FDA Requires Major Changes to Opioid Pain Medical Labeling

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 changes follow a public advisory committee meeting in May that reviewed data showing serious risks — such as misuse, addiction and both fatal and non-fatal overdoses — for patients who use opioids over long periods.

The updated labeling change reflects robust data from two large FDA-required observational studies, called postmarketing requirements (PMR) 3033-1 and 3033-2, which recently provided new data on how long-term opioid use can lead to serious side effects. After reviewing those results, public comments, medical research and recognizing the absence of adequate and well-controlled studies on long-term opioid effectiveness, FDA decided to require safety labeling changes to help healthcare professionals and patients make treatment decisions rooted in the latest evidence.

The labeling changes will include the following updates:

• Clearer risk information: A summary of study results showing the estimated risks of addiction, misuse and overdose during long-term use.

• Dosing warnings: Stronger warnings that higher doses come with greater risks, and that those risks remain over time.

• Clarified use limits: Removing language that could be misinterpreted to support using opioid pain medications over indefinitely long duration.

• 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 not to stop opioids suddenly in patients who may be physically dependent, as it can cause serious harm.

• Overdose reversal agents: Additional information on medicines that can reverse an opioid overdose.

• Drug interactions: Enhanced warning about combining opioids with other drugs that slow down the nervous system — now including gabapentinoids.

• More risks with overdose: New information about toxic leukoencephalopathy—a serious brain condition that may occur after an overdose.

• Digestive health: Updates about opioid-related problems with the esophagus.

FDA has also required an additional prospective, randomized, controlled clinical trial to directly examine the benefits and risks of long-term opioid use, and will be closely monitoring the progress of the clinical trial to ensure its timely completion.