Fentanyl: A threat to Brazilian society or an opioid drug of great importance in pain management?

Abstract Introduction: About 450,000 Americans died from opioid overdoses from 1999 to 2018, characterizing one of the worst public health problems ever faced by the U.S. Methods: We conducted a narrative literature review by searching the central databases. We selected 101 studies. After analysis, they were reduced to 77 articles that allowed a comprehensive view of fentanyl in the U.S., the factors that triggered its high-risk consumption, and its consequences in Brazil. Results and Discussion: We identified three phases that have contributed to the opioid crisis in the U.S.: (1) Increased prescribing; (2) Heroin use associated with other drugs, especially fentanyl and (3) Illicit fentanyl use. In Brazil, in contrast to an opiophobia history, we have observed growing opioid prescriptions and illicit fentanyl-derived seizures. The impact of this increase is unknown regarding the high-risk/addiction consumption outlook. Final considerations: Fentanyl is a valuable tool in pain management and cannot be excluded from clinical practice. This is justified by the social and bioethical responsibility associated with pain control. Establishing control mechanisms and prevention measures is essential to ensure access to medicines while preventing illegal circulation.