What is fentanyl?
A derivative of opiates such as morphine or heroin. It is used as a painkiller on a large scale. In our country it is used in tablets, in transdermal patches that are applied to the skin and release the drug, or in forms of rapid mucosal absorption. There is also intranasal administration. And intravenous formulations to produce analgesia in the operating theater during the induction of anesthesia, before operations.
How long has it been used?
It has been marketed for nearly fifty years. It was synthesized looking for something that could fill this gap that we lacked in treating uncontrollable pain. It is a drug with a safe profile that is used every day in the ambulatory hospital environment.
For what pains?
In Spain, the forms of rapid administration to treat oncological and disruptive pain that no longer respond to other analgesia are restricted. Sometimes it can be used in nerve or post-surgical pain, but these are more isolated cases. Fentanyl must be signed for an inspection visa. It has very strict control. When other medicines don't work, that's when you turn to these drugs.
Is there a risk of addiction?
The addictive potential of fentanyl is a reality. There is a risk of addiction. But in our country, or even in Europe, it is a risk that we have greatly reduced, given the control we do. We don't treat other types of pain with this kind of drug commonly, as it happens in the United States. While there 90% of people who undergo surgery are discharged with an opiate prescribed for pain, in the rest of the world it is only 1%.
What to do if there is addiction?
There are addictive behavior units that have protocols. Attempts are being made to gradually replace this drug with others with less addictive potential. And at the same time it is treated with other drugs that reduce its effects. In the case of people addicted to fentanyl, we administer naloxone, which is the antidote to fentanyl, with these drugs so that the addiction gradually decreases.
Are there more addictive formulas?
Fast-acting orals, which are taken as tablets or absorbed through the mucosa. And those that generate more tolerance, because patients end up needing more doses. These are drugs that reach the central nervous system very quickly.
Can the control be done by a family doctor?
In principle, yes. But our country lacks some training to prescribe these drugs. Sometimes they are used for indications in which we should not resort to the former.
Could you give examples?
Mainly for non-oncological pain. There are very isolated cases in which it is prescribed when with another type of analgesia we could already control the pain: post-surgical patients, nerve-type pain... But many times the easiest thing when you are in front of the suffering patient is to remove the pain immediately. And in this we sin, because we are human. The consumption of opiates has also increased because the population is living longer and chronic diseases that cause pain are more prevalent.
...
We cannot do without fentanyl. The right to be free of pain is fundamental. The population should not be afraid. It has a very safe profile and will not always generate addictions, let alone with the control we do. Although it is necessary to talk about its dangers, because if we get confused, the same thing as in the United States could happen.
