Subsys (Fentanyl Sublingual Spray) Withdrawal And Detox

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Subsys is a medication that’s sprayed into the mouth of patients to relieve breakthrough cancer pain. The active ingredient in Subsys is non-ionized fentanyl. By having the fentanyl sprayed into the mouth, it’s absorbed by the sublingual mucosa, creating a rapid and powerful pain-relieving effect. Subsys is intended to be used only for patients who are already opioid-tolerant and on an around-the-clock opioid treatment like morphine. Unfortunately, Subsys is sometimes prescribed outside of those uses, or is diverted from medical use and misused. Fentanyl rapidly binds to the opioid receptors in the central nervous system. It changes how pain signals are sent but also can lead to addiction and dependence. Subsys and other opioids can cause euphoria, change levels of neurotransmitters in the brain and can alter the overall function of the brain. That’s why withdrawal symptoms can occur if someone suddenly stops using an opioid medication. Their body and brain have to readjust to functioning without it. Common Subsys withdrawal symptoms can include:

  • Anxiety
  • Constipation
  • Dilated pupils
  • Chills or goosebumps
  • Cramps
  • Muscle aches and pains
  • Irritability
  • Runny nose
  • Sweating
  • Yawning
  • Nausea and vomiting
Subsys (Fentanyl Sublingual Spray) Withdrawal And Detox
Everyone is going to experience a slightly different Subsys withdrawal timeline. Some of the factors that play a role in how long withdrawal symptoms last include how long the drug was used, whether it’s stopped cold turkey and the doses being used. If someone is also using other substances simultaneously to Subsys, that can affect the withdrawal timeline too. With any medication that is fentanyl-based, withdrawal symptoms can begin anywhere from six to 12 hours after the last dose is used for most people. Within the first 24 hours to three days following the last dose is when the peak symptoms will occur. This is usually the most difficult part of withdrawal. Within five to seven days, most people will find that their symptoms will start to subside. However, some symptoms including psychiatric symptoms like anxiety and depression can continue for weeks or months after someone stops using opioids.
Managing symptoms of Subsys withdrawal can be difficult. Opioid withdrawal isn’t usually deadly, but complications are possible. It’s also just extremely uncomfortable for a lot of people. Withdrawal symptoms can be a big deterrent for people to seek addiction treatment. A full detox is necessary for treatment, but some people experience recurrence of use because they find that managing the symptoms of Subsys withdrawal is too difficult. The best to keep the symptoms minimized is to follow a tapering down schedule for the drug. A physician can create a plan where the patient slowly lowers how much Subsys they take until they come to a gradual stop. Quitting cold turkey, especially without medical help or supervision, is one of the worst ways to manage symptoms of Subsys withdrawal.
Since Subsys is an opioid, certain medications are approved for use to help with withdrawal symptoms. Methadone is one of the most well-known treatments used during opioid withdrawal and detox, but it’s also controversial. Methadone is a milder opioid, so it can stop withdrawal symptoms and help with cravings. Methadone does have its own misuse potential, however, which is something to be aware of with its use. Buprenorphine is a shorter-acting drug compared to methadone, and it’s available in different brand name variations. Buprenorphine effects the same receptors as other opioids, but with milder effects as well. Naltrexone is a drug that blocks opioid receptors. It doesn’t help with withdrawal symptoms, and it doesn’t eliminate cravings, but it does block the effects of opioids if someone experiences recurrence of use while they’re on it. There’s also a combination of buprenorphine and naloxone available. Any time a medication is used during Subsys detox, it’s intended to be part of a larger treatment program. There’s no magic cure for withdrawal or addiction. Approved medications are instead tools that can be used to help increase the likelihood someone will receive addiction treatment.
A good option for someone dependent on something as powerful as Subsys is a professional medical detox. A medical detox includes constant supervision from a team of mental and physical healthcare professionals. When someone is considering a Subsys medical detox, they should think about whether or not the facility offers the following:

  • Along with the medications above, can other medications be prescribed to treat symptoms as they occur, such as insomnia?
  • Is mental health care available as well?
  • Is the medical detox part of an addiction treatment center, or do patients have to transfer somewhere after detox?
  • What level of support is provided?

To learn more about how to detox safely in a comfortable, professional facility, reach out to 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.