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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  • What the government has done to chroinc pain patients is very cruel. They have cut meds. So low that most of chronic pain patients are staying in bed most of the time.because the pain is so severe. Goverment needs to let the doctos give patients as much pain meds as they need. That why doctors went to school for 8 to 10 yrs
    Each patient is different. Some patients need more. And some need less. A person should not have to suffer
    Its time the government dea and ect stay out of this
    Chronic pain patients do the right thing with there pills. And they should worry about the big drug dealers. And veterans gave there life when they joined. And A lot of pain patients are killing there self. Because they can’t stand the pain.

  • Many chronic conditions result in chronic pain.
    Management of these disabilities involve one, maybe two narcotics and other medications specific to the different chronic ailments.
    If the treating physician is forced to see the patient monthly, to write for a new narcotic prescription, acute and chronic sick patients would be unable to be seen in office when needed.

  • MLS, Helene,Lynnea & others. Your Drs. can file with the insurance of why it is medically necessary for you to have this high dosage & have a 12 month ext. & possibly longer. I am very lucky I have a caring pain management Dr. who earlier explained this was going to happen. He said pain manage Drs. are working with medicare about their patient care. It does seem that some of you don’t have a Dr. like I do who has read what medicare wants in the new regulations & passed it on to his patients. IF YOU MEDICALLY NEED THE MEDS YOU ARE NOW ON, YOUR DR. CAN SEND YOUR PROOF & your meds can be extended up to 12 months. But. During that time your Dr. & you will have to try to reduce or change some of the meds you are taking or some other means to help lower the med dosage. It also means you will have to make life changes. many are already living below “quality of life”. No, that isn’t fair. But life is never fair for the people in this country who have had to work their health into the ground, just to make ends (sometime) meet. For people who are going to have surgery. It will be up to you to stand your ground about the extra pain meds you will need. Find things on the Web to back your claims up. They are there. Then make sure the Dr. or PA who will be caring for you in the hospital gets it before & after your surgery. Don’t yell, raise your voice or act like a crazy person (even if you are. remember, these people do not understand what you are going through. Pain will drive anyone crazy) Get your Spouse, family or friend to help speak up for you after surgery. It’s hard, but I have done it many times for myself & my husband. Also, before surgery, lower the amount of meds you take. Yes, you will hurt, but it will be much worse after surgery. Keep up with what pain meds you get at the hospital. What I had to do before I learned how to make the medical people listen to me, was keep up with how much pain meds I was getting, which was lower than I was prescribed, then called my pain management Dr.’s office & told them what was happening. I got relief. Our problem is because of some Drs. who let people “Dr. shop” to get pills. Also, there are addicts who will find any means to get drugs & there are people on pain management who sell their meds. These are only part of the reason people like us will now have to suffer even more than we already do. The people who keep up with how many people who die because of opiates are also not seeing that probably many of those who do die do so on purpose. Again, they don’t know or care what it’s like to live each & every day in some of the worse possible pain satan made. Then there comes a point that life isn’t worth fighting for when all you have to look forward to is more pain. Even my Dr. doesn’t understand how awful it feels to hardly ever get any sleep & when I do it isn’t really sleep. It’s just my brain can no longer remain awake after 4 days with no sleep. I just fall unconscious until someone makes me get up or the pain finally breaks through to my brain again & says OH MY GOD! PLEASE TAKE ME HOME!!! There are too many Drs. who have never hurt more than a few days in their life who are now in charge of our life. Who thinks we can just lower the mg. we take every day & help us by keeping us from going into withdrawal. Then in a little while thy can give us fake drugs to help our pain. Like we haven’t already tried them. Don’t get me wrong, they have helped some people, but not many. When I was put on them, I didn’t know what they were. I only knew that I couldn’t take the pain & begged the Dr. to change me to something else.(I got rid of him super fast, after the awful pain I went through. Words couldn’t describe the pain. Pulling my toe nails out one by one would have been a walk in the park) My life was a living Hell. I couldn’t bear the pain any longer & the Dr. wasn’t listening. I OD on my anxiety meds to make the pain stop. I was surprised when I woke up in the ICU. I thought the next site I would see was satan himself. So, I guess that’s what will happen before too long with everyone living in pain & the Drs. can’t do anything to stop the pain, because the government knows more than Drs. But, I’m beginning to believe the whole thing is about money.
    I hope that your Dr. will do everything he can(while he can)to help you get through this awful time everyone with pain will be going through. We can’t even get a group together to try to aid in a fight against this, because the news media will do to us like they do to Trump. Treat us like we are unworthy. Good luck to all & may God help you through your pain.

  • 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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