Dsuvia is a new brand name for a prescription opioid painkiller, sufentanil, which is a very potent narcotic analgesic. Despite concerns of substance abuse and overdose death that have plagued the pharmaceutical industry since the early 2000s when lax prescribing practices contributed to the current opioid abuse epidemic, the U.S. Food and Drug Administration (FDA) approved Dsuvia for prescription use on Nov. 2, 2018.
This opioid medication is prescribed in sublingual tablets, using the mucous membranes in the mouth to quickly release pain-killing medication into the blood so that it can bind with opioid receptors in the brain and bring rapid relief.
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Dsuvia, in particular, and sufentanil in general, is designed to treat acute, severe pain when other pain medications are ineffective.
A health care provider must administer it in a medically supervised health care setting, such as a hospital or hospice. It is not available to be prescribed and taken at home, and it is not currently approved for use for more than 72 hours (three days) due to its potency. To control access to this potent narcotic painkiller and reduce the risk of diversion to the illicit drugs market, Dsuvia is only available through a program called the Dsuvia REMS Program.
Although Dsuvia’s primary ingredient, sufentanil, is a Schedule II medication, opioid drugs related to it (like fentanyl) have been diverted, produced illicitly, and widely abused. An increase in illicit fentanyl production and distribution — it is often mixed into heroin or cocaine — has led to a spike in opioid overdose deaths around the United States because fentanyl and its analogs, like sufentanil, are much more potent than morphine and heroin.
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Understanding Morphine Milligram Equivalence
To understand how risky Dsuvia can be, it is important to understand how prescription painkillers’ effectiveness and potency are measured. The potency of each opioid is determined in relation to morphine, which was the first synthetic opiate, derived directly from opium in 1803. Morphine addiction became a serious problem after the drug was developed, and by 1874, heroin was derived from morphine to create a more effective and less addictive drug.
Unfortunately, heroin addiction became a much worse problem than morphine abuse. Throughout the centuries, chemists and doctors have tried to find a synthetic opiate drug that is not addictive, but still effective at treating pain for a long time.
Some opioid drugs, like fentanyl, were created to treat severe pain associated with specific, chronic diseases. Dilaudid, a brand name of fentanyl, was developed specifically to treat cancer pain. However, there are several analogs of fentanyl, like carfentanil, which are much more potent and have even more limited use. Carfentanil is used as a sedative for large animals like elephants in veterinary medicine. Fentanyl is between 50 and 100 times more powerful than morphine, and carfentanil is 10,000 times more potent than morphine, or about 100 times more potent than fentanyl.
When opioid drugs are referred to as more or less potent than morphine, this refers to the morphine milligram equivalence (MME) scale. This scale helps doctors prescribe safe doses of specific drugs to their patients that won’t trigger an overdose. Doses of 50 MME or more increases the risk of overdose, depending on whether a person has taken other opioids before.
The body quickly becomes tolerant to opioid drugs, so people with chronic pain who need consistent relief must work with their doctor over time to raise the dose of their opioid medication or switch to something more potent. A Veterans Administration (VA) survey found that some people overdosed on 98 MME per day, and others suffered an overdose at 48 MME.
Common opioid prescriptions have specific average MMEs. They are:
- Codeine is 0.15 MME
- Hydrocodone is 1 MME, equivalent in potency of morphine
- Oxycodone is 1.5 MME
- 1 to 20 mg of methadone equating to 4 MME
- Fentanyl transdermal drugs are 2.4 MME to 7.2 MME
Dsuvia is reportedly between 5 times and 10 times stronger than fentanyl, which is about 500 to 10,000 times more potent than morphine. Fentanyl itself is responsible for thousands of opioid overdose deaths. There is great concern among law enforcement and the medical community about abuse of Dsuvia or illicit production of sufentanil, which could lead to even more overdose deaths around the United States.
Opioid Side Effects That Might Appear With Dsuvia Use
When taken in a medical setting under controlled supervision, Dsuvia will have likely side effects based on those known to be associated with sufentanil. Those side effects include:
- Blurry vision
- Darkening of the skin
- Trouble breathing
- Difficulty swallowing
- Dizziness, faintness, or lightheadedness
- Fainting if trying to stand
- Rapid heartbeat
- Shallow, irregular, slow, or depressed breathing
- Loss of appetite
- Changes to mental state, including euphoria and delirium
- Muscle stiffness
- Overactive reflexes
- Shaking, twitching, or trembling
- Vomiting or nausea
The risk of these side effects is not widely known. Since Dsuvia is such a new medication with very specific limitations on when and how it is administered, it is unknown how serious some of these side effects will be.
Abusing such a potent narcotic painkiller as Dsuvia is much more likely to cause an overdose than intoxication associated with other opiates like heroin.
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Like other fentanyl analogs, exposure to sufentanil in general, and Dsuvia in particular, can quickly cause respiratory depression and death. Signs of an opioid overdose include the following:
- Very slow or stopped breathing
- Limp muscles
- Passing out and inability to wake up
- Vomiting or gurgling sounds
- Slow heartbeat or weak pulse
- Low blood pressure
- Cyanosis, or blue-tinted skin from oxygen deprivation
If someone takes a potent opioid drug like Dsuvia, by accident or as a form of drug abuse, opioid overdose is likely to occur very fast. You must call 911 immediately if someone is overdosing on any opioid, especially fentanyl analogs like sufentanil, to save the person’s life.
Treatment for Opioid Addiction Works
Dsuvia is a new drug, with specific requirements for administration and use, so it is unknown if people who receive treatment with this opioid painkiller will develop a physical dependence on it. With other opioid medications, like oxycodone or hydrocodone, long-term use for pain relief leads to both physical dependence and tolerance, even if the drugs are taken as prescribed.
Dependence on a drug means that you may experience withdrawal symptoms when you are not taking it anymore. General signs of opioid withdrawal include the following:
- Agitation, anxiety, or restlessness
- Muscle aches
- Watery eyes
- Runny nose
- Trouble sleeping, including insomnia
- Abdominal cramps, nausea, vomiting, or diarrhea
- Dilated pupils
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Typically, opioid withdrawal has physical symptoms that are similar to the flu. For some people, though, the cravings and discomfort are so intense that they relapse back into opioid abuse. Dsuvia is only recommended for three days total in a hospital with doctors and nurses supervising administration of the drug, so this may reduce the risk of some physical dependence. However, people who need Dsuvia treatment are not opioid-naïve, so they may have a physical dependence on a different opioid medication already.
There are no statistics yet on Dsuvia-involved addiction or overdose. However, if you struggle with addiction to another opioid drug like OxyContin, heroin, or codeine, there is treatment help.
Starting with medication-assisted treatment (MAT) like buprenorphine can ease withdrawal symptoms and reduce your risk of relapse. Medications are prescribed through medically supervised detox programs, which may be inpatient or outpatient.
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