To address this problem, researchers have developed rapid-delivery drugs, including the so-called "narcotic lollipop," Actiq (oral transmucosal fentanyl citrate). Absorbed quickly through the mouth, Actiq can begin relieving pain within five minutes and lasts at least an hour.
Off-label use of the narcotic "lollipop"
There is some controversy surrounding Actiq. Approved in 1998 only for cancer patients already being treated with opioids, it has been widely prescribed "off-label"for unapproved usesto noncancer patients. One estimate put the percentage of off-label prescriptions at 80%.
Cephalon, the makers of Actiq, have now released another drug, Fentora, which also contains fentanyl and is approved for the same uses. Absorption is better and faster than Actiq; it doesn't use a lollipop, but a patented form of effervescence.
Andrea Cooper, 52, of Phoenix, Md., who has fibromyalgia and spinal degeneration, says she couldn't live without breakthrough-pain medication. "The doctors call it a rescue dose, and it truly is a rescue dose for me," says Cooper, who initially used Actiq but has now switched to Fentora.
Cooper is constantly vigilant for signs of breakthrough pain; she realizes that if it takes hold, calming her pain generally becomes more difficult. "The whole thing about pain medication and pain management is to keep it at a manageable level all the time, and not allow it to ever spike. It becomes much harder to get it down, like a kid who's eaten too much chocolate. It's hard to tie him down."