Journavx and the Opioid Crisis: A Pharmacist’s Public Health Perspective

Obiageli Orabueze is completing her Master of Public Health at the University of Waterloo. She currently works as a clinical pharmacist, providing care to a diverse patient population, including individuals receiving opioid agonist therapy (OAT). Passionate about health equity and public health policy, she is committed to addressing the social determinants of health and advancing upstream interventions to improve community well-being.

The toxic opioid crisis continues to wreak havoc in the lives of families and communities. In response to the urgent need for safer pain management options, the U.S. Food and Drug Administration (FDA) recently approved Journavx (suzetrigine), a first-in-class non-opioid analgesic for moderate to severe acute pain in adults (FDA, 2025). 

The introduction of non-narcotic alternatives like Journavx offers a promising avenue to mitigate the opioid crisis. This article delves into the potential of such medications to transform pain management and combat opioid addiction in Canada.

The role of postoperative pain in the opioid crisis

Post-surgical pain management has long relied on opioid prescriptions to ensure patient comfort during recovery. However, this practice has inadvertently contributed to the opioid crisis, as a notable percentage of patients develop prolonged opioid use following surgery. 

A study examining opioid prescribing patterns after four common surgical procedures found that over 70% of patients in both the United States and Canada filled opioid prescriptions post-surgery (Ladha et al., 2019). In contrast, only 11% of Swedish patients did the same, highlighting significant international differences in prescribing practices (Ladha et al., 2019). A 2022 study found that approximately 6% of opioid-naïve surgical patients become persistent opioid users after receiving a prescription at surgical discharge (Fiore et al., 2022). It also found that up to 70% of opioid tablets obtained by surgical patients go unused, creating opportunities for diversion and misuse (Fiore et al., 2022). A retrospective analysis of Canadian population-based claims data found that individuals prescribed opioids within a week of a low-risk surgery had a 44% higher likelihood of prolonged opioid use within a year compared to those who were not prescribed opioids (Lawal et al., 2020). Prolonged opioid use either through prescription or illegally can result in opioid use disorder (John Hopkins Medicine, 2023). 

These statistics underscore the role that post-surgical opioid prescribing plays in the broader opioid crisis, and the likelihood that prescribing opioid-free analgesia can prevent adverse effects, enhance recovery, and help address the opioid crisis by reducing postoperative misuse, addiction and diversion (MUHC, 2022). 

Implications of Journavx for Canada’s Toxic Drug Crisis

Journavx (suzetrigine) represents a breakthrough in pain management as a non-opioid sodium channel blocker designed for moderate to severe acute pain. Unlike opioids, which bind to mu-opioid receptors in the brain, Journavx works peripherally by blocking sodium channels that relay pain signals from the peripheral nervous system to the central nervous system(Pulskamp et al., 2024). This mechanism is crucial because it does not activate the brain’s reward system, meaning it lacks the euphoric and addictive properties of opioids (Cleveland Clinic, n.d.). 

While this makes Journavx an exciting addition to the pain management landscape, it is important to manage expectations about its impact on the opioid crisis. Currently, Journavx is only approved for acute pain, meaning it is not a substitute for opioids in managing chronic pain conditions, which are a major driver of long-term opioid use and addiction (Smith, 2025). From a public health and clinical perspective, Journavx has the potential to redefine post-surgical and acute pain treatment by serving as a first-line alternative to opioids for procedures where moderate pain relief is required. It could also be a layered option with opioids to reduce the quantity prescribed while controlling pain. Journavx may significantly reduce the number of opioid-naïve patients exposed to opioids post-surgery, thereby decreasing the risk of long-term dependence. Further research is needed to determine whether Journavx or similar sodium channel blockers can be optimized for chronic pain conditions.

Drug approvals: The bottleneck in Canada

Canada's drug approval process, overseen by Health Canada, is designed to ensure that new medications are safe, effective, and of high quality before they become available to the public. This rigorous approach, while essential for public safety, often results in longer approval times compared to other countries. The median time from submission to drug approval was found to be 9 months for FDA and 12 months for Health Canada, indicating a 3-month longer process in Canada (Shaw & Wittevrongel, 2021). Not only that, after approval, it can take from 1 to 4 years for price and coverage negotiations with public and private plans to be completed prior to availability (Salek et al., 2019). 

In response to the COVID-19 pandemic, Health Canada implemented an expedited review process to assess vaccines more rapidly. This approach included rolling submissions, allowing manufacturers to submit data as it became available, and dedicating additional scientific resources to accelerate evaluations. Despite the faster timeline, the same rigorous standards for safety, efficacy, and quality were maintained (Shaw & Wittevrongel, 2021).The success of these expedited processes during the pandemic raises questions about their applicability to other pressing health crises, such as the opioid epidemic. Implementing similar fast-track mechanisms for non-opioid pain medications like Journavx could potentially address urgent public health needs more efficiently.

Regulatory Priorities: A Public Health Gap?

The U.S. Food and Drug Administration (FDA) Overdose Prevention Framework and Canada’s Drug and Substances Strategy (CDSS) differ significantly in addressing the opioid crisis, particularly regarding the approval of non-opioid analgesics like Journavx. The FDA explicitly prioritizes the advancement of evidence-based treatments for substance use disorders, which was a key driver in the expedited approval of Journavx as a safer alternative for acute pain (FDA, 2025). 

In contrast, Canada’s CDSS focuses on prevention, education, harm reduction, and enforcement, without emphasizing the development and fast-tracking of alternative pain management options (Health Canada, 2023). While the FDA’s approach proactively reduces opioid exposure at the prescribing level, Canada’s strategy is more reactive, emphasizing treatment and harm reduction after dependence has developed. Integrating non-opioid drug development and approval into Canada’s strategy could aid innovation and faster access to medications like Journavx.

What This Means for Public Health

As a pharmacist, I have observed that many patients receiving treatment for opioid addiction developed their dependence after being prescribed opioids for post-surgical pain, rather than because of social determinants of health. From a public health perspective, this highlights the need to reduce medically induced opioid dependence as a strategy to ease the burden of opioid use disorder. Incorporating non-opioid alternatives like Journavx into pain management protocols can help prevent the initial exposure to opioids, thereby reducing the risk of misuse and addiction. 

However, it's important to recognize that opioid addiction is a multifaceted issue, deeply intertwined with social determinants of health such as socioeconomic status, education, and access to healthcare. Addressing these underlying factors is crucial for a comprehensive solution to the opioid epidemic.

Call to Action

Canada’s approach to the opioid crisis must evolve to include proactive solutions that prevent opioid dependence before it begins. While harm reduction and treatment remain essential, public health strategies must also encourage safer pain management alternatives. The FDA’s expedited approval of Journavx demonstrates that regulatory bodies can support innovation in non-opioid therapies, even while Canada’s approval system remains slow and reactive. Health Canada should adopt a fast-track process for non-opioid pain medications, just as it did for COVID-19 vaccines. 

Public health professionals must advocate for faster regulatory pathways, ensuring that innovative treatments are accessible and integrated into pain management protocols, helping reduce the burden of opioid misuse and dependence across Canada.

References

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