The Scottish Medicines Consortium (SMC) has accepted for restricted use within NHSScotland, fentanyl nasal spray (Instanyl®) for the management of breakthrough pain in adults already receiving maintenance opioid therapy for chronic cancer pain. Use should be restricted to patients who are unsuitable for other short-acting oral opioids (e.g. oral morphine) as an alternative to other buccal and sublingual fentanyl preparations.