: courtesy Frog