CARA 2.0 Increases Opioid Funding, Limits Opioid Prescriptions to Three Days & Bolsters Fight Against Opioid Epidemic

WASHINGTON, D.C. — U.S. Senators Rob Portman (R-OH), Sheldon Whitehouse (D-RI), Shelley Moore Capito (R-WV), Amy Klobuchar (D-MN), Dan Sullivan (R-AK), Maggie Hassan (D-NH), Bill Cassidy (R-LA) and Maria Cantwell (D-WA) today introduced the Comprehensive Addiction and Recovery Act (CARA) 2.0 Act to increase the funding authorization levels for the CARA programs enacted in 2016 and put in place additional policy reforms to help combat the opioid epidemic — including limiting opioid prescriptions to three days.  CARA was a bipartisan, national effort designed to ensure that federal resources were devoted to evidence-based education, treatment and recovery programs that work.  CARA 2.0 builds on this effort by increasing the funding authorization levels to better coincide with the recent budget agreement while laying out new policy reforms to strengthen the federal government’s response to this crisis.  The CARA 2.0 bill text is here, section-by-section here, and a summary here.

“Now that CARA has been implemented and is starting to help communities around the country, it’s time to start the discussion about reauthorizing this important federal law,” said Senator Portman.  “Passage of CARA was a historic moment, the first time in decades that Congress passed comprehensive addiction legislation, and the first time Congress has ever supported long-term addiction recovery.  Now we have the opportunity to build on this effort, increasing funding levels for programs we know work and implementing additional policy reforms that will make a real difference in combatting this epidemic.  I want to thank Senator Whitehouse and my bipartisan colleagues for their leadership and partnership on this important national effort.”

“Senator Portman’s and my comprehensive addiction bill was an important step forward in our battle against addiction,” said Senator Whitehouse.  “It treats addiction for the disease that it is, and provides support for those walking the long, noble path of recovery.  States like Rhode Island are already putting CARA funding and programs to good use.  Now it’s time to extend CARA’s reach deeper into communities where the opioid crisis rages, and, given what we learned from people on the front lines of that crisis, add new policy reforms we know can make a difference.  I’m excited to join Senator Portman and this bipartisan group of cosponsors to meld the commitments we made in the funding deal with the progress we enacted in CARA.”

“The opioid epidemic truly is a national crisis that is affecting families and communities across the country, and in West Virginia, we’ve become far too familiar with its consequences,” Senator Capito said. “While we’ve accomplished a lot in terms of drawing attention to the drug epidemic and providing resources to help address it, it’s painfully clear that we still have a long way to go and need to be doing even more. This bipartisan legislation will help continue efforts that are critical to fighting the opioid epidemic and providing help to individuals struggling with addiction. This is an important next step in a much broader effort, and I’m confident it will bring us closer to making real progress in this fight.”

“Opioid addiction has increased exponentially in the last decade, rising to the level of a public health emergency and affecting millions of Americans across the county,” said Senator Klobuchar.  “The Comprehensive Addiction and Recovery Act (CARA) has made real strides in tackling this epidemic, and CARA 2.0  will increase our investment and commitment to proven strategies for combating opioid addition. Doubling down on the opioid crisis is as critical as ever, and this bill will help more families to access the treatment and recovery services they need.”

“Combatting the opioid addiction crisis in Alaska continues to be one of my top priorities in the U.S. Senate,” said Senator Sullivan. “Building off the momentum of CARA, CARA 2.0 will significantly increase funding levels for evidence-based treatment programs and enhance prescription drug monitoring, while also addressing many challenges unique to Alaska, such as prioritizing highly rural areas, including tribal regions, in the direction of funding. The scourge of addiction knows no social, economic or geographic boundary – it affects Alaskans and Americans from all walks of life. I am pleased to work with my colleagues on both sides of the aisle to ensure that those struggling get the help they need, when they need it.”

“The Comprehensive Addiction and Recovery Act 2.0 is a critical next step in our efforts to help save lives and strengthen prevention, treatment, recovery, and law enforcement efforts,” Senator Hassan said. “As part of the bipartisan budget agreement, we secured $6 billion in additional funds to combat the opioid epidemic, and this bill identifies some of the key areas that should be prioritized as we work to get funding to communities that need it most. This bill will help support additional treatment capacity and it will also help ensure that first responders are safe and well trained when responding to overdoses – a priority that I have heard about from New Hampshire public safety officials. It would also increase potential penalties on opioid manufacturers who have played a significant role in fueling this epidemic. I am grateful to Senators Rob Portman, Sheldon Whitehouse, and all of my colleagues on both sides of the aisle who came together to introduce this bill, and I will continue working across party lines to pass this bill without delay and strengthen our comprehensive response to this crisis.”

“We must keep up the fight against the opioid crisis in Louisiana to support healthier families and safer communities,” said Dr. Cassidy. “This legislation builds on our efforts to help those struggling with addiction recover and return to wholeness. I’m glad the Protection from Overprescribing Act is included in this bill, so law enforcement gets the information they need to identify providers who are overprescribing and fueling this crisis.”

“The opioid and heroin epidemic has afflicted every area of our society and has taken the lives of more the 10,000 Washingtonians in less than 20 years,” said Senator Cantwell. “This bipartisan bill is the next step needed to provide expanded treatment, education, and prevention to combat this growing crisis.  And importantly, this legislation strengthens penalties on drug manufacturers who negligently distribute opioids in our communities.” 

NOTE: Beginning in 2014, as part of the process of drafting CARA, Portman and Whitehouse hosted five national forums with experts and practitioners from the prevention, treatment, law enforcement, and recovery communities to share best practices in their fields from across the United States.  The objective was to write a bill to incentivize best practices and authorize funding for evidence-based education, treatment and recovery programs that work.  CARA, which became law on July 22, 2016, authorized an additional $181 million for these evidence-based programs, and 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.  The recent budget agreement includes $6 billion in additional resources for FYs 2018-2019. 

CARA 2.0 will build on the original law by increasing the funding authorization levels for CARA’s evidence-based programs to better coincide with the recent budget agreement and laying out new policy reforms to strengthen the federal government’s response to this crisis.  CARA 2.0 will authorize $1 billion in dedicated resources to evidence-based prevention, enforcement, treatment, and recovery programs.  Here is a brief summary of CARA 2.0:

CARA 2.0 Policy Reforms:

  • Imposes three-day limit on initial opioid prescriptions for acute pain as recommended by the Centers for Disease Control and Prevention (CDC), with exceptions for chronic pain or pain for other ongoing illnesses.
  • 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 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 residence to ensure quality housing for individuals in long-term recovery.

CARA 2.0 Authorization Levels:

  • $10 million to fund a National Education Campaign on the dangers of prescription opioid misuse, heroin, and lethal fentanyl (up from $5 million in the original CARA).
  • $300 million to expand evidence-based medication-assisted treatment (up from $25 million in the original CARA).
  • $300 million to expand first responder training and access to naloxone (up from $12 million in the original CARA).
  • $200 million to build a national infrastructure for recovery support services to help individuals move successfully from treatment into long-term recovery (up from $1 million in the original CARA).
  • $20 million to expand Veterans Treatment Courts (up from 6$ million in the original CARA).
  • $100 million to expand treatment for pregnant and postpartum women, including facilities that allow children to reside with their mothers (up from $17.9 million in the original CARA).
  • $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 (no authorization in the original CARA).
  • $10 million for a National Youth Recovery Initiative to develop, support, and maintain youth recovery support services (no authorization in the original CARA).