BREAKING: CARA moves to president’s desk

Congressional leaders Wednesday advanced a signature piece of opioid legislation to the president’s desk, having at last hammered out a final package that includes a $181 million authorization. The president is expected to sign the Comprehensive Addiction and Recovery Act (CARA) quickly.

“It’s a huge achievement, and they should be commend for following through with it,” says Corey Waller, MD, DFASAM, chair of the American Society of Addiction Medicine’s Legislative Advocacy Committee. “Legislation never gives us everything we want. It’s about compromise and making sure everyone feels they’re coming up with a solution that has real value for the country. And I think that’s really happening.”

Along the journey, there were repeated attempts to attach emergency, mandatory funding to CARA so federal dollars would be appropriated to the efforts directly. The amendments were struck down early. More recently, Democratic lawmakers sought to add $920 million skimmed from other programs, but the combined House and Senate conference committee did not approve the measures.

The original Senate-passed CARA authorized $78 million in new funding, but the conference agreement increased it to $181 million, funds which ultimately would come from other available funding sources, decided at a later time. Waller, who also helps to lead the Coalition to Stop Opioid Overdose, tells Behavioral Healthcare the figure represents only about 10% of the funds required to fully implement the provisions of CARA.

“To fully fund it, we need north of $1 billion, but we’re not there,” he says.

On July 6, White House Press Secretary Josh Earnest said the president might not sign the bill without appropriated funding, but Waller believes Obama’s signature is highly likely.

“It would be a surprise if the president does not sign a bill that has the potential to save millions of lives over a period of time,” he says. “The optimal outcome is to have a good bill with funding that matches what the bill says, but we don’t have that. Then the next step is to determine where we appropriate funds to put this bill into action.”

Top provisions

Two of the top provisions in CARA that will increase the numbers of people who receive treatment for addiction include: measures to allow midlevel clinicians, such as nurse practitioners and physician assistants, to prescribe buprenorphine; and measures to drive greater naloxone availability without prescriptions. Waller says the provisions will have immediate impact on saving lives.

A variety of reports are required by CARA to evaluate needs and to verify that the actions, once implemented, are effective. For example, Waller says there are only 3,000 providers who are waivered to prescribe buprenorphine, but more than 30 million people might benefit from the drug. It’s a gap he believes must be addressed.

“[Medication-assisted treatment] is the area that needs to be built out to match the capacity of behavioral therapy, but we need to grow both,” he says. “We still have a long way to go before we have matching capacity.”

Much of the heavy lifting on CARA will occur in the rule setting process, and that’s where the entire industry must get involved, he says.