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Subsys (Fentanyl Sublingual Spray) Abuse And Addiction

David Hunter, MA.Ed, LPC

Medically reviewed by

David Hunter, MA.Ed, LPC

February 13, 2019

Subsys, also known as fentanyl, is powerful man-made prescription opioid that is nearly 100 times more potent than morphine. This medication is typically prescribed to patients with cancer to treat severe pain. Illicitly manufactured fentanyl, however, is extremely dangerous and is responsible for a large number of opioid-related overdose deaths.

As the opioid epidemic continues to overwhelm our nation, Americans from all walks of life overdose from opioid drugs every day. Aside from heroin, this crisis is vastly fueled by prescription opioid painkillers. Fentanyl largely drives this epidemic. Even though authorities suspect that illicitly manufactured fentanyl is responsible for a greater number of fentanyl-related overdose deaths, prescription fentanyl is still very much to blame.

What Is Fentanyl?

The CDC tells us that “Fentanyl is a synthetic (man-made) opioid that is 50x more potent than heroin and 100x more potent than morphine.” This opioid appears (and is abused) in two forms: an illicitly-manufactured version (non-pharmaceutical fentanyl) and prescription versions. Subsys belongs to the latter type. The pharmaceutical versions of this drug are used to treat chronic cancer pain.

What Is Subsys?

Subsys is a fast-acting sublingual spray medication. To administer this drug, a person sprays it underneath their tongue. The tissues in this region are very permeable, which means certain substances or medications can pass through them quite easily and rapidly. This is due to the high concentration of blood vessels in this area.

Once Subsys is absorbed, it travels quickly throughout the bloodstream, where it’s soon able to cross over the blood-brain barrier. This means the drug moves into your brain, where it begins to affect your central nervous system (CNS).

MedlinePlus cautions that Subsys should only be used to treat breakthrough pain in cancer patients who:

  • Are 18 or older
  • Are taking another opioid analgesic (painkiller) on a regular dosing schedule
  • Have developed a tolerance to other opioid analgesics

Within these circumstances, a person should only use two doses per breakthrough pain episode. If a person’s pain requires more than four doses daily, the dosage of the main opioid painkiller should be decreased. Ignoring any of these guidelines increases your risk of drug misuse, abuse, and complications.

Subsys can be very dangerous if used off-label (for purposes other than as described above). Because of this, it’s only manufactured in strictly set doses. Each dose delivers a specified amount of medication, and each unit can be only used once. After this, the unit becomes locked.

NBC News informs us of Subsys’ hefty price tag, stating that “ one package of 30 sprays can cost between $900 and $3,000, depending on the dosage, and those prices only seem to be increasing.” Despite these extreme costs, this drug is still diverted and used as an illicit drug of abuse.

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Why Do People Abuse Subsys?

Used alone, fentanyl will produce a high or relaxed euphoric state which many drug abusers seek. However, this drug is also used to amplify the effects of heroin and other drugs. Using fentanyl with other substances, especially potent opioids like heroin, increases the risk of fatal overdose.

Sadly, some people equate the sublingual form to decreased risks. Certain people have an aversion to taking pills, while others think that they’re more addictive. Others believe there’s a stigma with “pill popping” and think that the sublingual method seems less characteristic of abuse or addiction.

On the other hand, the intensity of sublingual delivery is exactly why many people prefer this drug for recreational use. Again, this method delivers this powerful drug quickly into the user’s system. This method of action makes it anything but safe or less risky in comparison to other routes of administration. Regardless of what a person thinks, fentanyl in any form is supremely hazardous to your health.

How Does Subsys Affect The Central Nervous System?

As an opioid drug, Subsys impairs a person’s CNS. When an individual’s CNS slows down or becomes depressed, their brain activity is reduced. This action causes the:

  • blood pressure to fall
  • body’s temperature to go down
  • heart rate to slow
  • pulse to drop
  • respiratory system to become sluggish

During this time, a person’s speech, perception, thoughts, and movement may become impaired.

Due to the immense strength of this drug, these actions are quicker and more intense than that of many other opioids. Similarly, the risks and dangers of Subsys are more acute than with other drugs within this class.

How Can You Tell If Someone Is Abusing Subsys?

If you suspect your loved one is abusing Subsys, it’s critical that you recognize signs of abuse as quickly as possible.

Physical and mental signs include:

  • drowsiness
  • euphoria
  • constipation
  • decreased anxiety
  • inability to feel significant pain
  • sedation

Behavioral signs include:

  • craving the drug
  • “doctor shopping”
  • drug-seeking behaviors
  • hiding, hoarding, and/or stealing the drug
  • ignoring important responsibilities within the home, school, or workforce
  • lying about patterns of drug use
  • losing pleasure in activities which previously brought fulfillment
  • pushing friends and family members away
  • spending more and more time finding and using the drug
  • tolerance (needing more of it to feel the same effects)
  • using the drug despite knowledge of the harm it causes
  • withdrawal

Ignoring these signs even for a brief period can allow abuse to accelerate into addiction or even death.

What Are The Symptoms Of Subsys Withdrawal?

When an addicted individual stops using a drug without tapering their dosage, they will go into withdrawal. Severity can vary, but since Subsys is such a strong opioid with a high potential for dependence, symptoms are often quite pronounced and extreme.

They may include:

  • anxiety
  • chills
  • constipation
  • dilated pupils
  • goosebumps
  • increased heart rate
  • intense cravings
  • muscles aches and pains
  • restlessness
  • runny nose
  • stomach cramps
  • sweating
  • yawning

Withdrawal is not only very uncomfortable and painful, but it can jeopardize your health and safety. A good treatment program should offer a medically-supervised detox to help you progress safely through this period.

What Are The Dangers Of Subsys Abuse And Addiction?

Subsys packs a powerful punch, one which often escalates into overdose at a fast pace. This occurs due to the profound impact on the user’s CNS, as we discussed above.

Signs of Subsys overdose include:

  • blue lips or fingertips
  • cold, clammy skin
  • confusion
  • muscle weakness
  • pinpoint pupils
  • seizures
  • shallow, slow, or stopped breathing
  • stupor

Severe CNS depression can lead to life-threatening coma and/or respiratory depression.

Overdose risks which are specific to Subsys include:

  • Elderly or debilitated individuals face heightened risks of overdose
  • Individuals with chronic obstructive pulmonary disease face a greater risk of overdose
  • Interactions with cytochrome P450 3A4 inhibitors can lead to fatal overdose
  • Individuals without a tolerance to opioids more easily overdose from Subsys
  • One dose can cause overdose in children
  • A dose of Subsys may hit a user differently than an equal dose of a different form of fentanyl
  • Used Subsys spray units still contain enough fentanyl to cause complications
  • Using these drugs along with CNS depressants like alcohol or benzodiazepines increases overdose risk

Subsys misuse and abuse should not be taken lightly. Severe opioid addictions are best treated within inpatient drug rehab centers which utilize medication-assisted treatment.

Take Steps To Overcome Your Addiction Today

If you’re concerned that your Subsys use is turning into abuse, get help now. Subsys abuse can rapidly accelerate into addiction. If you or a loved one are currently struggling with Subsys addiction, we can design an individualized treatment plan for you. Contact now.

DailyMed - Label: SUBSYS- fentanyl spray

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