A 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.


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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.

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  • A billion dollars spent on treatment? Why? Everyone is focused on treating the street addict and punishing the ones that never abused any of the medications

  • I am a long time sufferer of an Autoimmune Disease called Rheumatoid Arthritis with permanent damage that causes chronic pain. I just had an Dr.’s appointment today and regardless of the fact I am going through a Flare-up right now, he is still cutting my meds down…as of today! I feel it is sooo wrong of him to do this to a patient dealing with a Flare-up for one, and also holding an anti-anxiety med over my head to either quit taking it or significantly reducing it…which is given to me by another Dr.
    Is there any wonder why I’m so anxious and streesed out to need it?
    He says the according to Doppler (some computer program some Dr’s use to measure dosing pain meds)…I have a “Pretty high number”. But yet, being on these meds for quite a while (over a couple of years for some, and way longer than that for others) none of this was a problem, until now?!
    It doesn’t make any sense! He also did the same thing earlier in the year to get me off it or another muscle relaxer, but revoke my muscle relaxer, again one I had been one since 2005!
    They never had a problem up until recently….?? It doesn’t make any sense!
    I’m sure if it were some patients they would go to street drugs. If the Dr,’s or Government don’t see this, they are all stupid!!

  • I am so sick of seeing commercials for erectile dysfunction and peyonies disease i could vomit. I had my pain management taken away and they passing out pills to stiffen and straighten a penis. Give me a freakin break.

  • I am very concerned about what this new bill will do to long-term chronic pain patients especially after surgery. I recently had back fusion surgery and was physically and emotionally tortured by doctors, nurses, and administrators because of the high doses of pain meds I was already taking and what was needed after having my back cut open. I was not given enough pain meds straying in the recovery room after surgery through two weeks of rehab. People like me should not be labeled the same as people who abuse narcotics and heroin and illegal fentynal. We will suffer greatly after this new bill is passed.

    • I agree 100% im in the same boat. I was treated like they should have put hand cuffs on me over a knee surgery . Im taking lowest dose of pain meds 4 times daily. Then when i had surgery they said dont take what you take daily then gave me a prescription of the same meds and dosage as i was all ready taking. I was in shock and tried to fight them on it. Needless to say i suffered dearly on it. Not to mention i been on this main meds for 6 years no dose change so has little affect on me. So i suffered. After 10 days i told them it hurt so bad and would not give me anymore to take because according to them it should but hurt like that. Im pretty scared to have my knee replacement. Im all most 70 .

  • These new opiate laws are just set up now as population control towards many age groups.
    These groups will vehemently run towards drug dealers and street opiates like heroin and horse tranquilizers.
    To top this off these laws will give life sentences to the street dealera who deal in heroin and opiates.

  • Warning…anything Paul Ryan is involved with is because he took tons of campaign money from the insurance and pharmacy industries…next law? Allowing pharma and insurance companies to be in control if medical marijuana because of the huge amounts of $$$ involved and Ryan will be working for huge salary at one of these companies in the near future just like John boener the last leader of the Republicans

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