Intranasal use - nasal anatomy and most efficient mucus membrane for highest BA

[RoboRobot]

So, I was looking into nasal anatomy to see where would be the best place to try and "direct" the powder I am insufflating into my nostril (or liquid solution). It seems from experience that you can snort too hard, and it'll go to the back of the throat, or too little and powder will fall out. (Usually never have these issues, but still curious.) So, I wanted to look into the best place to position the straw or oral syringe to place either powder, or liquid solution, in the most efficient place in my nasal cavity.

I did a bit of research and I'll post some quotes and links and images of what I've found. (PS- if you'd like to look at a few images beforehand so you can clearly picture what Im talking about, scroll down and open up the spoiler tags- they contain illustrations of the nasal anatomy.)

So, basically, there seems to be the three separate sections in the nose that have the ability to absorb a drug due to it's mucus membrane. They're called turbinates. There's the lower "inferior" turbinate, middle turbinate, and upper "superior" turbinate.

Here's some explanation:

"The nasal cavity is bounded in by bony sidewalls (lateral nasal walls). Attached to these sidewalls are three structures called turbinates. The turbinates are fingerlike projections made up of a bony core and outer soft tissue. They are covered with a lining (mucosa) which is continuous with the lining of the rest of the nasal cavity. The turbinates serve to increase the mucosal surface area of the nasal cavity, and also direct smooth nasal airflow towards the lungs. Between each turbinate and nasal sidewall lies a space termed a meatus. These spaces are named according to the turbinate above them.

The bottom most turbinate, the “inferior” turbinate serves the most important role in the air-conditioning action of the nose. This capacity of the inferior turbinate comes from soft tissue below the lining. This tissue is extremely rich in blood vessels and glands, and helps the nasal air-conditioning function. The inferior turbinate is the largest of the three paired turbinates, and runs along the entire length of the lateral nasal wall, adjacent to the nasal floor. Sometimes, the inferior turbinate can get enlarged due to allergy or irritation, and can cause nasal blockage and a runny nose. The tear duct (nasolacrimal duct), which drains tears from the eye, drains beneath the inferior turbinate into the inferior meatus.

The middle turbinate lies above the inferior turbinate and is a very important structure with a complex, boomerang shape. The front part of the middle turbinate is vertical, attaching to the skull base. The back of the middle turbinate is horizontal, and attaches to the nasal sidewall just above the inferior turbinate. The middle part of the middle turbinate is oblique, connecting the vertical and horizontal parts, and is thus connected both the skull base in the front and the nasal sidewall in the back. The frontal sinus and anterior ethmoid sinus cells drain beneath the middle turbinate into the middle meatus.

The superior turbinate is the smallest of the turbinates. It resides just above and behind the middle turbinate. The sphenoid sinus and posterior ethmoid sinus cells drain into an area between the nasal septum and superior turbinate called the sphenoethmoid recess."

Justin H. Turner, M.D., Ph.D.
Devyani Lal, MD
Jayakar V. Nayak, MD, PhD

http://care.american-rhinologic.org/nasal_anatomy?print

And here's the physiology: http://care.american-rhinologic.org/nasal_physiology



(Me again :D haha) So, basically what I deduced from that is it seems the lower (inferior) turbinate would have the best absorption rate, due to it's larger surface area and being the most vascular of the three (the veins being necessary to absorb any drug in the membrane).

Here's a quote from the same three doctors on the blood supply in the nose:

BLOOD SUPPLY
"The nasal cavity has a very rich blood supply arising from both the internal and external carotid arteries. A confluence of these blood vessels supplying the nasal septum in the front (“Kiesselbach plexus” in the “Little’s area”) is a common source of nasal bleeding (epistaxis). This area can often be cauterized in the office to stop nasal bleeding. The anterior and posterior ethmoid arteries, both branches of the internal carotid artery system supply the upper nasal septum and nasal sidewalls. The superior labial branch of the facial artery supplies the front part of the nose. The sphenopalatine artery, a branch of the external carotid system supplies most of the back of the nasal cavity. It enters the nasal cavity through an opening located along the nasal sidewall called the sphenopalatine foramen. When nasal bleeding is more from the back part (posterior epistaxis), this artery is often the culprit. When recurrent posterior epistaxis becomes a problem, the sphenopalatine artery may need to be tied or embolized.

In addition to this larger vasculature, there is a confluence of the small vessels that supplythe front portion of the nasal septum that is termed Kiesselbach’s plexus. This lattice of veins is a common source of nasal bleeding (epistaxis) due to trauma and dry air exposure, and may require medical attention in many cases."

Spoiler: Nasal anatomy and turbinate illustrations

^^^ Those pictures I wrapped in spoiler tags so they wouldnt have to load if people didnt feel like looking at them. I am unsure if I should've done this or if this is the way to do it, so please let me know if I need to change something. These pictures are just illustrations, nothing graphic at all, just to let you know.

Anyways, judging by those pictures, I can almost imagine an exact position of the straw (or oral syringe w/ solution) during intranasal use to get the majority into the lower turbinate.. It seems to be helpful information to know if you insufflate anything. I know I was always worried about it not getting to the best possible place in my nose and getting wasted, and I like being informed on what drugs do to my body and how.

So, I thought it was far past the due time for me to figure this out, and Ill be a lot more comfortable next time I insufflate knowing Im not just going off what people say on the street. (e.g. vitamin c helps mdma, lsd stored in spine, lololol etc)

I wanted this to remain as professional and informative as possible, but alas, I am not 100% *positive* on my conclusion. I would really enjoy any opinions on the matter, or better yet, any supporting factual data! Is the lower turbinate the best for absorption due to the highest amount of capillaries and veins? Seems plausible, but Im not well-versed in Nasal Anatomy

Would love to see the discussion start flowing, though. It'd help us get better BA intranasally if we actually had an exact planned destination for said insufflated substance.

!!!!
oh yeah, and judging by my first quote, where they are talking about lateral sidewalls (and adjacent mucus membrane) makes me almost think that these turbinates are located on the SIDES of the nose. But judging by the pictures, these turbinates look to clearly run horizontally, not vertically.
As quoted from the article the lower turbinate "runs along the entire length of the lateral nasal wall, adjacent to the nasal floor."

I was initially planning to try and direct insufflated material to just a tiny bit above the floor of my nasal cavity, where the pictures seem to show the lower turbinate. Reading that quote makes me think otherwise, though, and maybe it'd be better to position it towards the side walls of my lower nasal cavity. Any info on the matter would be greatly appreciated!

(here's some illustrations I just pulled up of the "lateral" nose walls and turbinates.. Let's see what you guys can make of it %) )

Spoiler: lateral nose wall illustrations

http://www.instantanatomy.net/diagrams/HN075b.png[IMG]

[IMG]http://image.slidesharecdn.com/lec-140909023023-phpapp01/95/lec4nose-ptrc-7-638.jpg?cb=1410229896

lat·er·al
ˈladərəl,ˈlatrəl/
adjective
1.
of, at, toward, or from the side or sides.
"the plant takes up water through its lateral roots"
synonyms: sideways, sidewise, sideward, edgewise, edgeways, oblique, horizontal
"lateral movements"
noun
1.
a side part of something, especially a shoot or branch growing out from the side of a stem.


but this still throws me off: lower turbinate "runs along the entire length of the lateral nasal wall, adjacent to the nasal floor." Right when I think I have it all figured out. I have a pretty good idea, just would love some feedback!

 

[Raysu]

Bravo Roborobot! I applaud your efforts to put together useful medically based data and while I'm no ENT MD I would agree with your hypothesis. Have you come across anything in your research that would suggest products with efficacy in priming said vessels to increase blood flow and/or widen vessels. In my past I would use Afrin prior to insufflation but was so messed up in those days I couldn't tell you one way or another its impact. I would think that using a Neti-pot would be almost essential to clean and clear nasal mucose membranes. Perhaps using a humidifier prior to and afterwards would also aid in improved absorption rate. I too would love to hear the experts in this field weigh in on such theories.

 

[RoboRobot]

Bravo Roborobot! I applaud your efforts to put together useful medically based data and while I'm no ENT MD I would agree with your hypothesis. Have you come across anything in your research that would suggest products with efficacy in priming said vessels to increase blood flow and/or widen vessels. In my past I would use Afrin prior to insufflation but was so messed up in those days I couldn't tell you one way or another its impact. I would think that using a Neti-pot would be almost essential to clean and clear nasal mucose membranes. Perhaps using a humidifier prior to and afterwards would also aid in improved absorption rate. I too would love to hear the experts in this field weigh in on such theories.

hey thank you man! I appreciate your gratitude! To be completely honest, Im dealing with a hell of an opiate addiction right now, and I wasnt entirely in the mood to make that thread. I had the info up, though, and I did want some feedback at the time, so I decided to make a thread about it real quick...Of course it took a bit longer than I originally intended like I was hoping wouldnt happen

Anyways, I appreciate your response and feedback. That's what Im looking for, at least, if there isnt anyone educated specifically on the subject Id LOVE some opinions from some educated minds such as your own.

Now...for the Afrin. I hate to be the one to say it, but from all that pharmacology tells me (or more so, what Ive learned from my at-home hobby interest in it), Afrin was actually REDUCING the BA of whatever you were insufflating afterwards. The reason for this being that most nasal sprays (other than just saline) works as a vasoconstrictor (which narrows blood vessels), hence equaling less absorption into those said blood vessels. Apparently, the act of constricting blood vessels in the nose help out with congestion and that sort of thing.

Here's some info on the matter:

"Oxymetazoline is a sympathomimetic that selectively agonizes α1 and, partially, α2 adrenergic receptors.[6] Since vascular beds widely express α1 receptors, the action of oxymetazoline results in vasoconstriction. In addition, the local application of the drug also results in vasoconstriction due to its action on endothelial postsynaptic α2 receptors; systemic application of α2 agonists, in contrast, causes vasodilation because of centrally-mediated inhibition of sympathetic tone via presynaptic α2 receptors.[7] Vasoconstriction of vessels results in relief of nasal congestion in two ways: first, it increases the diameter of the airway lumen; second, it reduces fluid exudation from postcapillary venules.[8] It can reduce nasal airway resistance (NAR) up to 35.7% and nasal mucosal blood flow up to 50%."

The Journal of Laryngology & Otology, Volume 100 , Issue 03, pp 285-288

Vasoconstriction is the narrowing of the blood vessels resulting from contraction of the muscular wall of the vessels, in particular the large arteries and small arterioles. The process is the opposite of vasodilation, the widening of blood vessels.

(Oxymetazoline is a selective α1 adrenergic receptor agonist and α2 adrenergic receptor partial agonist. It is a topical decongestant, used in the form of oxymetazoline hydrochloride in products such as Afrin)


Now, what people are looking for is VASODILATORS to increase the size of blood vessels and increase the absorption rate.

Funny enough, I read a few days ago that alcohol is a vasodilator. I am unsure how that would feel in the nasal cavity, but I will find out soon enough! 8) Now, they dont recommend it being all alcohol, but more just a small amount of clear 40% + liquor, usually mixed with water or saline.

"At intoxicating levels, alcohol is a vasodilator (it causes blood vessels to relax and widen)"
Anthony Dekker D.O.

http://www.scientificamerican.com/article/what-are-the-effects-of-a/

It worked out very well for me, because the drug I was currently making a liquid intranasal solution with (Buprenorphine ) has a far higher solubility in alcohol versus water. So, with the added benefit of it being more soluble in alcohol, it will also dilate my blood vessels thus enabling quicker absorption of a *more concentrated* (and thus more potent) solution of said opioid.

I actually already made a solution, with 2mg bupe, .4ml of boiled (home-made distilled) water and salt (a home-made saline mix %) ) , and I had LITERALLY a few drops of 45% vodka left. to the point it was hard pouring it out of the bottle, so I threw a few drops of my saline mix in the bottle to mix with the vodka and had that. I tasted the solution (before bupe was added) , and it wasnt TOO strong, so I feel it was a safe solution that shouldn't irritate my nasal cavity too bad. Or hopefully at all.
I could imagine prolonged use of an intranasal alcohol solution would really dry out your sinuses...Esp. mixed with salt as sodium has the property to dehydrate anything its in contact with.

 

[Raysu]

Haha I'm a chick but you're welcome. And like I said the Afrin was to placate my mind which I was losing at the time and try to open sinuses in order to have more ease with insufflation and moisten mucus membranes to adhere powder better. I did more than enough drugs in other ROAs to compensate during that phase which is a blur really. I read a thread somewhere (maybe on dilaudid potentiation) of a method of adding it to a saline spray bottle to boost throughout the day, though dilaudid BA isn't stellar that route, it was mentioned as an alternate ROA for needle shy people. The vodka is interesting and I would consider trying that as I saw first hand in vet med vodka added to IV lines for antifreeze OD cases to prevent further uptake. I doubt alcohol would burn worse than quality ice. I've also tried using filtered opioids before and using an oral syringe to administer intranasal doses but found no significant difference compared to powder but it's a cleaner method at least. Now there are plenty of intranasal syringes with special applicator tips for administering narcan. Those no doubt have some research because of the importance of rapid absorption. We all have our battles so that makes your contribution particularly note worthy in my opinion. Most days I find it difficult to motivate myself to do much at all. If you could benefit from more detailed history about my experiences on this topic feel free to PM me. Keep up the good work!

 

[Kittycat5]

I think you are over thinking this. As long as you get whatever you are taking into the nasal cavity, you should be ok. And while in theory, a topical decongestant such as Afrin would seem to decrease absorption, Im not so sure in practice it does.

I have to look, but think there is some paper on a hydromorphone nasal spray that tested this and absorption was very similar.

 

[Raysu]

Good lookin out kittykat and thank for the one up on another thread. All my pharmacy experience was in veterinary medicine. I know there are a lot of similarities and I incorporate my personal experiences with all my posts. To me education + experience = veritable contribution so I appreciate the one ups from a human pharacist! My past is past but I am curious to know if my applied logic back then was spot on or just addictive thinking. So you think the intranasal absorption is just negligible as long as there is even coating on mm?

 

[Kittycat5]

For the drugs we love here on bl, for sure. Now they have attempted to use intranasal administration in studies for a million things and nasal anatomy plays a far greater role, but even in them the physiochemical properties of the drug and more importantly how it is formulated are much more relevent.

So snort up.

http://www.medscape.com/viewarticle/493398_5

 

[RoboRobot]

Haha I'm a chick but you're welcome. And like I said the Afrin was to placate my mind which I was losing at the time and try to open sinuses in order to have more ease with insufflation and moisten mucus membranes to adhere powder better. I did more than enough drugs in other ROAs to compensate during that phase which is a blur really. I read a thread somewhere (maybe on dilaudid potentiation) of a method of adding it to a saline spray bottle to boost throughout the day, though dilaudid BA isn't stellar that route, it was mentioned as an alternate ROA for needle shy people. The vodka is interesting and I would consider trying that as I saw first hand in vet med vodka added to IV lines for antifreeze OD cases to prevent further uptake. I doubt alcohol would burn worse than quality ice. I've also tried using filtered opioids before and using an oral syringe to administer intranasal doses but found no significant difference compared to powder but it's a cleaner method at least. Now there are plenty of intranasal syringes with special applicator tips for administering narcan. Those no doubt have some research because of the importance of rapid absorption. We all have our battles so that makes your contribution particularly note worthy in my opinion. Most days I find it difficult to motivate myself to do much at all. If you could benefit from more detailed history about my experiences on this topic feel free to PM me. Keep up the good work!

Oops, sorry about that! Didnt mean to assume. Makes sense using the Afrin to placate your mind and open sinuses..I mean if there's any small drop in BA due to the afrin it shouldnt be noticeable and being able to breath freely is entirely worth it, regardless. (kittykat's article shows that there shouldnt be a noticeable difference in BA) haha I swear being on a deep drug binge (and losing your psyche) and being congested doesnt go well together. Haha at least, I get very frustrated with it!

Lmao, Miss "Im no EMT," you went to vet school though Really? you saw alcohol administered in IV lines to prevent the uptake of antifreeze? In animals? that's very interesting! From what experience tells me and others as well, alcohol usually isnt the most pleasant to IV haha.
Ill shoot you a message/request later when I have a bit more time, Id definitely like a bit more info sometime (cool that you come from a medical background), if YOU have the time as well

I think you are over thinking this. As long as you get whatever you are taking into the nasal cavity, you should be ok. And while in theory, a topical decongestant such as Afrin would seem to decrease absorption, Im not so sure in practice it does.

I have to look, but think there is some paper on a hydromorphone nasal spray that tested this and absorption was very similar.

Personally I dont think Im "overthinking" it.. Im not really freaking out or worried about it.. Just kinda interested. And what finally led me to look into it is because I am currently physically dependent on opiates and I have a very small amount of bupe left. Im usually an IV user, but slamming suboxone makes me uncomfortable. Ive done it plenty of times, but its not the safest thing to IV, esp. without a micron filter. I actually just shot some the other day.

Sadly, when Im at the point of thinking about stabbing a dull rig in my arm, or at the least breaking off the needle tip and shoving that thing up my ass (which Im far less comfortable with than IV for some reason), just to get the smallest difference in BA, I felt it was worth the short time I invested in looking up the *ideal* position to administer intranasal solutions/powders.

I know it'll only make the slightest difference, IF that, and it wont be a noticeable one. But, if it keeps me well for even 2 seconds longer, then its worth it for me. I like being informed on the body, anyways, so it worked out. Also, placebo is a pretty major thing for most people, and even though I use some of the hardest drugs, it still effects everyone. So if I *know* Im administering it in exactly the right nasal turbinate, then Ill feel a little safer, and probably will feel like it'll work better, henceforth, giving me a better mind state and effect. I really dont enjoy learning things just from word of mouth, and I never realled looked into the whole IN route mechanics before now. Where as I made sure I knew a lot about medical IV use before I continued jabbing myself (or so I try telling myself ). Same with oral routes, and sublingual..thought it was about time to learn the specifics on intranasal since I occasionally use that route.

For the drugs we love here on bl, for sure. Now they have attempted to use intranasal administration in studies for a million things and nasal anatomy plays a far greater role, but even in them the physiochemical properties of the drug and more importantly how it is formulated are much more relevent.

So snort up.

http://www.medscape.com/viewarticle/493398_5

I really appreciate the link to the medscape article. Im glad you linked it, because you made me wonder after citing that study. Seems you are right, (atleast with hydromorphone, which doesnt have the best intranasal BA as is) It is kind of as I thought, it'd be such small difference it should be altogether unnoticeable (if I have the standard nasal anatomy)

haha had my nose broken in a fight before, but that just made my septum slightly off-center, shouldnt effect absorption.

update:so I just "administered" some of that bupe/saline/ethanol solution I said I made. Had a slight different burn to it, but not worse than snorting it already. The main perceivable difference was that I could actually "smell" the cheap vodka..Otherwise, no unnecessary burn, agitation, or unusually bad taste. hardly noticeable. (though, I mixed 45% vodka in with the saline, its probably a ~15-20% solution)

Knowing where the "turbinates" were helped me position the syringe better to try spraying in the right areas. I definitely didnt have NEARLY as much drip as I did yesterday knowing this now and where to position, BUT Im also administering less of the solution at a time (where yesterday I sprayed a bit more all at once accidently, obv. contributing to the drip)

Thanks again guys (and girl )! I apologize for my long ass posts haha.

 

[carolinagurl412]

You do get a better high this way because it does absorb more of it and you end up with less gunk in the back of your nose, or that's been my experience, however, it also presents two problems.

1. the lower turbinate will begin swelling soon after doing coc depending on the quality and how much you're done. Even with grade A quality stuff, if I have a binge night, I end up with one side swollen. I always take two small lines when I take a hit, one up each side, but only my right side swells.

2. the other issue you have is this makes it super easy to come in contact with your nasal septum. if any of it absorbs there then you're going to be screwed in the long run. I'm actually working on quitting because I like my nose. The membrane on the outside of the septum in my right nostril has worn down and I think I can see the septum cartilage underneath. I'm not sure. I'm honestly too scared to go to the doctor. Even if I test negative at the time for drugs and they aren't supposed to technically turn you in unless you're posing a threat to yourself or someone else, they don't care about that around here. They'll call the sheriff's department before you can get out the door. There's not an actual hole there but from what I hear, even after stopping, it can still continue to "rot" away and you will end up with a hole. I'm terrified that it's going to become a hole. I have been cleaning my nose every day with a neti pot and saline solution since my last hit to make sure there's nothing in my nose and that it stays clean and I'm going to get some bacitracin. I know the nasal septum won't grow back but I've heard the tissue (mucosal membrane) itself can grow back over time. As I said though, I don't have an actual hole yet so I'm hoping that since I've stopped, the membrane will grow back and it won't get worse but I haven't done it in about two months and I still have what feels like a terrible sinus infection.

 

[carolinagurl412]

go order or buy you a snuff bullet. I have one that just looks like a straw with a mushroom tip but it gives you a great location for absorption and you don't scratch your nose because the top is smooth. I won't be using mine anymore if I can help it....... but it was great while it lasted.

 

[bhamonion]

Believe it or not but 'Arm and Hammer' make a saline spray called, 'Simply Saline' and while there are a couple of different 'models' (types) it is a nasal mister and it works great at keeping the mucus membranes moist. Or washed clean. Careful though, dont 'adjust' the hole size with a needle or anything as I did thinking it was stopped up.

Damn near drowned myself !!! I've been doing Opania for 3 years now and no issues at all.
Good luck.