CARA 2.0 makes a statement on the opioid crisis

President Barack Obama signed the Comprehensive Addiction and Recovery Act (CARA) into law in July 2016, but its funding mechanism has expired. To continue the momentum created by CARA, a bipartisan group of senators in recent weeks introduced CARA 2.0, which would authorize $1 billion for prevention, law enforcement and treatment and recovery programs.

Mark Dunn, public policy director for the National Association of Addiction Treatment Providers, tells Behavioral Healthcare Executive that the proposals in CARA 2.0 should be viewed as positive, calling out a few specific provisions.

For example, the bill puts a three-day limit on opioid prescriptions for routine, acute care—a tighter restriction than current state policies.

“There may be some pushback, and perhaps three days is unrealistic,” Dunn says. “But it sends a message that physicians should not give you two weeks of a prescription for a sore tooth. Whether it’s three days or five or more, it acknowledges that there has to be some limits on how these drugs are prescribed.”

Massachusetts passed compromise legislation in March 2016 that imposes a seven-day opioid prescribing limit for routine, acute care, even though the governor initially proposed a shorter three-day limit. In Ohio, the state’s seven-day limit is enforced not with legislation but by medical boards.

It’s difficult to say whether CARA 2.0’s stricter limit would stick with federal lawmakers.

Budget plans

Charles Ingoglia, the National Council For Behavioral Health’s senior vice president for public policy and practice improvement, says CARA 2.0 demonstrates the interest by Congress to move legislation forward to address the opioid crisis. It also resonates with the preceding bipartisan Senate budget deal that would make $6 billion in discretionary funding available for mental health and substance use disorder programs for two years.

“My impression is that the rapid introduction of CARA 2.0 was a way for senators to say that if the $6 billion is parceled out, [this legislation] presents ideas for how to spend it,” Ingoglia says.

CARA 2.0 is a tweak of the original CARA plan, he says, updated to address today’s concerns. For example, CARA 2.0 directs the secretary of the Department of Health and Human Services to publish best practices for recovery housing—a largely unregulated sector in behavioral health.

Ingoglia says some states have attempted to rein in sober homes by requiring that treatment providers only refer to or accept referrals from residences that have voluntarily obtained certification. In the coming weeks, National Council will release a recovery residence tool kit that will help operators adopt best practices.

“There are a lot of bills out there, and we hope Congress lives up to the rhetoric,” he says.

Experts say the only viable option to secure funding to address addiction and overdose is legislation passed through Congress.  Stakeholders have emphatically thrown up their hands on any meaningful action coming out of the federal public health emergency. The emergency declaration expires April 23.

In a statement, Sen. Charles Schumer’s (D-N.Y.) office said: “Despite President Trump declaring the opioid crisis a public health emergency, his administration has put zero new dollars toward ending the scourge.”

Meanwhile, the Centers for Disease Control and Prevention last week revealed that emergency department visits related to opioid overdoses have increased 30%.

The CARA 2.0 bill was introduced by Rob Portman (R-Ohio), Sheldon Whitehouse (D-R.I.), Shelley Moore Capito (R-W.V.), Amy Klobuchar (D-Minn.), Dan Sullivan (R-Alaska), Maggie Hassan (D-N.H.), Bill Cassidy (R-La.) and Maria Cantwell (D-Wash.). The two largest funding buckets provide $300 million each to expand medication assisted treatment and naloxone training for first responders. An additional $200 million in grant money is proposed to help communities connect recovery support services, and smaller amounts are dedicated to a variety of efforts.