Few would have predicted at this time last year that a policy like the Comprehensive Addiction and Recovery Act of 2015 (CARA) (S. 524/H.R. 953) would pass the Senate in a near unanimous vote. Behavioral health leaders are truly pleased by its passage but acknowledge that CARA is only one step to begin addressing addiction in the United States. They generally believe it's not enough.
The legislation authorizes $600 million for grants—however, it does not actually appropriate federal funds. That's an important distinction. Instead, money would come out of the budget bill, which already passed last December. Funds would be used under CARA for treatment and recovery services, alternatives to prison, law enforcement initiatives and programs to prevent overdose deaths and overprescribing.
Efforts to include an amendment for $400 million in upfront emergency funding under CARA were struck down.
CARA moves to the House of Representatives with an identical bill that has 92 co-sponsors, where it will potentially face a more difficult journey because the House tends to be more fiscally conservative.
“Senator [Sheldon] Whitehouse (D-R.I.) and I believe we'll get a strong vote in the House as well, and we can get it to the president's desk for signature and begin to reverse this trend,” said Sen. Rob Portman (R-Ohio) on the Senate floor in advance of the bill passing. “The bill went through what is a unique process around here, which is bipartisan, or nonpartisan, from the start and a process of bringing in experts from all around the country, rather than us saying we know all the answers.”
Portman and Whitehouse introduced CARA in the Senate Feb. 12, 2015.
And the president will sign it?
Highly likely. The White House is angling to make its mark on addiction. Just last month, the administration asked for $1 billion in new mandatory funding to tackle the opioid crisis in the fiscal year 2017 budget, including $920 million to help states increase the use of medication-assisted treatment (MAT). Currently, 22 states receive MAT funding, and the new proposal would increase the number to 45.
Additionally, leaders are currently reviewing a number of reports that the president previously requested from federal agencies late last year—reports that specifically address barriers to MAT and what should be done about them.
Who was the dissenting vote?
“Republicans Lindsay Graham and Tim Scott [of South Carolina] were among the 94 members who voted in favor of the bill,” says Ron Manderscheid, PhD, executive director of the National Association of County Behavioral Health and Developmental Disability Directors. “Only one senator, Republican Ben Sasse of Nebraska, voted no.”
According to The Hill, Sasse said he doesn't believe it's the federal government's role to fight addiction.
What does the industry say?
Linda Rosenberg, president and CEO of the National Council for Behavioral Health, said in a statement: “The only way to attack a crisis of this magnitude is for the government, healthcare and law enforcement communities to attack the problem with adequate prevention, treatment and recovery services. Such an effort takes time, commitment, patience and yes, money. We are so gratified that the Senate has come to their aid.”
What's still missing?
For one, many are still waiting for the administration to make good on its promise to change policies around MAT. In September, federal leaders vowed that they would change the limitations that only allow prescribers to treat 30 patients with buprenorphine at a time (or 100 patients with special waivers). More to come on this.
What would CARA do?
According to industry insiders, the operative word in CARA is “comprehensive.” Use of naloxone, criminal justice reform and support for law enforcement are coupled with treatment, prevention and recovery components. If it became law, CARA would:
Expand prevention and educational efforts—particularly aimed at teens, parents and other caretakers, and aging populations.
Expand the availability of naloxone to law enforcement agencies and other first responders.
Expand resources to identify and treat incarcerated individuals with addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence-based treatment.
Expand disposal sites for unwanted prescription medications.
Launch an evidence-based opioid and heroin treatment and interventions program to expand training and resources for medication-assisted treatment.
Strengthen prescription drug monitoring programs.