Republican Controlled Senate Overwhelmingly Passes Landmark Opioid Bill – the Comprehensive Addiction and Recovery Act (CARA)

Measure Promotes Expanded Use of Diversion from the Criminal Justice System for Drug Law Violations, Medication Assisted Treatment for Opioid Addiction and Naloxone to Reverse Opioid Overdose; Advocates Praise Passage of CARA as Proof that Emerging Political Consensus Behind Treating Drug Use as a Health Issue is Gaining Traction

Washington, D.C. –(ENEWSPF)–March 10, 2016.  The U.S. Senate today passed the Comprehensive Addiction and Recovery Act (CARA). This bipartisan measure co-sponsored and championed by Senator Sheldon Whitehouse (D-RI), Senator Rob Portman (R-OH) and others next goes to the House where a companion measure has remained pending for over a year. CARA advances a large number of treatment and prevention measures intended to reduce prescription opioid and heroin misuse, including evidence-based interventions for the treatment of opioid and heroin addiction and prevention of overdose deaths. The Drug Policy Alliance (DPA) has concerns with some of the provisions in the legislation but applauds the change in political discourse among both Democrats and Republicans on Capitol Hill as CARA has been considered. DPA also applauds the overall direction that CARA takes in favor of dealing with opioid and heroin misuse as the public health crisis that it is.

“The momentum behind CARA offers hope that lawmakers are starting to evolve toward treating drug use as a health issue, rather than a criminal justice issue,” said Grant Smith, deputy director of national affairs with the Drug Policy Alliance. “CARA will save many lives. The only regret is that this positive step forward didn’t come sooner, and many thousands of lives have already been tragically lost in communities impacted by heroin and opioid overdose,” said Smith.

DPA specifically supports three initiatives advanced in CARA and urges Congress to immediately appropriate funding for these initiatives:

  • CARA supports the expansion of diversion programs that direct people accused of low-level drug law violations away from the criminal justice system and into evidence-based treatment and other services.
  • CARA supports the expanded provision of buprenorphine, methadone and other forms of medication-assisted treatment, including to people involved with the criminal justice system. The vast majority of correctional facilities do not provide medication-assisted treatment despite an overwhelming need among incarcerated people and the strong evidence base supporting medication-assisted therapy to treat opioid dependence.
  • CARA supports the expanded use of naloxone by law enforcement and first responders. Naloxone effectively reverses opioid overdoses and is safe to use but people who are at-risk of experiencing or witnessing an overdose often cannot access this lifesaving drug.

Advocates applauded passage of CARA out of the Senate Judiciary Committee last month, noting that the panel’s long track record of endorsing counterproductive punitive drug policies was largely set aside in favor of the health-centered measures advanced in CARA. This bill, however, does not appropriate federal funding. Senator Chuck Schumer (D-NY) and other Senate Democrats led an unsuccessful effort on the floor of the Senate to amend CARA with a $600 million emergency appropriation authored by Senator Jeanne Shaheen (D-NH). Advocates expressed disappointment that Senator Shaheen’s amendment included funding for federal law enforcement programs that have a long track record of perpetuating drug war abuses. Advocates instead urge lawmakers to appropriate emergency funds to CARA’s initiatives that would expand access to naloxone, the use of medication-assisted treatment and the diversion of people struggling with addiction away from the criminal justice system.

“Lawmakers in Congress should be looking at ways to build upon the bipartisan political will that CARA has cultivated for reducing the role that law enforcement plays in addressing substance use,” said Grant Smith, deputy director of national affairs with the Drug Policy Alliance. “Important work underway in Congress right now to reduce draconian mandatory drug sentences, roll back collateral consequences of a drug law conviction and enhance funding for evidence-based treatment and overdose prevention present critical opportunities to continue building upon the political momentum for change to our nation’s drug policies.”

As work on CARA continues in Congress, lawmakers in other parts of the country are exploring innovative solutions to dealing with problems stemming from opioid and heroin addiction. Earlier this week, the Maryland House of Delegates held legislative hearings on two bills that would create a safe and supervised space for people to use drugs and establish a pilot program to treat severe opioid dependence with pharmaceutical grade heroin.  Another bill pending before the Maryland legislature would decriminalize possession of personal amounts of any drug in an effort to shift drug policy towards a health-centered approach. Last month, Svante Myrick, the Mayor of Ithaca, New York became the first U.S. mayor to release a comprehensive drug policy plan to reduce overdose deaths, incarceration and addiction. The plan includes recommendations for a 24-hour crisis center, safe and supervised space for people to use drugs and greater access to medication assisted treatment.

Related Material:

New York Times Editorial

Drug Deaths Reach White America, Jan. 25, 2016–

Congress has historically treated drug abuse as a malady afflicting mostly poor, minority communities, best dealt with by locking people up for long periods of time. The epidemic of drug overdose deaths currently ravaging white populations in cities and towns across the country has altered this line of thinking, and forced lawmakers to acknowledge that addiction is a problem that knows no racial barriers and can be best addressed with treatment.

This realization is driving bipartisan support in Washington for saner, less punitive drug policies, some of which Congress had steadfastly resisted for decades.

Recently, Congress effectively lifted a destructive, longstanding ban that prevented state and local governments from using federal money on needle exchange programs. These programs have been shown to slow the spread of H.I.V. and other infections by giving intravenous drug users ready access to clean needles. A similar shift in attitude is reflected in bills like the Comprehensive Addiction and Recovery Act, which is pending in both houses of Congress. Its purpose is to expand and improve drug treatment services nationwide.

The need for such services was underscored in a recent Times analysis based on data released by the Centers for Disease Control and Prevention. It shows that drug overdose deaths driven primarily by addiction to prescription painkillers and heroin had increased in nearly every county between 2002 and 2014, a year when more than 47,000 people — an average of about 125 a day — died of overdoses. Some medical experts likened the toll to the H.I.V. epidemic in the 1990s, but with this difference: Then, H.I.V. deaths were mainly centered in urban centers; now, rural areas have higher drug overdose death rates than large cities.

Drug addiction has been especially visible in New Hampshire, where voters have been raising the issue with visiting presidential candidates. The deadly drug of choice in New Hampshire is a brand of heroin mixed with a highly potent painkiller called fentanyl. In Appalachia, deaths frequently occur among injured workers who become addicted to widely prescribed painkillers.

In addition to driving up mortality rates, excessive use of painkillers costs the country tens of billions of dollars in lost productivity, medical complications and higher insurance costs.

The Recovery Act would attack these problems on several fronts. For starters, it would direct the secretary of health and human services to convene an interagency task force to develop a system of best practices for prescribing pain medications that would then be conveyed to doctors. It would authorize the attorney general to make grants to state and local governments, nonprofit agencies, and other entities to assist them on several fronts: expanding or developing alternatives to incarceration, such as treatment, for defendants who meet certain criteria; improving educational opportunities for offenders in jails, prisons and juvenile detention facilities; making more widely available the drug naloxone, which reverses the effects of an overdose; creating high-quality drug treatment programs; and establishing places where people with unused medications can safely dispose of them.

A particularly important provision in the bill would help states strengthen prescription drug monitoring systems. Insurers would be able to track pharmacies that illegally dispense drugs, as well as consumers who get unnecessary prescriptions from multiple doctors, either to satisfy their own habits or to sell them to other parties. The prescription data would also allow addiction treatment programs to make sure that patients take only the drugs required for their treatment regimens.

The act represents a rational approach to drug policy. It would be a first step in a long and difficult struggle to get the national addiction crisis under control, and it deserves approval as soon as possible.