On February 8th, 2016, Massachusetts Senator Elizabeth Warren sent a letter to Dr. Thomas Frieden, the Director of the Center for Disease Control and Prevention (CDC). In this letter, Senator Warren addresses the opioid epidemic that is sweeping our nation, and asks for the CDC to continue aggressive pursuit of a solution.

Cannabis as an Alternative to Opioids for Chronic and Acute Pain

Cannabis as an Alternative to Opioids for Chronic and Acute Pain

The increase in opioid addiction and unintentional overdoses has spiked in recent years, and in this letter, Senator Warren calls for the CDC to consider alternative solutions to opioids for chronic and acute pain. The letter was also sent to the acting directors of the National Institute of Health, the Substance Abuse and Mental Health Services Administration, and the Drug Enforcement Administration.

Senator Warren’s most notable suggestion is for a rapid increase in researching the benefits of medical cannabis as an alternative to the destructiveness of opioid abuse. CBD and THC have appeared to be efficacious in previous clinical studies. A few examples of these clinical studies:

Senator Warren’s letter was originally published at http://www.warren.senate.gov.

Full Letter from Senator Elizabeth Warren, February 8th, 2016

Dear Dr. Frieden,

As you know, our country is faced with an opioid epidemic that only continues to grow at an alarming pace. I continue to hear stories from constituents across Massachusetts affected by this crisis – parents fighting for their kids, doctors fighting for their patients, and communities fighting for each other.

According to the Massachusetts Department of Public Health, there were almost 1,100 confirmed cases of unintentional opioid overdose deaths in 2014 – a 65% increase from 2012. This 2014 estimate is the highest ever in Massachusetts history.[1] Opioid abuse is a national concern and warrants swift and immediate action.

Prescription painkillers are at the center of this epidemic. According to the National Institutes on Drug Abuse (NIDA),  the U.S. remains the largest consumer in the world. Despite accounting for only 5% of the global population, Americans consume 75% of prescription opioid medications in the world.[2]

In 2013, the U.S. Centers for Medicare & Medicaid Services reported that more hydrocodone acetaminophen (trade name Vicodin) was prescribed to Medicare beneficiaries than any other drug.[3] 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.

I applaud the Centers for Disease Control and Prevention (CDC) for the actions it has taken to study the epidemiology of this public health crisis, support the ongoing work conducted in states, and provide guidelines to prescribers on the use of painkillers for chronic pain treatment.

These guidelines are aggressive and provide much-needed direction for primary care physicians treating chronic pain while making clear that there are certain circumstances for which opioid prescriptions are appropriate. The guidelines are an important step in combatting this epidemic, much like those issued by the Massachusetts Medical Society, which also provide prescribing guidance for patients with chronic pain, as well as acute pain.

As with the draft CDC guidelines, there is an emphasis on determining when to continue opioid use and assessing appropriate durations of such prescriptions. I strongly urge you to finalize the CDC Guidelines for Prescribing Opioids for Chronic Pain as soon as possible to inform stakeholders and lead to further collaborative and informative discussions about additional ways to help prescribers combat the opioid epidemic.

Additionally, I hope that the CDC continues to explore every opportunity and tool available to work with states and other federal agencies on ways to tackle the opioid epidemic and collect information about alternative pain relief options. Your agency has produced an enormous amount of scientific and epidemiological data that has helped to inform stakeholders on the breadth of this crisis – however there is still much that we don’t know. I encourage the CDC to collaborate with the National Institutes of Health, the Substance Abuse and Mental Health Services Administration, and the Drug Enforcement Administration to fill the gap in our knowledge about:

  1. the long term impact that opioids have on children treated at a young age;
  2. the use, uptake, and effectiveness of medical marijuana as an alternative to opioids for pain treatment in states where it is legal;
  3. the impact of the legalization of medical and recreational marijuana on opioid overdose deaths;
  4. the increased use of fentanyl, including its sources;
  5. how fentanyl may be contributing to opioid overdoes and deaths.

Fighting this epidemic will take hard work on the part of federal, state, and local governments working together with local law enforcement, medical professionals, and members of the community. I appreciate the work that the CDC has done and ask that you continue to work collaboratively with stakeholders to finalize the Prescribing Guidelines without further delay and identify other ways to aggressively tackle this issue.


Elizabeth Warren, U.S. Senator (Massachusetts)

CC: Dr. Francis S. Collins, Director of the National Institutes of Health
CC: Ms. Kana Enomoto, Acting Administrator of the Substance Abuse and Mental Health Services Administration
CC: Mr. Chuck Rosenberg, Acting Administrator of the Drug Enforcement Administration

[1] http://www.mass.gov/eohhs/docs/dph/quality/drugcontrol/county-level-pmp/data-brief-overdose-deaths-ma-residents-january-2016.pdf
[2] https://www.drugabuse.gov/related-topics/trends-statistics/infographics/popping-pills-prescription-drug-abuse-in-america
[3] https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-04-30.html

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