A bipartisan group of eight U.S. senators has introduced an update to the Comprehensive Addiction and Recovery Act, which became law in 2016. Among its provisions, CARA 2.0 would authorize $1 billion in dedicated resources for evidence-based prevention, enforcement, treatment, and recovery programs.
CARA 2.0 would make the following policy changes:
- Three-day limit on initial opioid prescriptions for acute pain as recommended by the Centers for Disease Control and Prevention (CDC).
- Makes permanent Section 303 of CARA which allows physician assistants and nurse practitioners to prescribe buprenorphine under the direction of a qualified physician.
- Allows states to waive the limit on the number of patients a physician can treat with buprenorphine so long as they follow evidence-based guidelines. There is currently a cap of 100 patients per physician.
- Require physicians and pharmacists use their state prescription drug monitoring program (PDMP) upon prescribing or dispensing opioids.
- Increases civil and criminal penalties for opioid manufacturers that fail to report suspicious orders for opioids or fail to maintain effective controls against diversion of opioids.
- Creates a national standard for recovery residences to ensure quality housing for individuals in long-term recovery.
CARA 2.0 would authorize:
- $10 million to fund a National Education Campaign on the dangers of prescription opioid misuse, heroin, and lethal fentanyl.
- $300 million to expand first responder training and access to naloxone.
- $300 million to expand evidence-based medication-assisted treatment (MAT).
- $20 million to expand Veterans Treatment Courts.
- $100 million to expand treatment for pregnant and postpartum women, including facilities that allow children to reside with their mothers.
- $60 million to help states develop an Infant Plan of Safe Care to assist states, hospitals and social services to report, track and assist newborns exposed to substances and their families.
- $10 million for a National Youth Recovery Initiative to develop, support, and maintain youth recovery support services.
- $200 million to build a national infrastructure for recovery support services to help individuals move successfully from treatment into long-term recovery.
“While CARA’s evidence-based programs were funded at $267 million for FY 2017, there is bipartisan agreement that more resources will be necessary to help turn the tide of this epidemic,” Portman said in a statement.
The Trump Administration’s FY 2019 budget includes $17 billion in resources to combat the opioid epidemic. In addition, the bipartisan congressional budget deal includes $6 billion in additional resources for FYs 2018-2019.
“We know from researchers, the law enforcement community and treatment providers that the most effective way to address the challenges posed by addiction is to initiate a comprehensive response to the twin epidemics of opioid and heroin addiction, utilizing evidenced-based programs that work,” Portman said.
The House Energy and Commerce Committee considered eight bills related to the opioid crisis ranging from making telemedicine more available in rural areas to disposal of unused drugs in homes, according to Mark Dunn, director of public policy for the National Association of Addiction Treatment Providers (NAATP). “While no action was taken, we anticipate more to come in the weeks ahead,” Dunn said.
Dunn believes one of the more significant new provisions in the bill is the requirement for the Department of Health and Human Services to develop best practices for recovery residences. “If enacted, it would be the first attempt to address some of the treatment quality issues at the federal level, similar to the work NAATP is promoting through its Quality Assurance Initiative,” he said.