What You Should Know:
– The U.S. Food and Drug Administration (FDA) is requiring safety labeling changes to all opioid pain medications to better emphasize and explain the risks associated with their long-term use.
– The decision follows a public advisory committee meeting in May that reviewed data showing serious risks, including misuse, addiction, and both fatal and non-fatal overdoses, for patients who use opioids over long periods.
Evidence-Based Decision-Making
The FDA’s decision to require new labeling reflects robust data from two large, FDA-required observational studies (PMR 3033-1 and 3033-2) that recently provided new information on how long-term opioid use can lead to serious side effects. The agency also reviewed public comments and medical research and recognized the absence of adequate and well-controlled studies on long-term opioid effectiveness.
Tragically, the initial new drug application for OxyContin was approved without study data supporting its long-term use to treat pain in many patient populations for which it has been prescribed. To prevent similar issues in the future, the FDA has required an additional prospective, randomized, controlled clinical trial to directly examine the benefits and risks of long-term opioid use. The agency will be closely monitoring this trial to ensure its timely completion.
Summary of New Labeling Changes
The required labeling changes aim to help healthcare professionals and patients make treatment decisions rooted in the latest evidence and include the following updates:
- Clearer Risk Information: A summary of study results will be added, showing the estimated risks of addiction, misuse, and overdose during long-term use.
- Dosing Warnings: Stronger warnings will be included to emphasize that higher doses come with greater risks that persist over time.
- Clarified Use Limits: Language that could be misinterpreted to support using opioid pain medications for an indefinitely long duration will be removed.
- Treatment Guidance: Labels will reinforce that long-acting or extended-release opioids should only be considered when other treatments, including shorter-acting opioids, are inadequate.
- Safe Discontinuation: A reminder will be included not to stop opioids suddenly in patients who may be physically dependent, as this can cause serious harm.
- Overdose Reversal Agents: Additional information on medicines that can reverse an opioid overdose will be provided.
- Drug Interactions: An enhanced warning about combining opioids with other drugs that slow down the nervous system will now include gabapentinoids.
- More Risks with Overdose: New information about toxic leukoencephalopathy—a serious brain condition that may occur after an overdose—will be included.
The FDA has sent letters to the relevant applicants outlining the required changes. The companies will have 30 days to submit their labeling updates to the FDA for review.
“The death of almost one million Americans during the opioid epidemic has been one of the cardinal failures of the public health establishment,” said FDA Commissioner Marty Makary, M.D., M.P.H. “This long-overdue labeling change is only part of what needs to be done — we also need to modernize our approval processes and post-market monitoring so that nothing like this ever happens again.”
HHS Secretary Robert F. Kennedy, Jr. added, “Today’s FDA action is a long-overdue step toward restoring honesty, accountability, and transparency to a system that betrayed the American people.”
