Far-Reaching Opioid Bill Goes to Obama for Signature

July 13, 2016

Opioid-epidemic legislation aimed at helping everyone from pregnant women and infants to veterans and inmates goes to President Barack Obama for his yea or nay after the Senate passed it in a 92-to-2 vote today.

The bill, called the Comprehensive Addiction and Recovery Act (CARA), also allows nurse practitioners and physician assistants to prescribe buprenorphine to treat addiction to widely prescribed and widely abused opioids.

The bill passed the House by a vote of 407 to 5 last week.

The massive bipartisan majorities in favor of CARA mask partisan rancor over the bill's funding, which right now stands at zero. CARA has no provisions to pay for itself, although Democrats unsuccessfully tried to add some to the tune of nearly $1 billion, close to the amount recommended by Obama for battling opioid abuse and addiction. A GOP-crafted appropriations bill in the House would set aside $581 million to address the crisis, but its legislative future is far from certain in a volatile Congress. Sen Charles Schumer (D-NY) said on the Senate floor that he didn't trust his Republican colleagues to come through with the money, given their track record of cutting the budgets of drug-abuse programs.

"Without actual appropriations, this bill is like a Hollywood movie set: something that appears real on the surface but has no substance and no life behind its false facade," said Schumer.

It is not clear whether Obama intends to sign CARA. In March, the White House said that without funding, the bill "would do little to address the epidemic." The administration also faulted the bill for an unnecessary feasibility study on training prescribers.

Clinicians treating opioid addiction also are disappointed by the dearth of dollars.

"We need that funding," said Andrew Kolodny, MD, executive director of Physicians for Responsible Opioid Prescribing, in an interview with Medscape Medical News. "CARA alone will not be very helpful."

Attacking the Epidemic From All Angles

Since 1999, deaths from prescription opioids such as oxycodone and hydrocodone have quadrupled, closely tracking the increase in the amount of prescription opioids sold in the United States, according to the Centers for Disease Control and Prevention. More than 14,000 people died from overdosing on a prescribed opioid in 2014.

CARA attacks this epidemic from all angles — prevention, treatment, research, and law enforcement. Among other things, the bill would do the following:

  • Make naloxone, a drug that reverses an opioid overdose, more widely available and train clinicians, pharmacists, and first responders in how to use it.

  • Create or expand programs to prevent and treat opioid addiction among veterans and pregnant women, including those in prison.

  • Allow pharmacists to partially fill prescriptions for opioids to help reduce the amount of unused pills, which can find their way into the wrong hands.

  • Toughen opioid prescribing protocols at Veterans Affairs facilities.

  • Launch a study into improving care for newborns who are in withdrawal from an opioid addiction passed onto them by their mothers.

  • Award grants to state, local, and tribal governments to investigate illegal opioid distribution.

  • Strengthen prescription drug monitoring programs that operate at the state level to track the diversion of controlled substances and identify opioid-seeking "doctor shoppers."

Follow Robert Lowes on Twitter @LowesRobert

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