The FDA on Thursday required new safety label updates for all opioids to “further emphasize and characterize the risks associated with long-term use,” following a May advisory committee meeting that discussed new postmarketing data.
Specifically, the FDA told companies to pull the phrase “extended treatment period” in the Indications and Usage section of their labels, “to avoid misinterpretation that there are data to support safety and efficacy of opioid analgesics over an indefinitely long duration.”
The updates also clarify that extended-release/long-acting opioids “should only be used” when alternatives, such as immediate-release opioids, “are inadequate to manage severe and persistent pain, and to emphasize the importance of avoiding rapid dose reduction or abrupt discontinuation in patients who may be physically dependent on opioid pain medicines,” the agency
said in the update
.
In May, panelists on an FDA advisory committee
offered mixed takes
on whether the agency should update opioid labels with data from two required postmarketing studies. Some panelists found the studies’ findings difficult to interpret and not generalizable to current medical practice, since they were several years old.
The FDA opted to add that information to the labels, which shows that over a 12-month period, approximately 1% to 6% of participants across the two postmarket groups newly met the criteria for addiction, and about 9% to 22% of participants newly met criteria for prescription opioid abuse and misuse.
The FDA first approved extended-release/long-acting opioids in 1987. In 2013, it sought five additional postmarketing studies after concluding that more data were needed regarding the serious risks of misuse, abuse, addiction, overdose and death associated with long-term use.
Allergan, Endo Pharmaceuticals, Hikma, Janssen, Mallinckrodt, Pfizer and Purdue Pharma were among those tasked with conducting the four observational studies and one prospective clinical trial.
The agency also said it’s requiring label updates on which opioid overdose reversal agents are currently available. The FDA in March 2023 approved the first over-the-counter nasal spray version of naloxone, and in August 2024, FDA approved the first nalmefene hydrochloride auto-injector to treat opioid overdose in adults and children 12 years and older.
Manufacturers must further “emphasize that higher doses are associated with increased risk of serious harm, and that the risks of serious harms persist over the course of therapy,” the FDA said.