Senator Warren Pushes for Medical Marijuana Research
The war on pain has led to a new awareness of the undertreatment of pain, yet as opioid prescriptions almost doubled in the last decade,1 a harsh light has been cast on the rise in drug misuse, abuse, addiction, overdose, and death.2
In 2013, nearly 2 million Americans aged 12 or older either abused or were dependent on opioid drugs, according to the Centers for Disease Control and Prevention (CDC).3 In that same year, more than 16,000 Americans died from overdoses related to prescription opioid drugs.3
These are some of the many concerning statistics that have highlighted an unsettling problem in the US, where excessive opioid prescribing and escalating opioid abuse and deaths are prompting government agencies, including the Food and Drug Administration, and lawmakers to call for action.
The CDC recently announced plans to draft a guideline on prescribing opioids for chronic pain. The guidelines, which will be intended for patients 18 or older, will include a number of clinical practices, including:
- Prescribing opioids for chronic pain outside of end-of-life care
- Dosing considerations
- Fixing proper duration of treatment for acute and chronic pain conditions
- Facilitating discussion with patients of risks and benefits
- Selecting opioid therapies and also non-pharmacologic/non-opioid pharmacologic therapies
The guidelines also reportedly will cover follow-up and discontinuation of opioid therapy (weaning), review of prescription drug monitoring program data, use of urine drug testing, use of opioids and benzodiazepines, arrangement of treatment for opioid use disorder, and other important areas.3
Massachusetts Senator Elizabeth Warren commended the CDC for their plan to build a consensus guideline on this topic, stating in a letter to Thomas Frieden, MD, MPH, director of the CDC, that “the guidelines are an important step.”
“Prescribers – specifically those in primary care settings – are truly on the front lines and have the ability to stem the tide of this growing epidemic,” Sen. Warren wrote. Indeed, primary care physicians (PCP) have reported opioid abuse to be “big” problems for the communities in which they practice and have expressed discomfort over prescribing the drugs for chronic noncancer pain (CNCP) conditions.
However, while Sen. Warren commended the CDC for the guideline, she also stressed the importance of collaborating with the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, and Drug Enforcement Administration to investigate other important topics, such as the use of medical marijuana (MM) as an alternative form of pain management.
Medical Marijuana – Promising Yet Contested
Sen. Warren recommended further research be done to explore the efficacy of MM, studies which can be conducted in the 23 states where MM is currently legal, including Massachusetts, New York, and DC. Such studies already have begun to expound the legitimate benefits of MM as a form of pain management for a number of cancer and noncancer conditions.
Patients have reported better pain management taking MM with their opioids as opposed to opioids alone.4 Practitioners note that marijuana may be less addictive, which may make it a more favorable choice over opioid agents. There even may be anti-inflammatory benefits from activating cannabinoid receptors in the body.5
However, marijuana’s issues with legality, especially with the discrepancy between the state and federal jurisdictions, still impose a barrier to facilitating research and development into the substance’s clinical and biomedical prospects.
The Rohrabacker-Farr amendment (H.R. 83, Sec. 538) 6 passed by Congress at the end of 2015 did ease restrictions on medical marijuana research.7 Yet some claim the amendment will do little to prevent the Department of Justice (DOJ) from using federal funds to prosecute MM users and providers, rendering the legislation more of a theoretical shift, rather than a practical change.
Senator Warren also in her letter urged the CDC to explore “the impact of the legalization of medical and recreational marijuana on opioid overdose deaths.” Interestingly, some research already has explored this topic, finding that states with MM had lower annual opioid overdose death rates by 24.8%.8
Other Issues: Pediatric Opioid Use and Physician Opioid Training
Sen. Warren also urged the CDC to look more into the long term effects that opioids may have on children treated at a young age. Unfortunately, this is a topic the proposed guidelines will not cover since they apply only to patients 18 years or older.
The topic of pediatric opioid use is a significant one, though. Research on pediatric opioid use, in general, is scant. Still, this did not stop the FDA from approving the use of OxyContin in pediatric patients last August. And yet this month, the FDA also released its own initiatives for combating the opioid abuse epidemic, including an intention to assemble a Pediatric Advisory Committee specifically for approving any new pediatric opioid labeling in the future.
Sen. Warren also mentioned the contested topic of fentanyl, a powerful synthetic opiate analgesic superior in potency to morphine, which she believes deserves more attention, particularly its possible contribution to opioid overdoses and deaths. Current status quo of pain management training for medical students also may require reform, as the current allotted teaching time to the subject is noticeably inefficient, according to experts.
More information about the CDC’s guideline, including the content, methodology, and scope of the guidelines, can be found here.