group of eight senators on Tuesday unveiled bipartisan legislation that would increase funding for addiction treatment and prevention by roughly $1 billion and impose a sweeping three-day limit on opioid prescriptions for initial pain treatment.

The CARA 2.0 Act, billed as the sequel to the Comprehensive Addiction and Recovery Act of late 2016, would be the most substantive action Congress has taken to address the opioid crisis since President Trump took office.

The legislation’s unveiling comes as Republicans in both chambers of Congress are ramping up their legislative efforts to address the opioids crisis. The two-year budget deal Congress passed earlier this year included $6 billion in extra funding to address the crisis in 2018 and 2019, but offered only broad outlines of how the funds would be used. Now, legislators, lobbyists, and policy advocates are hurrying to identify policies that could fit into that funding framework.


The bill’s eight co-sponsors are divided evenly between Democrats and Republicans, and include the authors of CARA’s first iteration, Sens. Rob Portman (R-Ohio) and Sheldon Whitehouse (D-R.I.).

The bill would aggressively limit doctors’ ability to hand out lengthy opioids prescriptions, exempting only cancer, chronic pain, and hospice treatment from the three-day initial prescription limits. The Centers for Disease Control and Prevention issued new prescription guidelines in 2016 that indicate three-day prescriptions are typically sufficient and seven-day prescriptions are rarely necessary. A number of states have already enacted laws limiting first-time opioid prescriptions to three, five, or seven days.


Sign up for our D.C. Diagnosis newsletter

Please enter a valid email address.

The bill would also make permanent temporary provisions that allow nurse practitioners to prescribe buprenorphine, a form of medication-assisted treatment, and that waive the current 100-patient limit for physicians wishing to prescribe the drug. It would fund $300 million in training and expanded access to the overdose-reversal drug naloxone for first responders, more stringently require physician use of prescription drug monitoring programs, and fund a variety of other new treatment and outreach programs.

The bill’s quick introduction matches the aggressive timeline congressional leaders had recently begun to outline for opioids-related packages in 2018. The chairmen of the two primary health committees in Congress pledged to push major legislation to address the opioid crisis within the next several months. Energy and Commerce Committee Chairman Greg Walden of Oregon has said he will push the House to pass legislation before Memorial Day, and convened the first of three legislative hearings this week.

Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander of Tennessee has said his committee’s markup could come as soon as the end of March.

The initial CARA, in combination with the 21st Century Cures Act, authorized roughly $1 billion in annual spending on a more limited scope of programs.

Some provisions in the new bill mirror the 56 recommendations issued by the White House commission last November. Members of that commission and treatment experts alike had openly fretted that much of the document was likely to be ignored.

The White House is also holding an “opioids summit” on Thursday, at which Trump adviser Kellyanne Conway — who has largely taken over the White House addiction policy portfolio — and other federal officials are expected to tout steps they have taken since the administration declared a national public health emergency in October.

Erin Mershon contributed reporting.

Leave a Comment

Please enter your name.
Please enter a comment.

  • I’m glad to see that it’s not just “opioid ” addiction conversation, but that theyou acknowledge that drs do dismiss patients with too much medication. But also that they acknowledge those that need the med. I would like to see implementation of the need others have medically and not so much of the “gateway” to more. For those who have chronic pain, we don’t feel the addicting aspect of the med. I can’t imagine the “high” others speak of when I’m getting just a “breakthrough ” basically pain reliever but still leave in pain. People will always take things to another level, but we can’t keep taking away from those who need or deserve. I think we need to focus more on mental health than this. I feel that we fail many in need of help. I have seen it with the foster system, our veterans, and loved ones first hand. They get on a med to help and then go through a process of approval or wait month after month. Well then mental health meds take 2 wks to take affect, then 2 wks laterrible they r back waiting for approval. So many…many ..self medicate. We fail them. We start their need to find mental stability. We help them and then ping pong them. That is the issue. I don’t see chronic pain using meds or having addictive behavior to opioidsee as much as I see those who need the help and we can’t give them a ongoing and stable process of mental well being. Another issue I have seen to cause self medicating or addiction is the ping pong game insurance plays. You pay to be covered and then after one in pain goes through proper process and urine checks and to the day refills, it’s terrible that the insurance has the right to make the call on your wellbeing. They don’t know you. Your Dr does. But they still will sit on one’s well being and quality of life to decide on if one needs their meds prescribed? It’s not right. It’s about the money nit the individual. Unfortunately, we live in a corrupt and greedy world where one rather let another roll in agony and pain then just trust the process and the dr and help keep the quality of life as best as possible. It all becomes labels and money. Not well being, quality of life, or consistency for one’s physical need or mental well being.

Sign up for our Morning Rounds newsletter

Your daily dose of what’s new in health and medicine.