Breaking News: the FDA (re)issues warning about fentanyl

In September, I wrote about the double-edged sword of narcotics and pain control for cancer patients. Around that same time, there were news reports of patients dying from improperly prescribed Fentora, which is a preparation of the powerful narcotic, fentanyl, that is absorbed through the lining of the mouth.

Fentanyl is in the news again this week. This time, the issue is with fentanyl patches. These are a favorite tool for oncologists, because the drug is absorbed through the skin. This means the patient need not swallow a pill, a big deal for patients receiving chemotherapy (notorious for causing nausea and vomiting). Fentanyl patches are also great for managing chronic pain in patients who have significant prior narcotic exposure, and it’s hard to imagine practicing oncology in the US without this tool.

However, like all tools, improper use can result in great harm.

At a news conference last week, the FDA reissued a 2-year-old warning about fentanyl patches, which have been linked to at least 120 deaths. They repeated their advice that these patches be reserved for patients with chronic pain and a tolerance to opioids. The patients who have died have all been prescribed for acute pain (in one case, a headache) and had never taken narcotics before.

Fortunately, the FDA does not seem likely to heed the call from some people to limit the ability to prescribe fentanyl patches to pain specialists. This would be a big mistake, because there are only 4,000 pain medicine specialists in the US, and many, many patients with chronic pain are treated safely and effectively by experienced physicians without specific pain training.

Bottom line? Pain medicines are powerful medicines. Used incorrectly, these medications can be deadly. But, used correctly, they can make life tolerable for people who would otherwise suffer terribly. That fact alone is sufficient to keep them on the market, and in the hands of doctors who know how to use them and patients who need them.