Will Journavx Lead to Medical Board Actions Against Doctors?

In 2018, the FDA approved Lucemyra (lofexidine hydrochloride) to mitigate withdrawal symptoms for abrupt opioid discontinuation in adults. Lucemyra, approved for up to 14 days, is not a treatment for opioid use disorder (OUD) but can be part of a broader OUD management plan.  The medical board has asked physicians why have not been tapering opiate users?  Why have you not used Lucemyra to assist in the tapering process.  The same types of questions are asked about Buprenorphine (Subutex).   

On January 30, 2025, the FDA approved Journavx (suzetrigine) 50 mg oral tablets, a first-in-class non-opioid analgesic for moderate to severe acute pain in adults. Journavx targets a pain-signaling pathway involving sodium channels in the peripheral nervous system, preventing pain signals from reaching the brain. It is the first drug in this new class of pain management medicines.

In 2023, the Medical Board of California revised its pain control guidelines, emphasizing patient access to safe and effective pain management while supporting physicians. The guidelines encourage customized treatment plans and do not replace a physician’s clinical judgment.

However, the board has prosecuted doctors for "old school" opiate prescription practices, demanding tapering and calculating morphine equivalents based on board experts rather than individual patient needs. Patients are contacted directly, and physicians' practices can be ruined.

With Journavx, opioid prescriptions will be closely scrutinized. The effectiveness of combining opioids with Journavx or its response in patients with significant opioid use remains uncertain.

Beware also of potentiation abuse.  Soma and opiates create a different "high".  So users will even use Benadryl to potentiate opioids.  However, what is the function of Journavx as a potentiator?  We don't know but addicts will know very quickly.  As you prescribe Journavx thinking you are safe from medical board inquiry you might not be if your patient (or multiple patients - beware an influx of new patients qualifying for a new drug) is using the drug as a potentiator.

 Pain management doctors, orthopedists, and others should beware. Tapering and substitution are key to avoiding medical board intervention. Detailed notes are essential if tapering or Journavx is inadequate.

The Horowitz office specializes in representing physicians in board actions, applying science and evidence to counter political forces that interfere with independent medical judgment.

FDA Approvals:

• Lucemyra (2018):

  • Approved for mitigating withdrawal symptoms during abrupt opioid discontinuation in adults.

  • Not a treatment for opioid use disorder (OUD), but can be part of a broader OUD management plan.

  • Approved for up to 14 days of treatment.

• Journavx (2025):

  • Approved as a first-in-class non-opioid analgesic for moderate to severe acute pain in adults.

  • Targets a pain-signaling pathway involving sodium channels in the peripheral nervous system.

  • First drug in this new class of pain management medicines.

Medical Board of California Guidelines (2023):

• Emphasize patient access to safe and effective pain management.

• Support physicians in providing treatment to pain patients.

• Encourage customized treatment plans.

• Do not replace a physician’s clinical judgment.

Concerns:

• The board has prosecuted doctors for "old school" opiate prescription practices.

• Demands tapering and calculates morphine equivalents based on board experts, not individual patient needs.

• Patients are contacted directly, and physicians' practices can be ruined.

Journavx Scrutiny:

• Opioid prescriptions will be closely scrutinized.

• Uncertainty about combining opioids with Journavx or its response in patients with significant opioid use.

Advice for Doctors:

• Tapering and substitution are key to avoiding medical board intervention.

• Detailed notes are essential if tapering or Journavx is inadequate.