DOI: 10.1177/0269216315593452

pmj.sagepub.com Addiction to transmucosal fentanyl: Is it a cause for concern in cancer pain management? Transmucosal fentanyl (TMF) is a µ-receptor agonist used in the management of pain in patients with cancer.1 Current licensing restrictions allow for prescribing of TMF only in patients with cancer who are opioid tolerant and taking the equivalent of 60 mg oral morphine daily.2 In the United States, prescribers and dispensers of TMF must be specifically certified and enrolled to do so. It has previously been reported that off-label use of TMF can be as high as 90%.3 Our recent clinical experience of instances of TMF abuse caused us to examine the literature in this area. A case series in 2011 reported addiction to TMF in two patients with terminal cancer,4 and Passik et al.5 reported an 11 % incidence of aberrant behavior and a 1 % incidence of abuse events with TMF. We conducted an anonymous survey which was directed to palliative medicine physicians to ascertain their experi-ence of possible episodes of TMF abuse, its management, and subsequent reporting. The survey was designed and administered using SurveyMonkey. It was sent to palliative medicine membership organizations in Ireland and the United Kingdom. Responses were collected betwee