The final conference report on the “CARA” legislation includes changes under nine titles.  Its emphasis, unlike past anti-drug initiatives, is more on prevention and treatment. It is a distance from some of the efforts of the 1980s when crack-cocaine was attracting all the attention in regard to substance use.  Actions then and into the 1990s were more focused on interdiction and criminal sentences. In 2014 the Center for Disease Control and Prevention (CDC) reported over 28,000 deaths due to opioid overdoses.  This bill would attempt to address that situation with a broader strategy than in the past.

The Comprehensive Addiction and Recovery Act of 2016 includes nine titles: Prevention and Education, Law Enforcement and Treatment, Treatment and Recovery, Addressing Collateral Consequences, Addiction and Treatment Services for Women, Families and Veterans, Incentivizing State Comprehensive Initiatives to Address Prescription Opioid Abuse, Miscellaneous provisions, Kingpin Designation Improvement, and Department of Veterans Affairs.

The first title sets up a federal panel to address better use and implementation of pain management methodology.  It provides some funds for awareness campaigns, a closer examination of how pain relief is used in youth sports, and grants for local initiatives that target high opioid use including improving access to address and prevent overdoses.  Grants would encourage comprehensive community-wide strategies that address local drug crises and emerging drug abuse issues.

The third and fifth tiles focus on treatment services with the third title including some limited funding for communities of recovery.  These competitive grants would build connections between recovery networks, recovery community organizations, and with other recovery support services, including behavioral health, primary care and physician providers.  Grants would also connect to the criminal justice system, employers, housing services, child welfare agencies, and other services that can facilitate recovery from substance use disorders.

Other goals within these communities include efforts to reduce the stigma associated with substance use disorders; and to conduct outreach on substance use disorders and recovery.

The fifth title includes amendments to the Child Abuse Prevention and Treatment Act (CAPTA).  It does not reauthorize CAPTA but amends current provisions around a plan of safe care. This part of the legislation includes new directives to HHS on creating a national clearinghouse for information relating to the topic as well as best practices relating to the development of the plans.  This is to include information on how to address withdrawal symptoms (or a Fetal Alcohol Spectrum Disorder).

The plan of safe care for infants requires a state that receives part of the $26 million in state CAPTA grants to (1) address the health and substance use disorder treatment needs of the infant and family or caregiver, and (2) specify a system for monitoring whether and in what manner local entities are providing services in accordance with state requirements. HHS must monitor state compliance with child protective services system grant requirements.

It also amends the largely voluntary data collection requirements under the National Child Abuse and Neglect Data System (NCANDS) child maltreatment reporting system to include data on the number of such infants, the number of infants for whom a plan of safe care was developed, and the number of referrals that are made for services. This section of the bill also directs a new GAO report on the prevalence of Neonatal Abstinence Syndrome.

That same title five also addresses treatment for pregnant and post-partum women and veteran’s treatment courts.  It amends the public health services law and the Residential Treatment Program for Pregnant and Postpartum Women by strengthening certain provisions of this grant program to allow for providing therapeutic comprehensive child care for children with a parent in treatment and to support reunification of children in kinship and foster care settings where appropriate.

Title four deals with a GAO report on recovery and titles six and seven provide competitive state grants for state wide efforts to address prevention through better tracking and other efforts to control opioid overuse and abuse.  There are also new provisions to assist in the tracking of prescription medication and it expanding use.   Titles two, eight and nine deal with law enforcement, drug kingpin designations and veteran’s services.

CARA is an authorization meaning that it is up to Congress to appropriate funds to actually carry out many of the proposed funding levels.  Democrats have been calling for new funding of approximately $920 million which would go toward expanded treatment, prevention and enforcement provisions of the bill.  The Administration had asked for emergency funding of $1 billion early this year.  The first attempt to fund the program will not occur until a new FY 2017 bill is approved or at least partially funded through a fall CR.