How New Pain Drugs May Prevention Addiction

I’m glad to learn that states are mandating insurance coverage for non-opioid pain medications. Advocates push for laws that eliminate higher copayments for non-opioids. Despite challenges, bipartisan support is growing, driven by healthcare concerns regarding opioid dependence and addiction.

This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.

Please do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with your physician or other qualified healthcare provider.

Pain Treatment: A Problem for Doctors and Patients

When I was practicing medicine, pain was one of the most difficult problems to manage. I had to balance the need to relieve a person’s pain while not creating dependence or addiction.

Sometimes patients came to me already on chronic opioids for pain. I had to decide whether to continue them or change the person to another treatment, which can be hard to do. Sometimes patients came to me requesting “something” for pain. Only by checking the state pharmacy database did I learn they were already receiving prescriptions for opiates from other physicians, sometimes several.

In my long medical career, there have been few non opiate alternatives for severe pain. So I am pleased to learn of a new drug which is exactly that. Unfortunately, its use may be limited due to cost. This article explains how states are trying to circumvent that problem.

(For the purpose of this article, consider the terms narcotic, opiate, and opioid as referring to the same type of drug.)

More states are requiring insurers to cover non-opioid pain meds

by Nada Hassanein, Oklahoma Voice
February 16, 2026

(edited for readability and clarity, no change to content)

More states are requiring their Medicaid programs and health insurance companies to cover non-opioid pain medications as an alternative to opioids, which can be cheaper for insurers but also more addictive for patients.

Advocates, providers, medical associations, and state lawmakers are pushing for parity in coverage. That means prohibiting insurers from charging higher copayments for non-opioids than they do for opioids, and barring them from requiring prior authorization or step therapy — mandating that patients try other medications first — before they will cover non-opioid drugs.

At least eight states have enacted such laws: Arkansas, Illinois, Louisiana, Maine, Massachusetts, Oklahoma, Oregon, and Tennessee. In states that are still considering legislation, the efforts have been bipartisan, pushed by lawmakers in some Democratic-controlled states, Colorado and New York, and some Republican-leaning states, Kentucky and Missouri.

The issue has gained momentum in recent years, as leading medical associations such as the American Society of Regional Anesthesia and Pain Medicine have urged providers not to prescribe opioids as the first-line treatment for pain.

Meanwhile, bipartisan legislation introduced in Congress last year aims to increase Medicaid Part D enrollees’ access to non-opioid pain medications. It’s been referred to a committee.

Dr. Patrick Giam, president of the American Society of Anesthesiologists, said the organization “believes it is important that insurance plans make non-opioid therapies as accessible to patients as opioid-based therapies.”

drugs to treat pain

The U.S. Food and Drug Administration has encouraged non-opioid pain relief alternatives.

Non-opioid pain medications include

prescription-strength non-steroid anti-inflammatory NSAIDs such as naproxen and ibuprofen,
nerve-blocking injections,
certain antidepressants,
anticonvulsant medications,
acetaminophen , such as Tylenol and other brands, and
other medications.

(affiliate links)

Opioids include

oxycodone,
codeine,
morphine and
fentanyl.

suzetrigine-Journavx

Last year, the agency approved a new drug called suzetrigine, under the brand name Journavx, the first non-opioid pain relief medication in a new class of analgesic drugs. The drug, which is available in tablets, can be prescribed for acute pain after surgery or injury. Vertex Pharmaceuticals, the manufacturer, is one of the funders of Voices for Non-Opioid Choices, which has been lobbying for the bills.

In Missouri, where GOP-sponsored legislation would prohibit insurance companies from denying coverage of a prescribed non-opioid or requiring a higher copayment for a non-opioid, the Missouri Insurance Coalition has argued that the measure would increase health care costs and effectively create “a monopoly” for Journavx. Each tablet can cost around $15 per tablet out-of-pocket. But lawmakers pointed to non-opioid alternatives.

Why non-opioids often cost more

Newer non-opioid drugs entering the market are more expensive than opioids because there isn’t yet a generic alternative, explained Sterling Elliott, an Illinois clinical pharmacist and lecturer at Northwestern University’s Feinberg School of Medicine and a board member of Voices for Non-Opioid Choices.

Generic opioids are amongst the cheapest medications that you’ll find flowing through the American pharmaceutical supply,
Sterling Elliott, clinical pharmacist

“The price is so high for a lot of things because the price for generic opioids is so low. Generic opioids are amongst the cheapest medications that you’ll find flowing through the American pharmaceutical supply,” Elliott said. “When you get a new entrant into the pain market, the marketplace factors are set up to drive the price up.”

Elliott added that some insurance plans don’t cover prescription-strength NSAIDs such as ibuprofen because they’d rather people pay out-of-pocket for lower strength, over-the-counter versions of those drugs.

In New York, Democratic Assembly member Phil Steck, the cosponsor of a bipartisan bill that hasn’t received a hearing, said challenging the insurance companies isn’t easy.

“You’re trying to tell insurers what to do,” Steck said. “Those are usually difficult undertakings. … Our experience is that the [legislature’s] insurance committee is very difficult to deal with, and so it hasn’t been pursued as much as we would like.”

Coverage of non-opioids can vary widely across insurance plans, explained clinical pharmacist Emma Murter, who co-chairs the advocacy committee of the Society of Pain and Palliative Care Pharmacists.

“There are so many [non-opioid] medications that can be used for chronic pain,” Murter said. “It isn’t gut-instinct obvious, what is and isn’t covered. It’s very Wild West, chaotic.”

When it comes to filling prescriptions, Murter said, she often has to “fight and appeal for some of these non-opioid therapies” with insurance companies.

Dima Qato, associate professor of clinical pharmacy at the University of Southern California, said non-opioid pain prescription meds are less common on insurance companies’ “preferred” drug lists. Because insurers may favor the less expensive opioids, that can result in higher copayments or consumers paying more out-of-pocket.

That was the case for Chris Fox, the Washington lobbyist who serves as executive director of Voices for Non-Opioid Choices. Fox has traveled to state capitals around the country to lobby for the bills. Recently, he had a personal experience with pain medications following oral surgery.

“For everything but the non-opioid, my out-of-pocket expectation was $0,” he said. He was charged $30 out-of-pocket for the non-opioid.

His oral surgeon wasn’t familiar with the availability of the new first-in-class non-opioid suzetrigine, Fox added. When he asked the doctor for a prescription for it, the surgeon wrote it but also prescribed an opioid along with an antibiotic.

“He prescribed me hydrocodone to go along with it, just in case, because he wasn’t as familiar with [suzetrigine],” Fox said.

Preventing addiction

As he spoke with Stateline by phone, Fox was driving to the local sheriff’s office to drop off the hydrocodone, which he didn’t take following his surgery.

“We’ve neglected the opportunity, I would say, to prevent opioid addiction where we can, which is in those patients that will develop a newly persistent opioid use pattern following exposure to an opioid that they get for medical reason,” Fox said.

Although opioid overdose deaths have declined, the drugs still kill about 200 Americans a day.

Health care professionals at hospitals also run into issues with lower reimbursement rates for some non-opioids.

Dr. Joseph Smith, an anesthesiologist at a Virginia surgical center who has practiced for three decades, pointed to a nerve-block pain pump as an example. Administering a brand-name version of the drug could cost up to $400 for all the equipment, he said. Smith, like Elliott, sits on the board of Voices for Non-Opioid Choices.

“So the hospital is like, ‘Well, I can spend $400 or I can spend 25 cents on a narcotic pill,’” Smith said.

Smith treats many young teen athletes with sports injuries. Research has shown post-surgery narcotic use can increase risk of addiction.

“My goal when I get a 14-year-old or 15-year-old in here is to never have them try a narcotic, never have them exposed to narcotics,” he said.

Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes Oklahoma Voice, and is supported by grants and a coalition of donors as a 501c(3) public charity.

It is shared here under a Creative Commons License.

Tolerance vs. Dependence vs. Addiction

Long-term use of prescription opioids, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects.

Drug dependence occurs with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug. The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug.

Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes can result in harmful behaviors by those who misuse drugs, whether prescription or illicit drugs.

Source:

NIDA. Prescription Opioids DrugFacts. National Institute on Drug Abuse website. https://nida.nih.gov/publications/drugfacts/prescription-opioids. June 1, 2021 Accessed February 19, 2026.

Images in this Post

The infographics in this post were created by the NIH, National Institutes of Health, and used with permission.

The cover photo is by Towfiqu Barbhuiya and used courtesy of Pexels.com.

Get Help with Substance Use at FindTreatment.gov

While the initial choice to use a drug is often voluntary, the powerful effects of addiction makes it very hard to stop, even if someone wants to.

When drugs or alcohol are used so often that they have significant negative effects on your life, this is called a substance use disorder.

It causes intense cravings for alcohol or drugs, and can include:

Using illegal drugs like heroin or cocaine, or excessive alcohol drinking.
Using prescription drugs in ways other than prescribed, or using someone else’s prescription.

Using drugs repeatedly changes the brain, including the parts that help exert self-control. That’s why someone may not be able to stop using drugs, even if they know the drug is causing harm, or want to stop.

FindTreatment.gov lists facilities across the country. It gives guidance on what to expect from treatment, different kinds of treatment, and how to pay for treatment.

If you live outside the United States, contact your local source of medical care or search online for substance use treatment in your country.

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Dr. Aletha

7 overused medications

What 7 drugs are overused? Find out here.

This week I discuss 7 groups of medications that are overused. This, and the next post about drugs which are underused, has many links; you may want to bookmark for future review.

medication capsules — Sometimes we need medication, but sometimes we don’t.

I call these drugs overused. However, I do not mean

That you should never take them
That you should quit using them
That your doctor should not prescribe them
That you should quit taking them if your doctor prescribed them
That they are bad or dangerous drugs

We should think more about when, why and how to use these drugs.

By drugs and medications, I consider any substance we put into our bodies to treat or prevent a disease or symptom, whether prescribed or over-the-counter (OTC), synthetic or “natural”. I’m not considering foods,nor any substance that is illegal or mostly recreational in this discussion.

I picked classes of drugs that I am most familiar with as a family physician so excluded highly specialized medications like cancer chemotherapy, cardiovascular drugs, anti-rheumatics and neurological drugs.

I based my assessment on my professional experience as well as medical literature and the opinions of other physicians. As always, your best source of information about the right drugs for your conditions is your personal physician.

Antibiotics

Every infectious disease expert says we use too many antibiotics unnecessarily-but we keep doing it. Doctors and patients share the responsibility of using antibiotics appropriately.

Reasons to avoid antibiotics

They don’t help most of the things we use them for, namely respiratory infections which are usually caused by viruses.

They add to the cost of medical care.

They frequently cause side effects; they are one of the top four causes of adverse drug reactions that lead to ER visits and hospital admission.

They can change the balance of the good bacteria that live in our bodies, the microbiome.

Here is a previous post about the use and misuse of antibiotics for respiratory infections, the most common culprit in the inappropriate antibiotic battle.

How to navigate the antibiotic highway

Opioid pain medication

These are the drugs that comprise the current opiate epidemic. Like antibiotics, they are a frequent cause for ER visits and admissions for adverse reactions. Unlike antibiotics, they can create physical and mental dependency and addiction, and can be fatal in overdose which is happening more often. The New York Times reports

Opioid poisonings increase in toddlers and teenagers

Some of the overdose deaths are accidental, especially in children, but in adolescents and adults are too often intentional.

Used properly, opiates relieve severe pain due to cancer, trauma,and surgery, but doctors and patients should consider other alternatives for less severe pain first, especially if it is a long term condition.

Dr. Sanjay Gupta, CNN medical correspondent, suggests doctors and patients work together to achieve pain relief without the risk of addiction.

“But most simply, we as doctors need to engage our patients and discuss treatment with them, whether its short term opioids or alternatives like physical and occupational therapy. We need to help set realistic expectations for our patients: Living entirely pain free is not always possible. As doctors, we need to have follow-up conversations with our patients to see how treatment is going. If we better understand our patients, we can provide better treatment and help develop pain strategies that are effective and safe.”

Talk to your doctor if you believe your use of opiate pain medication has become a problem.

Doctors must lead us out of our opioid abuse epidemic

lying woman with palm full of pills — Deaths from accidental and intentional opioid overdoses are skyrocketing.

Anti-inflammatory drugs

These are the non-steroid anti-inflammatory drugs, referred to as NSAIDs. This includes generic ibuprofen and naproxen, available in both otc and prescription strengths. ( Brand names include Motrin, Advil and Aleve.) There are other NSAIDs but these are most frequently used.

When these drugs first hit the market, we were excited to have effective drugs for people with joint pain from arthritis. Then we recognized they also worked well for headaches, menstrual pain, and other forms of muscle and joint pain.

Now they seem to have become the go-to drugs for almost any discomfort or symptom, with people taking multiple doses daily (often exceeding the recommended dose) without medical supervision.

Although usually well tolerated, they do pose risk to the kidney, heart and liver, especially in people who already have disorders of those organs. And they can cause stomach ulcers with bleeding in anyone.

Acetaminophen

The name Tylenol has become synonymous with the drug acetaminophen, although there are other brands and generic versions. Sometimes abbreviated APAP, this drug relieves pain and reduces fever, and is used frequently by adults who also give it to their children. It does not carry the risk of stomach ulcers as do the NSAIDs. However, it also can cause harm to the liver and kidney.

At this link you can

understand your OTC pain reliever options better

Sleeping medications

Many people have trouble falling asleep, staying asleep, or getting a restful sleep and turn to medications, both prescription and non-prescription for help.

Sleep specialists avoid the routine use of sleeping medications, due to lack of effectiveness long term and potential side effects and risks. They recommend altering conditions related to sleep such as bedtime, sleeping arrangements, temperature and activities, often called sleep hygiene, or mind-body interventions like meditation, hypnosis, yoga, tai chi and music.

Here is a Consumer Reports review of

Sleeping pills for insomnia

person sleeping on a couch — Sometimes getting a good night’s sleep can be a challenge.

Rescue inhalers for asthma

People use quick acting or rescue inhalers for asthma or COPD symptoms. The inhalers usually relieve symptoms promptly and if they aren’t, people may believe the inhaler “isn’t working”.

Instead, it may mean that the lungs aren’t “working” to full capacity and need more aggressive treatment. Continuing to use the inhaler repeatedly with little or no relief can be dangerous and lead to respiratory failure. Instead, you need to seek medical attention at a clinic or hospital emergency room.

This article explains

Inhaled asthma medications

Vitamins, minerals and other supplements

People spend $37 billion annually on vitamins, minerals and other supplements with little to no proof that they prevent or treat anything. Most nutrition scientists teach that appropriate eating will supply our requirements for vitamins and minerals.

Vitamins and/or minerals are recommended in some medical situations, including-

Pregnancy and nursing
People with intestinal disorders who absorb nutrients poorly
People with restricted diets for any reason
People with or at high risk of macular degeneration, a cause of blindness

Find out why

most adults don’t need dietary supplements

In a future post I will discuss non-drug alternatives to these drugs and others.

Listen to a podcast by two physicians at 2 Docs Talk

Tag: NSAIDs

How New Pain Drugs May Prevention Addiction

Pain Treatment: A Problem for Doctors and Patients