Immediate-release fentanyl: the tip of the iceberg

Abstract

Recently we are seeing in the Units of Pain how the number of patients with abuse or misuse of fentanyl in their presentation of with inmediate-release increases. The percentage of patients with chronic pain who are addicted to prescription opioids vary widely from 3% to 40%. In addition, the use of rescue medication in non-oncologic chronic pain with fast release fentanyl lacks sufficient evidence and is associated with risk of tolerance, dose escalation, and inappropriate or addictive use. The possibility of generating addiction in patients with chronic non-oncologic pain should make us consider the desirability of initiating fentanyl with inmediate-release treatment in those vulnerable patients. This problem of fast-release fentanyl addiction is so emerging, that we do not yet have numbers in Spain. The American Food and Drug Administration (FDA) is conducting a strategies to assess and mitigate abuse, overdose, addiction, misuse and death by these drug. It seems desirable to devise a strategy to detect this growing problem. We think that it is fast-release fentanyl may be the "legal" drug of the 21st century.