Comprehensive Addiction and Recovery Act: Addressing Opioid Crisis
Following the July 13 U.S. Senate's passage of Comprehensive Addiction and Recovery Act (CARA), providers, families and communities should evaluate the act's impacts. The reform, S. 524, is viewed as a comprehensive approach to expand education, prevention and treatment of opioid abuse.
The act passed by a vote of 92 to 2 following the House's passage of the bill the preceding week by a vote of 407 to 5. The bill now heads to the President's desk for signature. The compromise bill was approved by conferees from both the U.S. House and Senate who worked together to resolve differences between versions passed in each chamber earlier in the Congressional session.
The passage of CARA means:
Grants to states and the Substance Abuse and Mental Health Services Administration (SAMHSA) to address opioid abuse and expand on state prescription drug monitoring programs (PDMPs)
Authorization for collaboration between the Centers for Medicare & Medicaid Services (CMS/HHS) and prescription drug plans, as well as private health plans, to monitor and curb opioid misuse
Raising the number of patients healthcare provider may prescribe buprenorphine to from 100-275. Buprenorphine is a medication used to treat opioid addiction. This may help as many as 90,000 more patients annually.
$181 million a year for discretionary spending for various program funding
Opioid abuse has come to the forefront as a serious public health issue. In fact, drug overdoses are now the leading cause of death in the United States, ahead of motor vehicle accidents and firearms1. On October 21, 2015, President Obama announced that his administration and the private sector would work together to address opioid abuse, focusing specifically on prescription drug and heroin abuse. During his announcement, the President recommended prescriber training for health care professionals and improving access to care and treatment. This year, the Administration also included an additional $1.1 billion in its annual budget request to Congress to address this growing need2.
A number of federal legislative proposals have recently been introduced to address this crisis. While the U.S. House passed several bills on the issue, the U.S. Senate passed its own measure, S.524, the Comprehensive Addiction and Recovery Act of 2016 (CARA Act). In a bipartisan effort, both the House and Senate appointed conferees to hammer out differences. Those appointed to the Conference included 35 House members (made up of 21 Republicans and 14 Democrats) including Representatives from -key Committees including the House Energy and Commerce Committee and the House Ways and Means Committee. The Senate had seven conferees including Senators Chuck Grassley (R-Iowa), Lamar Alexander (R-Tenn.), Orrin Hatch (R-Utah), Jeff Sessions (R-AL), Patrick Leahy (D-VT), Patty Murray (D-WA) and Ron Wyden(D-OR).
While addressing opioid abuse is bipartisan in nature, there was disagreement on process and content throughout the legislative process. One area of debate was funding for the bill. This was evident in a Democratic letter, published July 5, requesting an additional $920 million in funding.
CARA includes several provisions concerning the need for expansion of prevention and education on the misuse of prescription pain killers and heroin. Law enforcement agencies and first responders are permitted to distribute naloxone for the reversal of overdose. Evidence-based treatment and intervention programs for incarcerated individuals and those across the country will be implemented. There will be safe disposal sites for prescription medications to diminish the opportunity for ill use. Creates a medication assisted treatment program for pain management and expands states' drug monitoring programs to eliminate doctor shopping.
Now that CARA has passed and is on its way to be signed into law by the President, stakeholders will be watching closely for implementing rules, regulations, changes to incentive-based patient surveys, as well as any grant opportunities. Further discussion of funding may arise as Congress discusses budgetary options in the FY17 and beyond.
Brianna Keefe is co-author of this article.