Fentanyl alert, restrictions on prescriptions

The first alarm nationwide took place in February 2024, in the wake of the “epidemic” that exploded in the United States. The warning for fentanyl – the synthetic opioid used in pain therapy, for example for cancer patients, but whose improper use can equate it to a very powerful drug – is now added with further precautions: about ten days ago, the Ministry of Health has issued operational indications to strengthen surveillance on the circulation of prescriptions for fentanyl and similar drugs, with the aim of avoiding illicit or abuse in the distribution of the medicine.

In essence, through a specific decalogue pharmacists become “sentinels” on this front too. It happens because, we read in the ministerial document, “there remains a need to maintain a very high level of supervision on the use of the paper prescription (the white prescription, ed.), considered particularly exposed to risks of falsification or improper use”. On the other hand, fentanyl is 30-50 times more potent than heroin: in the USA there were 100 thousand overdose deaths in 2023 and around 87 thousand in 2024. From a package for medical use, many doses can be obtained to put on the drug market.

The Bergamo healthcare system is also keeping its guard high. «While waiting for total dematerialisation, which gives the certainty that a prescription is not counterfeit, the ministry has identified the weak point in white paper prescriptions, more easily falsified – explains Davide Petrosillo, president of the Order of Pharmacists of Bergamo –. Pharmacies have been identified as sentinels through a sort of decalogue to combat the phenomenon and extend controls across the board: among the points envisaged are the inspection of the prescription, checking for example the quality of the print, the doctor’s signature and stamp and any suspicious corrections; it is suggested to delve deeper into the patient’s history and consistency with previous prescriptions, verify the congruity of the dose compared to the standard posology, promptly communicate any suspicions to the authorities, and the possibility of not dispensing the drug is also contemplated”. Thus, continues Petrosillo, «The pharmacist also has a responsibility for public safety: not only must we dispense the drug correctly, but we also have an active role aimed at intercepting attempts to divert from therapeutic use.”

For the moment, there is no emergency in Italy. «Fortunately the situation is very different from the United States – remarks Andrea Raciti, president of Federfarma Bergamo –, also thanks to much more rigid control over prescriptions and dispensing. These they are not over-the-counter drugs, but in almost all cases they are prescribed by the National Health Service: the rare circumstances in which the prescription is paid by the citizen are those with the greatest possibility of counterfeiting, because the prescription is not linked to an automatic control system, but pharmacies are very careful.” Of course, Raciti acknowledges, “the problem of counterfeit prescriptions exists, not only for fentanyl but also for other products, especially opioids.” According to what appears, at least a couple of “fake” documents have been reported in the Bergamo area in recent times.

In the area, prevention also involves another action: the careful control of prescriptions, also aimed at reduction. In 2022, in the Bergamo area, there was a consumption of around 275 average daily doses of fentanyl for medical use, compared to a regional average of 225: in 2025 this dropped to just 75 average daily doses (a drop of over 70% compared to 2022), exactly in line with the current regional value. «Important work has been done – explains Arrigo Paciello, director of the Territorial Pharmaceutical Service of the ATS –, both towards pharmacies and with specialist and general practitioners. Cases of inappropriateness in prescriptions had emerged, an element that should not be underestimated: the problem in the United States also arose in this way, from a carelessness in the indications given to patients”.