On the last day of summer session, Thursday, July 14, the Senate approved the conference report on the “CARA” legislation and sent the legislation onto the President who will sign it.  The vote was 92 to 2 with only Senator Mike Lee (R-UT) and Senator Ben Sasse (R-NE) voting no.

CARA or the Comprehensive Addiction and Recovery Act 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 but failure to get the funds did not stop final passage.  The Administration had asked for emergency funding of $1 billion early this year.  The White House also expressed frustration with a lack of funding but said the President would sign it.  Much of the urgency has been driven by the expanded opioid use across much of the country.   In 2014 the Center for Disease Control and Prevention (CDC) reported over 28,000 deaths due to opioid overdoses.

The new act amends CAPTA (but does not reauthorize the CAPTA law) to create specificity in regard to infant “safe care plans.”  State plan requirements are amended under CAPTA to require states to address the health needs and any substance use disorder resulting from a caregiver’s substance use.  The amendments also direct greater monitoring of states by HHS, new data reporting through the current data collection systems and greater dissemination of best practices by HHS.  That section of the bill also directs a new Government Accountability Office (GAO) report on the prevalence of Neonatal Abstinence Syndrome.

The legislation amends a number of parts of federal law that impact on drug use with the main changes through the Public Health Services Act and the Omnibus Crime Control and Safe Streets Act of 1968.  It allows grants to state and local substance abuse agencies, Indian tribes or tribal organizations, or nonprofit organizations in geographic areas that have a high rate of—or have had rapid increases in—heroin or other opioids to expand treatment.  Other initiatives target schools and institutions of higher education.

Despite full implementation being dependent on the yet incomplete FY 2017 appropriation, key changes in law include:

  • Expanded prevention and educational efforts—particularly aimed at teens, parents and other caretakers, and aging populations—to prevent the abuse of opioids and heroin and to promote treatment and recovery.
  • Expanding the availability of naloxone to law enforcement agencies and other first responders to help provide emergency reversals of heroin overdoses.
  • Encouraging greater identification and treatment of incarcerated individuals suffering from addiction through collaboration between criminal justice stakeholders.
  • Better coordination of and use of disposal sites for unwanted prescription medications to keep them out of the hands of our children and adolescents.
  • Strengthen prescription drug monitoring programs to help states monitor and track prescription drug diversion and to help at-risk individuals access services

It also includes a directive to HHS to convene a pain management best practices inter-agency task force. The task force would be required to establish best practices for pain management and for prescribing pain medication.  In addition, the task force would develop a strategy for disseminating those best practices.