Weighing in on the off-label use of Actiq for noncancer-related pain: a recipe for success or a recipe for disaster?
OBJECTIVE
An editorial is provided based in part upon a recent Wall Street Journal article by John Carreyrou, which cast the off-label use of opioids, in this case, Actiq (oral transmucosal fentanyl citrate), in an extremely negative light from the viewpoint of contributing to addiction. As in the past, this article seems to follow a "recipe" used to demonize opioids, the pharmaceutical industry and the physicians who prescribe pain medications. Specifically, the case is made that using oral transmucosal fentanyl citrate in noncancer patients, for whom there is no current indication, is contributing to the prescription drug abuse problem.


CONCLUSIONS
We discuss the faulty logic in parsing the use of opioids between malignant and non-malignant pain patients. A call is made to pain professionals to begin discussion of the common use of pharmaceuticals in off-label ways to treat pain issues as well as a discussion of the dangers of not addressing this practice openly.
Passik
Steven D
SD
Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York 10022, USA. passiks@mskcc.org
Kirsh
Kenneth L
KL
D000014:Abnormalities, Drug-Induced / Q000453:epidemiology; D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008881:Migraine Disorders / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy*; D011247:Pregnancy; D012308:Risk Management; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
D000701:Analgesics, Opioid; D005283:Fentanyl