Is Journavx a Step Forward In Pain Management or a Repeat of Past Mistakes?

While the approval of Journavx (suzetrigine) has gained much positivity in non-opioid pain management, former FDA medical officer in the division of psychiatry, Josef Witt-Doerring, M.D., warns that history has shown new pain drugs tend to come with unexpected challenges, and without a bigger change in how we approach pain treatment, we could risk repeating past mistakes.

FDA-approved in January, Vertex Pharmaceuticals Incorporated’s Journavx, a first-in-class non-opioid medication for treating moderate to severe acute pain in adults, is used twice daily and offered as an alternative to opioids for patients experiencing acute pain.

This is the first new class of pain medicine approved in more than 20 years.

In the Q&A below, Witt-Doerring, the founder and CEO of TaperClinic, a virtual program dedicated to safe, personalized psychiatric drug tapering, shares the pros and cons of the alternative non-opioid pain medication, expressing that while it could help cut down on opioid use, its long-term impact is unclear.

Josef Witt-Doerring, M.D.

The Q&A has been edited for length and clarity.

MHE: What are your thoughts on Journavx’s approval?

Witt-Doerring: It’s definitely a step forward that Journavx isn’t an opioid—we need better options that don’t carry the same risk of addiction. But just because it’s non-opioid doesn’t mean it’s without problems.

It works on the NaV1.8 sodium channel, which is new territory, and while early trials look promising, we’ve seen this kind of hype before. There’s no long-term data yet, so we have no idea how this will perform in real-world settings. My guess is tolerance will show up, as it usually does with pain medications. Long-term safety is also a big question mark.

Related: FDA Approves Journavx, New Nonopioid Med, for Acute Pain

Historically, we tend to get excited about new pain meds and then realize a few years in that the picture is more complicated.

MHE: Do you see Journavx as a potential game-changer in pain management, particularly in reducing opioid dependence? What will determine its success in clinical practice?

Witt-Doerring: Calling any new pain drug a “game-changer” right out of the gate is premature. Journavx might help reduce opioid prescribing in some post-op or acute pain situations, which is good—but it’s not going to fix the larger systemic issues in pain management.

If this gets heavily prescribed, we need to be honest that tolerance will probably limit its usefulness long-term—the same story we’ve seen with other classes of analgesics. Whether or not it succeeds depends less on the drug itself and more on how it’s used. If doctors treat it like a one-stop shop for pain management, we’ll end up in the same spot we did with opioids.

This drug needs to be part of a bigger, more balanced pain strategy—one that includes non-drug approaches.

MHE: From your perspective, what challenges might physicians and patients face when transitioning from opioids to non-opioid alternatives like Journavx?

Witt-Doerring: The biggest challenge is expectations. Patients who’ve used opioids might not feel like Journavx is doing much—despite trial data showing that it reduces pain similarly to low doses of opioids. That’s because opioids don’t just dull pain—they also reduce anxiety and create a calming, sometimes euphoric effect, which many patients find appealing.

A drug like Journavx that doesn’t produce those same subjective effects might be less addictive, but it also means some patients won’t feel as satisfied with it.

Physicians still navigating the fallout from the last decade of opioid-related scandals may feel relieved to reach for Journavx as the new “safe” option. But that kind of automatic, box-checking mindset is exactly what led to the overprescribing of gabapentin off-label.

If Journavx is going to be a greater benefit than harm to the public, it has to be implemented alongside non-drug pain strategies. Otherwise, we risk falling into the same pattern—just with a different drug.

MHE: What best practices would you recommend for safely discontinuing opioid medications and encouraging the adoption of non-opioid therapies?

Witt-Doerring: Safe opioid discontinuation should be slow, patient-led and supported by non-drug pain tools like anti-inflammatory diets, physical rehab and mental health support.

Throwing a new drug like Journavx into the mix might help some people, but it’s not a substitute for addressing the bigger picture of what’s driving the pain and providing patients with more sustainable and safer non-drug approaches.

MHE: How do you think the approval of Journavx reflects how the FDA and the healthcare industry approach pain management and addiction prevention?

Witt-Doerring: It shows the FDA is trying to move beyond opioids, which is a good thing. But we’ve got to be careful not to repeat old mistakes.

There’s a familiar pattern: a new drug gets a big PR push, becomes widely prescribed, and a few years later the downsides start to emerge. With Journavx, that could mean tolerance, unforeseen side effects or off-label overuse.

The deeper issue is that we have a very transactional healthcare system, where medications are often the most satisfying—at least in the short term—and the easiest option in the limited time doctors have with patients.

Real progress will come when we can judiciously combine new therapeutics with evidence-based non-drug approaches to pain management.