As a chronic pain patient who is allergic to almost every other narcotic available, fentanyl has been a Godsend. I use the patches as my base meds, and have used fentora and fentanyl citrate (actiq lozenges) for breakthrough pain. Yes I have signed all the TIRF forms every year, and both my pain doctor and my pharmacist have to take courses and pass tests to prescribe and fill prescriptions for instant release fentanyl drugs, respectively. Because of the difficulty in getting the generic actiq approved as an exception (because I don't have cancer, just serious anaphylaxis to the other narcotics), my pain management doctor has suggested that I try subsys now. His reasons are that it is fentanyl, and the company that makes it apparently has a very good department that works to get it approved for the patient. I should be starting it in the next week.
My experience with the fentanyl drugs has been great. I keep everything locked in a safe for the safety of others. But the important thing is that fentanyl works for pain. I was on these when they first became available and then had an intrathecal pump for several years until it failed and I got a bad MRSA infection from the surgery to repair it, and had to have the pump removed. So back on the patches and lozenges I went. They work almost as well as the pump. I don't have any side effects at all most days. Every so often I experience a bit of nausea, but that's usually on really bad pain days. Also the forms of fentanyl (fentora and actiq) that I have used for breakthrough pain give almost instant pain relief for the breakthrough pain that occurs daily. While I haven't tried the subsys spray yet, I think it will work just as well as the other forms as long as it is used correctly.
I suspect that your doctor wants you to meet with a rep to educate you on its correct use. In the past I have met reps for the pump company and also for the fentanyl company for those reasons (efficacy in my situation and correct use) . I don't know if the recent changes to the HIPPA laws now make that illegal or unethical. However, as chronic pain patients, it is up to us to make sure that we educate ourselves as best we can about the conditions we live with, as well as any treatments available to us for treating the underlying conditions as well as the pain caused by them. Don't be put off by the idea of talking to the rep, with or without your doctor. That will give you more information with which to make nformed decision about your treatment. Good luck to you.