People in acute pain might be relieved to know that the federal Food and Drug Administration (FDA) recently approved Journavx, a novel painkiller that aspires to be a safer, yet powerful alternative to potentially addictive opioids which have contributed to more than one million American overdose deaths since 1999.
Opioids like oxycodone (OxyContin) and hydrocodone (Vicodin) block pain signals by stimulating opioid receptors in the brain, but this first-in-class painkiller stops nerve pulses from even getting to the brain by blocking a sodium channel near the pain site called NaV1.8.
The new drug - known generically as suzetrigine - targets moderate-to-severe short-term pain – the type usually associated with an accident, injury or surgery - when over-the-counter pain relievers like ibuprofen or acetaminophen aren’t enough. It’s not designed for chronic pain that lasts longer than three months.
To be taken twice daily, Journavx will cost $15.50 per pill when it hits the market – far more than generic opioids that run about a few bucks each – so it’s unclear whether insurance companies will cover this more expensive option.
That likelihood, however, will probably increase if their bean-counters do the math.
Boston-based drugmaker Vertex Pharmaceuticals points out that over 80 million Americans are treated for acute pain each year and despite well-known warnings about addiction, about half of those people are prescribed an opioid. Without other good pain management options, nearly 10% continue to use opioids for longer than three months, and about 85,000 patients a year develop an opioid use disorder (OUD).
For those who need help getting off opioids, the tab for outpatient drug treatment is generally upwards of $8,000, and inpatient rehab stays average more than $50,000 nationwide. Addiction can be a chronic re-occurring disease and it’s not uncommon to require more than one round of treatment.
Opioid prescriptions have steadily dropped since 2010, yet the National Institutes of Health (NIH) says that more than 9 million Americans over the age of 12 misused opioids in the past year, and more than 5.5 million live with an opioid use disorder. Despite a recent decline in fatalities, 100,000 Americans are dying annually from drug overdoses or poisonings, and 75% of those deaths involve opioids – mostly synthetic opioids like fentanyl obtained on the street or online.
People are still hurting.
Journavx and emergent drugs in this new class will give acute pain patients another treatment option and potentially mitigate opioid risks, but won’t help the fifty million U.S. adults who live with longer-term chronic pain, half of whom struggle with severe pain every day. Nearly 20 million Americans suffer from pain that interferes with their daily lives, putting them at risk for depression, suicide and substance use.
Dr. Bruce Silber, a chiropractor at Massapequa Pain Management and past President of the New York State Chiropractic Association is hopeful that Journavx will give prescribers and patients another tool, but recalls the hype when OxyContin came to market in the 1990’s and urges a back to basics approach.
“Pain is one of the most common reasons for a visit to the doctor’s office,” he says, but it’s also a normal phenomenon that “alerts the body that something is wrong.”
Pain needs to be thoroughly investigated, he says and “when it cannot be controlled by nonpharmacological means, such as chiropractic treatment, physical therapy modalities, massage, acupuncture, etc. then an effective pharmacological approach should be considered.”
As $50 billion in opioid lawsuit settlement payments are being deployed to clean up the mess nationwide, addiction treatment expert Claudia Ragni, who founded and runs the Kenneth Peters Center for Recovery is also taking a wait and see attitude, especially for folks in recovery who can’t take opioids.
“Doctors need to prescribe carefully and thoughtfully,” she cautions. “We, as addiction professionals should not automatically recommend this drug until we have more experience and information.”
Bottom line she says, “comprehensive treatment of chronic pain involves a physical, emotional and spiritual approach” and “there will never be a magic bullet for pain elimination.”
A version of this article appeared on Innovate LI.