A recently licensed opioid, Abstral^®, a rapid-acting sublingual tablet of fentanyl, is different from other opioids in its complicated usage. The points to consider are; a careful titration grounded on the assessment whether the increase of base or rescue is appropriate, setting up the tentative upper limit suitable for the baseline opioid, the differentiation of the concept between the rescue dose and the additional dose, instruction to the medical stuff as well as patients and family and cost benefit balance. Taking account of these points, we recommend introducing Abstral^® in our hospital to patients who have difficulty in swallowing or other gastrointestinal function only in the wards. The palliative care team, the department of pharmacy and the division of nursing collaborated to let the medical stuff know these concerns and introduced a license system in which only those doctors who receive an intensive course on the use of Abstral^® can prescribe it. At the same time, we gave a lecture for the nurses and other medical stuff repeatedly (ten times) so as to include as many as possible. A monitoring system of Abstral^® prescription is also established in our hospital.