Alternatives to Opioids For Pain Management

In 2022, the Centers for Disease Control and Prevention (CDC) published a clinical guideline for prescribing opioids in pain management. Although opioids have been found to be effective in treating acute pain, their use comes with serious risks and potential side effects. The boxed warnings include excessive drowsiness and respiratory depression and the risk for abuse and addiction. Some recent data suggests that the U.S. opioid epidemic is abating, but it was initially fueled by misuse of prescription opioids, so it is no surprise that the CDC’s guidelines put nonopioid medications and treatments at the top of their recommendations. Clinicians are supposed to maximize the use of nonopioid medications and therapies before prescribing opioids.

Now, after over two decades with no new major advances in pain treatment, two U.S. pharmaceutical companies have stepped up in the development of nonopioid alternatives for pain management. Instead of targeting opioid they are exploring drugs that affect a sodium channel involved in signal transmission in
pain sensation. Vertex Pharmaceuticals in Boston is out in front in the drug development race with its agent, Journavx (suzetrigine). Latigo Biotherapeutics in Thousand Oaks, California, is following with its code named drugs, LTG-001 and LTG-305

Journavx

The FDA announced on Jan. 30, 2025, that it had approved Journavx as a treatment for moderate to severe acute pain adults. Journavx is an oral selective NaV1.8 pain signal inhibitor. NaV1.8 is a voltage-gated sodium channel present throughout the peripheral nervous system, including neurons of the dorsal root ganglia that transmit pain signals to the central nervous system (CNS). Because NaV1.8 is not expressed in the CNS, agents that target this pathway are not expected to produce dangerous CNS-related side effects often associated with opioids.

Journavx performed well in phase 3 clinical trials for the treatment of moderate to severe acute pain. The program included two randomized, double-blinded trials of Journavx compared with placebo following bunionectomy surgery and abdominoplasty surgery (also called “tummy tuck”). A third trial evaluated the agent’s safety and effectiveness in treating moderate to severe pain for up to 14 days in a broad range of surgical and nonsurgical conditions.

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The trials of Journavx following bunionectomy and abdominoplasty surgeries both met the primary end point of the time-weighted sum of the pain intensity difference from 0 to 48 hours compared with placebo. Journavx also showed a clinically significant reduction in pain at 48 hours from baseline as measured by the Numeric Pain Rating Scale in both trials. Neither trial met the secondary end point of superiority over the opioid pain reliever hydrocodone/acetaminophen, sold under the brand name Vicodin. In the third trial, 83% of patients rated Journavx as good, very good or excellent in pain management. The side effects of Journavx were considered mild to moderate in all three trials, and no serious events were reported.

Vertex has set Journavx’s wholesale acquisition cost price at$15.50 per tablet, which works out to $232.50 per week. In March 2025, the Institute for Clinical and Economic Review, an independent cost-effectiveness group, gave the new drug a “promising but inconclusive review.” A panel of 14 experts voted unanimously that the current evidence is not adequate to show a net health benefit of Journavx compared with oral nonsteroidal anti-inflammatory drugs.

LTG-001 and LTG-305

Latigo is also developing potential NaV1.8 blockers, provisionally called LTG-001 and LTG-305. In a phase 1 clinical trial, LTG-001 was absorbed in 1.5 hours, indicating the potential for a rapid onset of pain relief. In early March 2025, Latigo announced that the FDA had given a fast track designation to LTG-001, which, as the name suggests, can speed up the agency’s approval process