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.

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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  • The best way to control pain after surgery it to ignore the DR orders TO TAKE WHOLE DOSE EVERY 4 hours! DO this instead: cut all pain meds into quarter pieces. Take first dose as instructed by your doc…then as soon as you feel ANY pin take one quarter of the med and continue this. You will find you have leftover meds! It works and Yes pain specialist is a part of my job description for many years. I have taught this to many patients and no I did not learn this in medical school my dentist taught me after a root canal!
    Someone needs to tell the stupid lawmakers what is really going on. Fix the problem where the problem is not where it is easy for you to develop political soundbites for campaign F$ & Photo opportunities.

  • Someone needs to tell the stupid lawmakers what is really going on. Fix the problem where the problem is not where it is easy for you to develop political soundbites for campaign F$ & Photo opportunities.

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