Implications
Always room for more pain medications/formulations for cancer patients The sublingual fentanyl approach is a highly desirable formulation due to rapid onset of action ie BTP control The concern is the faster they can be made to act, the more the abuse potential by non cancer patients
Analysis
I have seen numerous pain medications introduced over my nearly 2 decades as an oncologist/hematologist. The focus has diverged from one of wanting more longer acting meds for chronic pain control to that of quicker BTP meds. I ca see value in most, but at the end of the day, I see patients getting what they can afford, if the diffedrence is only minor. It is true that a sublingual fentanyl would be a very rapid onset relief, but so was fentanyl "suckers" and they did not go over well either due to the fear of abuse and extra cost for the patient. I think every minute of pain is one minute too much, but many patients are willing to wait for a ten to fifteen minute onset of a rapid realease oral med as opposed to a 1 minute relief at extra cost. Also, while we put abuse concerns in cancer patients on the "back burner", there are those non cancer pateints/consumers that may not be so trustworthy to have this agent at their disposal.
