Subsys While Pregnant: What You Need to Know

Subsys is a sublingual spray version of the powerful opioid fentanyl. The Subsys sublingual spray is only intended to be used to treat breakthrough cancer pain in adult patients. For someone to be prescribed Subsys, they should already be receiving opioid pain medicines and they should be tolerant to opioid therapy. The idea behind Subsys is that the patient is already on around-the-clock opioid treatment and Subsys is used for treating breakthrough pain that cannot be treated with continual medication therapy. When someone uses Subsys, they spray it under the tongue. This allows for rapid absorption, and it should start working within five minutes. If someone uses Subsys and they’re not opioid tolerant, it can cause deadly respiratory depression. Subsys is extremely potent in its actions on the opioid receptors in the brain and central nervous system. It shouldn’t be used to manage acute pain or postoperative pain.

Subsys is part of a prescribing and dispensing program that aims to cut down on the non-prescribed abuse of opioids. The program is called the Transmucosal Immediate-Release Fentanyl (TIRF) REMS Access Program. For an outpatient to receive this medication, they have to be enrolled in this program. Opioids like fentanyl are highly addictive. The frequent prescribing of opioids has led to the opioid crisis in the U.S., contributing to tens of thousands of deaths each year. Along with the potential for addiction, dependence and fatal respiratory depression, there are other risks associated with the use of Subsys and similar drugs. Side effects of fentanyl can include vomiting, constipation, hallucinations and poor coordination.

Can you take Subsys while pregnant? The overall answer is no. There wouldn’t typically be a reason that a pregnant woman would or should take Subsys. The only medical reason for which a woman might take Subsys while pregnant is if she had cancer. Otherwise, there wouldn’t be an acceptable medical reason for Subsys to be prescribed. Regardless, a woman may have questions if she’s addicted to opioids like Subsys. The use of opioids during pregnancy generally isn’t advisable, unless instructed by a physician. Opioids are category C pregnancy drugs, based on FDA guidelines. A category C drug indicates that there is a potential for harm to the fetus if this drug is used during pregnancy. When considering category C drugs during pregnancy, a doctor will typically weigh the possible risks against the benefits. Since Subsys is such a tightly controlled drug intended only for very specific situations, it’s highly unlikely that a doctor would advise a pregnant woman to use it.

Subsys While Pregnant: What You Need to Know
There isn’t a lot of research about how Subsys specifically affects a fetus, but there is research and information available about the effects of opioids on a fetus. A baby may be at a higher risk for developing certain birth defects if they are exposed to an opioid like Subsys in the womb. For example, neural tube defects, such as spina bifida, may be more likely when there is opioid exposure during pregnancy. Spina bifida is a serious condition that affects the spinal cord as well as the brain. There is some evidence that opioid exposure in the womb increases the risk of congenital heart defects in a baby, as well as hydrocephaly -the buildup of fluid in the brain. Congenital heart defects are already one of the most common birth defects, even without the added factor of opioid exposure.

Another risk of using Subsys while pregnant is neonatal abstinence syndrome (NAS). This means that after being exposure to a drug in the womb, the baby is born physically dependent upon it. After birth, when they’re no longer exposed to it, they will go through withdrawal. NAS symptoms can vary. They can start shortly after birth, or it may be days or weeks before the symptoms occur. They can also range in severity. Common NAS symptoms include:

  • Excessive or high-pitched crying
  • Jitteriness
  • Restlessness
  • Problems sleeping
  • Tremors or convulsions
  • Problems with sucking and feeding
  • Failure to thrive
  • Yawning
  • Fever or sweating

Possible complications of neonatal abstinence syndrome include low birth weight and jaundice, as well as an inability to gain enough weight. When a baby has NAS, treatment in the NICU is usually required. Treatments can include medications and, in severe cases, something like methadone may be used. A baby’s stay in the NICU can range from several days to several weeks or more, depending on the symptoms and treatment.

Unless you are in a very specific situation and coping with cancer pain, it’s not likely that your doctor will prescribe Subsys. However, if you abuse Subsys recreationally while pregnant, you should speak openly with your healthcare provider. You may need to gradually taper off Subsys and other opioids to avoid complications that can stem from withdrawal during pregnancy. A medically-assisted detox may be one option if you’re using Subsys while pregnant. A pregnant woman abusing Subsys recreationally might benefit from an addiction treatment program as well.

If you’d like to learn more about medical detox and addiction treatment, including during pregnancy, call our team at The Recovery Village.

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.