Conductas aberrantes asociadas al empleo de fentanilos rápidos en pacientes oncológicos terminales: a propósito de un caso

We report the case of a 45 year old male terminal patient, with a previous history of alcohol and tobacco addiction, who developed aberrant behaviours associated with the use of a rapid onset fentanyl (oral transmucosal fentanyl citrate) as a rescue dose for the management of breakthrough cancer pain. The aberrant behaviours detected included, among others: addiction to the opioid, chemical coping, misuse, and self-medication. Once the behaviours were detected, the patient responded adequately to a strategy of open and assertive confrontation of the problem, and the establishing of a therapeutic contract with clear-cut limits. In the discussion we review our knowledge of the aberrant behaviours related to rapid onset fentanyl prescription, and we suggest some easy points that might raise the suspicion of the diagnosis. We also review known risk factors for these behaviours, suggested opioids for pain management under these circumstances, and the way to build an opioid treatment agreement.