A True Alternative to Opioids for Workers’ Comp? Questions Remain

Recent FDA approval of suzetrigine, representing the first new class of pain medication in more than 20 years, is generating excitement among workers’ compensation professionals who have long been looking for a viable alternative to opioids.

Suzetrigine is an oral sodium channel blocker sold and marketed by Vertex Pharmaceuticals under the brand name Journavx. It works by selectively targeting the body’s Nav1.8 sodium channel that transmits pain signals to the brain but is not expressed in that area, thus avoiding “the reward center,” which can lead to addiction. As a result, suzetrigine has the potential to act as an additional non-addictive option for pain management. Vertex expects the medication to be available at pharmacies in March.

If suzetrigine fulfills its promise, the impact on workers’ comp could be significant. Opioids still account for the largest share of workers’ comp prescriptions due to limited pain relief alternatives, despite the industry’s efforts to reduce frequency as well as the average morphine equivalent dose (MED) prescribed.

Opioid Crisis And Lack of Good Alternatives

According to the CDC, 82,000 Americans died of opioid overdose in 2022, accounting for more than 75% of all drug overdose deaths. Prescription opioids play a large role in fueling opioid use disorder (OUD). An NIH study found that injured employees were nearly two times more likely to die of an opioid overdose than their non-injured peers. Beyond the human toll, the financial cost of treating OUD nationally is roughly $100 billion annually.

Despite these risks, there are limited FDA-approved alternatives indicated for treating moderate-to-severe pain.

True analgesics such as acetaminophen and NSAIDs such as ibuprofen are considered first-line treatment for acute pain management. Topical analgesic use has also increased, and Enlyte drug trend research found they surpassed opioids in overall workers’ comp pharmacy spend in 2023.

Unfortunately, that’s driven by an increased price point rather than overall effectiveness. Private-label topical analgesics (PLTAs) are not approved by the FDA and are not generally evaluated for compliance with applicable regulations and policies pertaining to safe and effective use. In addition, PLTAs are marketed almost exclusively to physicians for direct dispensing. Doctors can then bill payers hundreds of dollars more for a PLTA with the same active ingredients as readily available over-the-counter products such as Bengay.

Injectable therapies are also an option, however, they do not offer long-term relief and require in-office administration by a trained clinician. What’s more, the delineation of acute pain vs. chronic pain can be challenging to navigate, and when first-line therapies don’t work, opioids are often prescribed.

Is Journavx The Answer?

Suzetrigine’s approval marks a milestone in pain management as the first non-addictive alternative to opioids to hit the market in several years. Currently, it’s only approved for treating acute pain lasting up to 90 days, and physicians will likely take a stepwise approach, beginning with a first-line non-opioid analgesic before moving to suzetrigine.

Costs could also be an initial concern for those looking to suzetrigine as an opioid alternative. The average wholesale pricing for Journavx is listed at $18.60 per tablet, with a twice a day dose costing payers nearly $40 a day. That’s significantly more than the cost of a generic opioid or non-opioid analgesic dosage, which can cost as little as $1 a day.

However, proponents of Journavx argue that its short-term use and non-addictive properties will result in long-term savings over opioids. Workers’ comp often must pay for any complications caused by treatment, which includes OUD. Plus, workers who are using opioids often cannot return to work because of the sedative qualities and other side effects.

Long-Term Potential

While Journavx hasn’t been approved to treat chronic pain, Vertex has announced its plans to do so, with clinical trials currently underway. If approved, the potential to reduce the incidence of adverse outcomes related to opioid use becomes even greater.

The arrival of suzetrigine represents a potential watershed moment in pain management, particularly for the workers’ comp industry.

While its initial approval is limited to acute pain treatment lasting up to 90 days, the drug’s unique mechanism of action—blocking sodium channels rather than engaging the brain’s reward centers—could herald a new era in pain management.

The higher daily cost of Journavx compared to existing medications will undoubtedly give some pause, but when weighed against the devastating human toll and astronomical health care costs associated with opioid overdose, misuse, abuse, and use disorder, it could prove to be a comparatively cost-effective alternative.

Wilson provides clinical leadership and strategic direction as senior director of clinical pharmacy services at Enlyte. As a licensed pharmacist, she has more than 15 years of industry experience through leadership roles across prescription home delivery programs, pharmacy operations and benefit management (PBM) and clinical program development.