Topics in Treatment: Treatment and Recovery Legislation, Part One – The Comprehensive Addiction and Recovery Act (CARA)

If you pay attention to national media, you know all about the opioid crisis – also called the opioid epidemic – that’s happening right now in the U.S. If you don’t follow the news and have never heard of the opioid crisis, it’s time to catch up – even if, from your perspective, it has not affected you in any way. It’s important to know the facts, because the crisis led to changes in public healthcare policy that affect almost everyone.

This article – Part One of our series – will discuss the first piece of legislation lawmakers passed in direct response to the opioid crisis: The Comprehensive Addiction and Recovery Act (CARA).

Part Two will discuss the 21^st Century Cures Act.

Part Three will  discuss the SUPPORT Act.

Ready for Part One?

Here we go.

Healthcare Legislation: Implications

Right now, as you read this article, you might wonder why any of this legislation matters to you. Maybe you don’t have an opioid use disorder. Maybe no one in your family or immediate circle does, either. Despite these facts, the legislation still matters to you.

Here are the three primary reasons why:

1. If you or someone you love develops a problem with opioids, you need to know what public resources are available.
2. If you or someone you love develops a problem with opioids, you need to have an idea of the level of care insurers are required by law to provide.
3. If you have a medical issue that requires surgery, or an injury that requires pain medication, you need to know about the medications you may receive for pain.

For example, if you recently went to the dentist for a tooth extraction, you may have been surprised you didn’t receive a three-day prescription for a medication like Percocet, which is a combination of acetaminophen (a.k.a. Tylenol) and oxycodone (an opioid pain reliever). The same goes for any other minor outpatient surgery. After the procedure, it’s likely the physician prescribed acetaminophen or ibuprofen to manage the pain but did not prescribe an opioid pain reliever.

Why?

Because of the changes in public policy related to the opioid crisis.

How We Got Here

Here’s a point by point summary of the trends and events that brought us to where we are now, which can be described as in media res. Or, more simply, right in the middle of a response to a serious public health crisis. Whatever way you put it, here’s what happened:

• Opioid prescriptions increased at an unprecedented rate from 1991-2012:
  • 1991: 76 million prescriptions written
  • 2012: 255 million prescriptions written
• Opioid prescriptions decreased from 2012-2017, with 191 million prescriptions written in 2017.
• During this period (2012-2017), some areas of the country saw the opposite:
  • On an average day in 2016, 650,000 prescriptions for opioids were written.
  • In 12 states in 2016, the number of opioid prescriptions written exceeded the total population of the state.
• Alongside the increase in opioid prescriptions, overdose fatalities increased:
  • 2000: 6,242
  • 2005: 12,991
  • 2010: 19,687
  • 2016: 32,500
• The use of illicit opioids also increased. On an average day in 2016:
  • 3,900 people initiated nonmedical use of prescription opioids.
  • 580 people used heroin for the first time.
  • 78 people died from opioid overdose.

That’s the story in a nutshell. There are more details, of course, but the long and short of it is this: opioid prescription rates skyrocketed, and overdose fatalities increased so much that the problem became impossible to ignore.

That’s when legislators stepped up and passed CARA.

What is CARA?

Before we define CARA, it’s important to recognize two articles of legislation that paved the way for legislation specifically designed to address addiction treatment.

First, the American With Disabilities Act (ADA) of 1990 established legal requirements for equal opportunities in public life for people with disabilities, including people with mental health and/or substance use disorders.

Next,  in 2010, the Patient Protection and Affordable Care Act – also known as the ACA or Obamacare – established rules requiring insurers to include coverage for mental health and alcohol/substance use disorder treatment as part of typical insurance plans, rather than as expensive extensions or supplements to existing policies.

Now, to CARA.

The Comprehensive Addiction and Recovery Act was introduced by Senator Sheldon Whitehouse (D-RI) in 2015 and passed into law in 2016. The language of the act clearly describes its goals and purpose:

“The Comprehensive Addiction and Recovery Act establishes a comprehensive, coordinated, balanced strategy through enhanced grant programs that expand prevention and education efforts while also promoting treatment and recovery.”

The key provisions in CARA allocate federal funding to:

• Launch evidence-based heroin and opioid treatment programs
• Expand education, prevention, and recovery support for adolescents and college students
• Expand education, prevention, and recovery support efforts for parents and the elderly
• Increase availability of the anti-overdose medication Naloxone
• Increase available resources to provide evidence-based treatment to incarcerated individuals
• Expand safe disposal sites for unused prescription medication
• Strengthen prescription drug monitoring programs to prevent diversion of medication for illicit purposes

The most important aspect of CARA lies in the phrase “allocate federal funding.” While CARA initiated test programs for opioid and heroin addiction treatment, the act significantly increased the amount of federal grant money available to local and state agencies to support preexisting education, prevention, and recovery support programs.

Additional Resources

To read a summary of CARA published by the American Society of Addiction Medicine (ASAM), click here. To read a summary of CARA published by Community Anti-drug Coalitions of America (CADCA), click here. We include both summaries to give you more perspective on CARA: the ASAM summary focuses on implications for treatment providers, while the CADCA summary focuses on implications for communities and individuals.

We won’t opine or editorialize any further, here. Through the links above, you can read the act itself – and the two summaries – to get a granular, detailed understanding of CARA and what it means to you.

Coming next: Topics in Treatment Part Two – The 21^st Century Cures Act.