Resources

Congress Passes CARA! ASAM applauds passage of historic addiction legislation

by ASAM Staff | July 13, 2016

July 13, 2016 – Today, the United States Senate voted overwhelmingly to pass the Comprehensive Addiction and Recovery Act (CARA). The Senate vote follows a similar near-unanimous vote in the House of Representatives last week and will send the bill to the President’s desk for his signature. The American Society of Addiction Medicine (ASAM) joins other members of the addiction prevention, treatment and recovery community in celebrating the passage of this important piece of legislation and calls on Congress to fulfill its commitment to fund CARA fully this year.

“ASAM is thrilled to see CARA pass and we look forward to the President signing this bill into law,” said ASAM President, Dr. Jeffrey Goldsmith. “It has been a privilege to be a part of the process as Congress has considered how best to respond to the epidemic of opioid overdoses that has been ravaging our nation, our communities and our families. It’s not a perfect bill, and we still need Congress to act to fund it this year, but it is a major step forward to help promote prevention, expand access to treatment, and enhance crucial recovery support services. With adequate funding, we believe this bill will help save lives.”

CARA is a sweeping bill that came together over the course of several years with input from hundreds of addiction advocates. Its provisions address the full continuum from primary prevention to recovery support, including significant changes to expand access to addiction treatment services and overdose reversal medications. In particular, ASAM applauds the inclusion of these important policy changes:

  • Expansion of office-based treatment by allowing nurse practitioners and physician assistants to prescribe buprenorphine for opioid addiction
  • Authorization of grants to opioid treatment programs and practitioners who offer office-based medication-assisted treatment to expand access to naloxone through co-prescribing
  • Reauthorization of funding for the National All Schedules Prescription Electronic Reporting Act for states to improve or maintain a prescription drug monitoring program (PDMP)
  • Directing the Secretary of Health and Human Services (HHS) to develop recommendations regarding education programs for opioid prescribers, including which prescribers should participate in such programs and how often participation is necessary
  • Authorization of grants to states to expand evidence-based medication-assisted treatment in areas with high rates of opioid and heroin use
  • Authorization of grants to state substance abuse agencies to carry out pilot programs for non-residential treatment of pregnant and postpartum women
  • Authorization of grants to states to implement integrated opioid abuse response initiatives, including education of medical students, residents and other opioid prescribers, and expanding availability of medication-assisted treatment and behavioral therapy for opioid addiction
  • Expansion of the Department of Veterans Affairs (VA) Opioid Safety Initiative, including a requirement that all VA opioid prescribers receive training on pain management and safe opioid prescribing

“Taken together, we believe these policy changes will have a meaningful impact on the opioid epidemic, and we are pleased that Congress was able to come to agreement on such a pressing public health issue for our nation,” said Dr. Kelly Clark, President-elect of ASAM. “However, we won’t realize the full potential of this important bill without the funding necessary to carry out the programs it authorizes.  We look forward to continuing to work with Congress this year to make sure adequate funding is made available for CARA to make a difference in the lives of those affected by this devastating disease.”

Highlights of the bill's provisions for ASAM members can be found here

8 comments

Leave a comment
  1. StevieC Apr 23, 2018 - 04:46 PM
    I am a chronic pain patient and I wish that in the bills and regulations for pain meds, that I would see even a paragraph addressing us pain patients.  Instead, we are all limited to the same hard morphine equivalent, which is a severe reduction for me.  I will be lying on the bed screaming 24/7.  Where I used to get sane and compassionate pain relief, which allowed me to live a much fuller life, I am quickly doing less and less and my life is having less quality, as the reductions continue.  Addicts get OFF opiates to have their lives back.  I got ON them to have mine back.  But we are all treated the same and there are millions and millions of us in 10 pain who are suffering because of the opiate addiction epidemic.  None of it makes any sense.  They know how the streets got flooded with opiates and that "pill mills" were allowed to stay open, dispensing millions of opiates per month, even into the height of the crisis.  While I feel for addicts, and hate that so many OD'd, the government can't start practicing medicine, when it was other factors that caused this.  And they aren't even addressing addiction well in all this.  Surely there are other solutions beyond Suboxone, but Big Pharma has been pushing it the last few years.  It has helped many, but has the same, or even more, problems that methadone has.  It is more damaging to the liver and more addictive than methadone, too.  Thanks for listening, this is a very hard time in many of our lives here, whether addicted or needed for pain.  I wish all of us well and that we get what we need to live full lives.
  2. StevieC Apr 23, 2018 - 04:43 PM
    I am a chronic pain patient and I wish that in the bills and regulations for pain meds, that I would see even a paragraph addressing us pain patients.  Instead, we are all limited to the same hard morphine equivalent, which is a severe reduction for me.  I will be lying on the bed screaming 24/7.  Where I used to get sane and compassionate pain relief, which allowed me to live a much fuller life, I am quickly doing less and less and my life is having less quality, as the reductions continue.  Addicts get OFF opiates to have their lives back.  I got ON them to have mine back.  But we are all treated the same and there are millions and millions of us in 10 pain who are suffering because of the opiate addiction epidemic.  None of it makes any sense.  They know how the streets got flooded with opiates and that "pill mills" were allowed to stay open, dispensing millions of opiates per month, even into the height of the crisis.  While I feel for addicts, and hate that so many OD'd, the government can't start practicing medicine, when it was other factors that caused this.  And they aren't even addressing addiction well in all this.  Surely there are other solutions beyond Suboxone, but Big Pharma has been pushing it the last few years.  It has helped many, but has the same, or even more, problems that methadone has.  It is more damaging to the liver and more addictive than methadone, too.  Thanks for listening, this is a very hard time in many of our lives here, whether addicted or needed for pain.  I wish all of us well and that we get what we need to live full lives.
  3. StevieC Apr 23, 2018 - 04:42 PM
    I am a chronic pain patient and I wish that in the bills and regulations for pain meds, that I would see even a paragraph addressing us pain patients.  Instead, we are all limited to the same hard morphine equivalent, which is a severe reduction for me.  I will be lying on the bed screaming 24/7.  Where I used to get sane and compassionate pain relief, which allowed me to live a much fuller life, I am quickly doing less and less and my life is having less quality, as the reductions continue.  Addicts get OFF opiates to have their lives back.  I got ON them to have mine back.  But we are all treated the same and there are millions and millions of us in 10 pain who are suffering because of the opiate addiction epidemic.  None of it makes any sense.  They know how the streets got flooded with opiates and that "pill mills" were allowed to stay open, dispensing millions of opiates per month, even into the height of the crisis.  While I feel for addicts, and hate that so many OD'd, the government can't start practicing medicine, when it was other factors that caused this.  And they aren't even addressing addiction well in all this.  Surely there are other solutions beyond Suboxone, but Big Pharma has been pushing it the last few years.  It has helped many, but has the same, or even more, problems that methadone has.  It is more damaging to the liver and more addictive than methadone, too.  Thanks for listening, this is a very hard time in many of our lives here, whether addicted or needed for pain.  I wish all of us well and that we get what we need to live full lives.
  4. StevieC Apr 23, 2018 - 04:42 PM
    I am a chronic pain patient and I wish that in the bills and regulations for pain meds, that I would see even a paragraph addressing us pain patients.  Instead, we are all limited to the same hard morphine equivalent, which is a severe reduction for me.  I will be lying on the bed screaming 24/7.  Where I used to get sane and compassionate pain relief, which allowed me to live a much fuller life, I am quickly doing less and less and my life is having less quality, as the reductions continue.  Addicts get OFF opiates to have their lives back.  I got ON them to have mine back.  But we are all treated the same and there are millions and millions of us in 10 pain who are suffering because of the opiate addiction epidemic.  None of it makes any sense.  They know how the streets got flooded with opiates and that "pill mills" were allowed to stay open, dispensing millions of opiates per month, even into the height of the crisis.  While I feel for addicts, and hate that so many OD'd, the government can't start practicing medicine, when it was other factors that caused this.  And they aren't even addressing addiction well in all this.  Surely there are other solutions beyond Suboxone, but Big Pharma has been pushing it the last few years.  It has helped many, but has the same, or even more, problems that methadone has.  It is more damaging to the liver and more addictive than methadone, too.  Thanks for listening, this is a very hard time in many of our lives here, whether addicted or needed for pain.  I wish all of us well and that we get what we need to live full lives.
  5. Russ E Aug 06, 2016 - 10:11 AM

    Edit to my last post. 

    Sorry Julia Rossi R.N. I was trying to reply to a comment by Henry Dela Torre M.D. So I actually agree with you. I just looked at the wrong name so I apologize!!

    Henry dela Torre is an MD and he doesn't have a clue about how to truly treat these patients. A lot of doctors are so arrogant because they went to school for 8+ years and assume they can "heal" anyone with there methods. It's partly what's  wrong with this countries very flawed medical system. Sometimes it takes someone who has lived it. Someone who has actually been through it and has got out on the other side to know exactly what it could take to work. Everyone is different so why treat everyone the same? Addicts need to be more involved in there treatment and doctors need to actually take the addicts suggestions sometimes. Instead of thinking they already have the answer when it's obvious they don't. WITH every other illness in this country doctors take patients advice when it comes to what medicines work for them and how it effects them and adjusts accordingly. Not Buprenorphine doctors. Thats one thing that could end up helping  

  6. Russ E. Aug 06, 2016 - 09:40 AM
    Julia Rossi R.N.  If you are seriously saying you agree with putting addicts in prison than you do not deserve the RN designation than you are obviously as ignorant as the Dr's that you say know nothing about addiction that are treating people. It's doctors like the ones you work for who benifit by Prescribing Opiate pain killers in the first place. Most Opiate addicts first become addicted to pain killers before moving on to something like heroine. NA is the oldest practice and one that hasn't updated its standards since inception many years ago. Addicts obviously have to take a lot of the blame but so to do the doctors who claim they are helping people and make more money off of it than 95% of the population would ever dream of making. Buprenorphine treatment has been very helpful in saving lives in that it keeps people from buy Opiates off the streets and risk overdosing but because so many doctors that prescribe it actually know so little about it they refuse to subscribe Buprenorphine without the Naloxone. If you you know anything about Buprenorphine than you know that the Naloxone does nothing for someone in Buprenorphine treatment. It's only in an overdose that Naloxone is useful. Buprenorphine has a very high binding affinity to the Opiate receptors and therefore raises your tolerance to opiates like pain killers and heroine yet it dose not get you high it just alleviates the withdrawal symptoms that addicts go through therefore helping them keep a job and sustain a normal lifestyle. Generic Buprenorphine  WITHOUT Naloxone is over $100.00 cheaper than Buprenorphine WITH Naloxone for a single months supply yet they are no different. Doctors refuse to prescribe generic Buprenorphine to people who need it for financial reasons or becuase they have some type of reaction or side affects to the Naloxone becuase they claim that it's more susceptible to abuse. However, it is a fact that people abuse (shoot up or snort) any form of Buprenorphine on the market and no one is abused more than the other. I personally believe that it's because doctors get some type of a royalty for each drug that they sale and in there eyes the more money for them the better. This alone is driving people back out to the streets or keeping them from going to treatment at all becuase they know that they can get there fix from the street  a lot CHEAPER than if they went to a doctor for treatment. This is just one example of the whole system being flawed. Doctors only have to take a stupid 8 hour class to be able to prescribe it. That's the same hour class people have to take for getting a speeding ticket and going to driving school. Why can't every single legitimate prescribing physician  out there prescribe Buprenorphine as a solution and treatment for the addicts of the  pain killers that they are currently aloud to prescribe. My brother who was an addict went into treatment and got generic Buprenorphine and was  back to his old self before addiction. It was night and day and obvious he had improved 10 fold. After 6 months he was cut off and the dr said he had to start taking Suboxone(Buprenorphine w/Naloxone). He tried it and he started having symptoms that he had never had before and some of them were Emergency Room worthy. The ER doctors even told him that he needed to go back to his previous meds which were the generic Buprenorphine WO Naloxone but his doctor refuse. He ended up back on heroine he got for very cheap out on the streets and has overdosed twice. This last time he was dead before they brought him back and luckily his brain was deprived of oxygen for very long. Why refuse this simple and much cheaper solution? Sadly, there are very few doctors who know how to treat patients CORRECTLY in this country and it starts at the very top. The addicts don't always know what it best for themselves but it's obvious to me with my experience first hand and dealing with others that I know and reading stories online that the addicts atleast know the best way to be treated. Whether that NA, Counseling, or Bupe Treatment. Everyone is different but they know what care they need to get better as long as they are honest with themselves and whether they choose to go that route or even have access to that route in a legally obtained manner. Putting addicts in jail would be the worst thing that could happen drugs are readily available in jail and putting a bunch of addicts together in confined spaces all day everyday. Well, it doesn't take a genius know that would be bad. MAKE every available prescribtionbon the market for treating looted. actually AVAILABLE to be obtained. That's one small step towards helping save lives and also limit the cost of the treatment and limit the amount of money that treatment centers can make off of a single patient. Doctors that truly want to help people will do it for minimum wage if they really want to help. But they need educated and they need the RIGHT PEOPLE TO EDUCATE THEM about this horrible addiction. Working TOGETHER from the top to the bottom. STOP refusing to work with patients but you believe you know what's best for them. Actually take the time to listen to the patients and WORK WITH THEM. Its obtainable but it's going to take some serious work. This country needs it badly!
  7. Andrew Waller Jul 14, 2016 - 04:58 PM

    "Section 303.

    ....Allows states to lower the patient limit and allows states to require practitioners to comply with additional practice setting, education or reporting requirements. States may not lower the patient limit below 30."

    I am confused by this. It sounds like a state may decrease the limit to 30 if they choose. This is not a step forward! What am I missing?

  8. Maggie Cipollone Jul 14, 2016 - 10:05 AM
    So excited about this legislation.  I hope it makes a big difference in the many people affected by addiction. 

    Leave a comment