Purdue Pharma closed its doors this month after agreeing to a multi-billion-dollar settlement that resolved claims tied to its role in the nation’s massive opioid crisis. But the road to developing new pain drugs to replace opioids has proven long.
Vertex Pharmaceuticals scored the first major victory toward this goal last year when it gained approval for Journavx, the first novel pain medicine approved by the FDA in decades.
“It was a massive win for the space,” said James Hackworth, chief business officer at Tris Pharma, a clinical stage company developing treatments for ADHD, narcolepsy and several types of pain. “From our perspective, it’s a good drug. It has a real niche.”
But Journavx hasn’t seen the instant runaway success many analysts were anticipating. While prescriptions for the drug surpassed 1 million in April, sales fell short of initial sales projections of $110 million in 2025 when it brought in nearly $60 million.
The company has since ramped up its sales efforts and embarked on a major marketing campaign. It’s also hoping to expand into what could be a more lucrative market in chronic pain. After facing a setback in this area when it fell short in a mid-stage sciatica study, Vertex’s prospects in this arena could partly hinge on the results of a late-stage clinical trial for a type of neuropathy that will conclude in May 2027.
Journavx also doesn’t fully close the gap for patients seeking non-addictive pain relief, Hackworth said. Initially heralded as an opioid replacement, the drug’s efficacy profile has made that a challenging proposition.
“The hope is that drugs like oxycodone and morphine can fade to the background and be used as a last resort."
James Hackworth
Chief business officer, Tris Pharma
Specifically, Journavx targets a sodium channel called NaV1.8, which has turned out to be a less potent pathway than opioids work on when it comes to pain relief. Some doctors have reported using Journavx as an add-on instead of a substitute for opioids, he said, which doesn’t eliminate addiction risk. While the number of overdoses has dropped substantially nationwide they still affect tens of thousands annually.
In addition, many patients fearing addiction won’t take opioids when recommended, which can delay recovery or create nervous system problems that can lead to chronic pain, Hackworth added.
Rising alternatives in pain
Tris is one of the companies looking to fill that void with its drug cebranopadol, a modified opioid designed to reduce addiction potential. The drug, a dual NOP/MOP receptor agonist, essentially targets the same anti-pain mechanism of an opioid along with another receptor that inhibits the production of dopamine, which can drive addiction. The treatment could provide a critical addition to the acute pain space if it proves to be as effective as an opioid, Hackworth said. Early studies also indicated that abruptly discontinuing the drug did not appear to trigger withdrawal symptoms typically associated with opioids, according to Hackworth.
And because the drug could block the effects of narcotics, it’s also in early-stage development as an addiction treatment.
But right now, the company is focused on its FDA submission in acute pain later this year to lay the groundwork for a potential 2027 approval.
Tris is also conducting mid-stage trials for chronic pain — an indication that could provide the largest returns. But Hackworth sees significant market potential in the acute pain space, and the company plans to determine what subsets of acute pain could be the best fit for the drug.
“Our target is going after opioids. So, when we come to market, our message to doctors will be this drug is here, you can now stop using oxycodone and use this instead,” he said.
Several other companies are also developing new pain drugs, the bulk of them in early stages. Many are looking to beat the pain-fighting effects of Journavx by targeting alternate ion channels or combining drugs to hit different channels simultaneously. These include Xenon Pharmaceuticals, Latigo Biotherapeutics and SiteOne, which Eli Lilly recently announced plans to acquire in an all-cash deal valued up to $1 billion including milestone payments.
The ultimate goal of the space, Hackworth said, is to replace opioids altogether.
“The hope is that drugs like oxycodone and morphine can fade to the background and be used as a last resort,” Hackworth said.
