How Long Does Subsys Stay In Your System?

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Subsys is the only non-ionized form of the opioid drug fentanyl available as an oral solution. Subsys comes in a single-use spray device. Patients spray the medication directly into the mouth, under the tongue. Then, the medication in Subsys is absorbed by the sublingual mucosa. Subsys is supposed to be prescribed only to treat breakthrough cancer pain in patients already on around-the-clock opioid medication, such as a certain dosage of morphine. Subsys isn’t supposed to be used for any other kinds of pain. Subsys can also only be prescribed by clinics and hospitals that are part of the Transmucosal Immediate-Release Fentanyl (TIRF) REMS program. The reason there are so may specific guidelines for the prescribing of Subsys is because fentanyl can lead to serious addiction and dependence problems as well as respiratory depression. If someone were to use Subsys without previously being opioid-tolerant, they could immediately overdose. Unfortunately, even with the prescription guidelines in place, sometimes Subsys is incorrectly prescribed or diverted from medical use.
How Long Does Subsys Stay In Your System?
Along with Subsys only being available through facilities that participate in the TIRF REMS Access program, it’s also a Schedule II drug. Schedule II drugs are defined by a classification set forth by the DEA in the U.S. Schedule II drugs are, according to the DEA, among some of the most addictive. Schedule II indicates the active ingredient in Subsys has a high likelihood of severe psychological and physical dependence. Possessing Subsys without a valid prescription is illegal. Despite the guidelines and regulations, whistleblower reports have shown Subsys has been prescribed inappropriately, including in non-cancer pain situations.
Fentanyl is a synthetic opioid, and it has strong pain-relieving abilities, but many risks as well. Fentanyl can be anywhere from 50 to 100 times stronger than morphine, in its pharmaceutical forms. There are illicit forms of fentanyl sold on the black market as well. These versions of fentanyl can be thousands of times stronger than morphine. Fentanyl is a major drug of misuse, and it’s at the center of the opioid epidemic currently affecting the U.S. Due to how strong fentanyl is, not only is it highly addictive but also very deadly. Fentanyl is found in other prescription drugs aside from Subsys. These drugs include Actiq, Duragesic and Sublimaze.
Since Subsys is an opioid, it binds to specific central nervous system receptors, and it does so very quickly. Subsys then changes how the body sends pain signals and senses pain. Subsys is also a central nervous system depressant. It can slow down essentially all major functions of the patient, including breathing and heart rate. Side effects of Subsys can include nausea, vomiting, dizziness, constipation and drowsiness. Subsys can also cause a euphoric feeling in patients, which is one reason it’s addictive. Subsys changes the amount of certain neurotransmitters in the brain, such as dopamine. That accounts for the euphoria patients may experience, but also triggers a reward response. A pleasure and reward response in the brain can give rise to the development of an addiction.
The half-life of Subsys can be used to estimate how long a dose of the drug might stay in the system of the patient. The half-life is important to prevent an overdose from occurring. The half-life of Subsys, on average, is anywhere from five to 12 hours. It takes around five half-lives for the full dose of a drug to leave the system. Based on these estimates, it could take 25 to 60 hours for a dose of Subsys to leave the system of the patient fully. Somewhere in the middle would be a half-life of seven hours and a total elimination time of 35 hours.
While it’s possible to estimate the half-life of Subsys based on average patients, there are individual factors that determine specifically how long any substance stays in your system. Some of the factors that influence how long Subsys stays in your system can include:

  • Research indicates drugs like fentanyl, which is the active ingredient in Subsys, stay in the system of older patients longer than younger ones. It can take twice as long for fentanyl to leave the system of an elderly patient as compared to a younger one.
  • Body mass and body fat: Larger people with a high percentage of body fat are more likely to store fentanyl, so it will take longer to be eliminated from the system. However, a larger person with a lower amount of body fat is likely to eliminate fentanyl more quickly than a smaller person.
  • Metabolism is important as well. Someone with a naturally fast metabolism will likely eliminate fentanyl or any other drug more quickly than someone with a slower metabolism.
  • Hepatic function: People with hepatic impairment tend to take longer to eliminate substances from their body.
  • Well-hydrated people may excrete Subsys more quickly.
  • When fentanyl is taken in transmucosal form, as is the case with Subsys, this can affect elimination time as well.
There are different types of drug tests. The most common drug screenings are urine, hair and blood tests, and each will have different detection times for the same drug. Subsys might not show up in a standard five-panel drug screening because fentanyl may need to be specifically tested for. If fentanyl is being tested for, the use of Subsys could show up in a urine test anywhere from 24 to 72 hours after using it. There is a lot of variance here, however. In a hair test, most drugs will show up for up to 90 days. Blood tests tend to have the shortest detection windows. Fentanyl might show up in a blood test for anywhere from one to four days after it’s used, or it might be less than 24 hours.

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Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.