Standard over-the-counter nasal sprays like saline or steroid-based allergy sprays do not produce a high. They have no meaningful psychoactive effects on the brain. However, certain other nasal sprays, both prescription and OTC, can produce euphoria, dissociation, or stimulant-like effects, either by design or through misuse.
The nose is one of the fastest routes for delivering a drug to the brain. Small molecules sprayed into the nasal cavity can be fully absorbed in under 10 seconds, bypassing the slower digestive process that oral medications go through. That speed is exactly why some drugs are formulated as nasal sprays for medical emergencies, and it’s also why misusing substances through the nose carries serious risks.
Why the Nose Delivers Drugs So Quickly
The inside of your nose is lined with a thin, blood-vessel-rich membrane that sits close to the brain. Drugs absorbed through this membrane can reach the central nervous system and the bloodstream almost immediately, without first passing through the liver, which normally filters and weakens medications taken by mouth. This is called “first-pass metabolism,” and skipping it means more of the drug reaches your brain at full strength.
This rapid absorption is why nasal delivery is used for time-sensitive medications like seizure treatments, which can begin relieving symptoms within 3 minutes and reach peak effect in about 10 minutes. It’s a feature that makes nasal sprays medically useful, but it also raises the stakes when a spray contains something with abuse potential.
Allergy and Saline Sprays Have No Psychoactive Effects
Steroid nasal sprays like fluticasone (the active ingredient in Flonase) work by reducing inflammation locally in the nasal passages. They are not psychoactive. Fluticasone has such low systemic absorption that even in an extreme overdose case involving 60 puffs of a related inhaler, the patient recovered within a day with only supportive care. The drug simply doesn’t reach the brain in amounts that would alter mood or consciousness.
Saline sprays are just saltwater. They moisturize nasal tissue and help flush out irritants. There is zero potential for a high.
OTC Decongestant Sprays Can Affect the Brain
This is where things get more complicated. Common decongestant sprays containing oxymetazoline (Afrin, for example) are chemically related to amphetamines. Oxymetazoline is lipophilic, meaning it dissolves in fat, which allows it to cross the blood-brain barrier and enter the central nervous system. Once there, it stimulates the same norepinephrine pathways that amphetamines do.
At normal doses, this effect is minimal. But case reports document real psychiatric effects from overuse: a 41-year-old patient developed paranoid psychosis from oxymetazoline spray, and a 26-year-old became dependent on a related decongestant and experienced toxic psychosis. Reported side effects of excessive use include agitation, anxiety, insomnia, and convulsions. These aren’t pleasurable highs. They’re dangerous overstimulation of the nervous system, sometimes accompanied by dangerously constricted blood vessels in the brain.
Propylhexedrine: A Specific Misuse Concern
Propylhexedrine, sold under the brand name Benzedrex, is an OTC nasal decongestant inhaler with stimulant properties. The FDA has issued a specific warning about its abuse and misuse, noting that it can cause fast or abnormal heart rhythm, high blood pressure, paranoia, hallucinations, and confusion. Some of these complications lead to hospitalization, disability, or death. The risk increases dramatically when people extract the drug and use it by routes other than nasal inhalation, which some individuals do specifically to chase a stimulant high.
Prescription Nasal Sprays That Cause Euphoria
Some prescription nasal sprays are designed to alter brain chemistry, and euphoria or dissociation is a known side effect.
Esketamine (brand name Spravato), a nasal spray approved for treatment-resistant depression, is a close relative of ketamine. In clinical trials, 31.4% of patients experienced dissociation, a feeling of detachment from your body or surroundings. The effect begins shortly after dosing, peaks around 40 minutes, and resolves within about two hours. Euphoria, hallucinations, dizziness, and nausea are also reported. Because of this abuse potential, the drug can only be administered in a certified healthcare setting where patients are monitored for at least two hours afterward.
Fentanyl nasal spray, prescribed for breakthrough cancer pain in patients already taking opioids, can cause what the Mayo Clinic describes as “a false sense of well-being.” This is the classic opioid euphoria. It also carries the risk of dangerously slowed breathing, overdose, and death. Using too much, or combining it with other opioids, can be fatal. Symptoms of overdose include pinpoint pupils, blue lips or fingernails, shallow breathing, and seizures.
Decongestant “Addiction” vs. Real Addiction
Many people who use decongestant sprays like Afrin for more than a few days develop a rebound effect called rhinitis medicamentosa. The spray shrinks swollen nasal tissue, but prolonged use causes the receptors in your nose to become desensitized. Your congestion comes back worse than before, and you need more spray to get relief. This cycle feels like addiction, and the underlying mechanism is similar: receptor downregulation, escalating doses, and a rewarding feeling when symptoms temporarily improve.
However, research shows this is not the same as substance addiction in the neurological sense. Studies have found no increased tendency toward drug abuse in patients with rhinitis medicamentosa, and no association with depression. The “addiction” is localized to the nasal tissue, not the brain’s reward system. It’s a real problem that can be difficult to break, but it’s a different category from the compulsive drug-seeking seen with opioids or stimulants.
Physical Damage From Chronic Misuse
Regardless of whether a nasal spray produces a high, chronic overuse can physically damage the nose. Excessive use of steroid sprays or inhaled drugs can perforate the nasal septum, the thin wall of cartilage between your nostrils. You might not notice a small perforation at first, but larger ones cause a whistling sound when you breathe, frequent nosebleeds, crusting inside the nose, a chronically runny nose, and in severe cases, a visible collapse of the nasal bridge called saddle nose deformity. Repair typically requires surgery.
Decongestant overuse also causes chronic swelling and ischemia, where reduced blood flow damages the nasal lining over time. This tissue damage can make it progressively harder to breathe through your nose, creating a worsening cycle of spray dependence.