Shaheen Joins Group of Senators to Introduce Bipartisan CARA 2.0 to Increase Access to Treatment & Prevention, Bolster Fight Against Substance Use Disorder Epidemic

December 11, 2020

**CARA 2.0 builds upon Comprehensive Addiction & Recovery Act programs enacted in 2016 by increasing the funding authorization levels and laying out new policy reforms to strengthen the federal government’s response to this crisis**

**Shaheen has led efforts in the Senate to respond to the substance use disorder epidemic**

(Washington, DC) — U.S. Senator Jeanne Shaheen (D-NH), a senior member of the Senate Appropriations Committee, and U.S. Senators Rob Portman (R-OH), Sheldon Whitehouse (D-RI), and Amy Klobuchar (D-MN) introduced the Comprehensive Addiction and Recovery Act (CARA) 2.0 to increase the funding authorization levels for the Comprehensive Addiction & Recovery Act (CARA) programs enacted in 2016 and put in place additional policy reforms to help combat the opioid epidemic that has worsened during the coronavirus pandemic. CARA was a bipartisan, national effort designed to ensure that federal resources were devoted to evidence-based education, treatment and recovery programs that work. In FY 2020, CARA programs were funded at $658 million. CARA 2.0 builds on this effort by increasing the funding authorization levels and laying out new policy reforms to strengthen the federal government’s response to this crisis. The CARA 2.0 bill text is here, section-by-section here, and a summary here.

“One of the most serious challenges of the pandemic is its effect on the substance use disorder epidemic – our communities are forced to respond to one public health crisis exacerbated by another. As COVID-19 cases surge and the impact of the crisis bears down, we need to bolster our response to the substance use disorder epidemic to meet the extreme challenges worsened by COVID. That is precisely why this expansion of the CARA bill is so urgently needed,” said Shaheen. “This bill addresses a number of priorities, including expanded access to medication-assisted treatment to help those with their recovery, which has been a critical tool for treatment providers in New Hampshire. This legislation builds on our bipartisan bill that was signed into law four years ago. I hope we can usher in that same bipartisan spirit to get this done a second time.”

CARA 2.0 authorizes $765 million in dedicated resources to evidence-based prevention, enforcement, treatment, criminal justice, and recovery programs. CARA 2.0 is part of the necessary response to the urgent call for adequate and sustained resources that appropriately reflect the magnitude of the crisis.

CARA 2.0 Policy Changes:

  • New research into non-opioid pain management alternatives
  • New research on long-term treatment outcomes to sustain recovery from addiction
  • Establishes a National Commission for Excellence in Post-Overdose Response to improve the quality and safety of care for drug overdoses and substance use disorders.
  • Sets a three-day limit on initial opioid prescriptions for acute pain as recommended by the Centers for Disease Control and Prevention (CDC).
  • Requires physicians and pharmacists use their state PDMP upon prescribing or dispensing opioids.
  • Mandates physician education on addiction, treatment, and pain management.
  • Prohibits States from requiring prior authorization for medication-assisted treatment under Medicaid.
  • Establishes a pilot program to study the use of mobile methadone clinics in rural and underserved areas.
  • Removes the limit on the number patients a physician can treat with buprenorphine and methadone.
  • Creates a sense of Congress that an employee using medication-assisted treatment is not in violation of the drug-free workplace requirement.
  • Permanently allows providers to prescribe medication-assisted treatment and other necessary drugs without a prior in-person visit, and to bill Medicare for audio-only telehealth services.
  • Expands access to federal housing for individuals who have misused substances or have a drug-crime conviction.
  • Incorporates changes in grant programs to gather more data on who receives services to achieve more equitable outcomes across race and socioeconomic status and emphasizes delivering culturally competent services.

CARA 2.0 Authorization Levels:

  • $10 million to fund a National Education Campaign on the dangers of prescription opioid misuse, heroin, and lethal fentanyl.
  • $25 million for training and employment for substance abuse professionals, including peer recovery specialists.
  • $300 million to expand evidence-based medication-assisted treatment (MAT).
  • $200 million to build a national infrastructure for recovery support services to help individuals move successfully from treatment into long-term recovery.
  • $100 million to expand treatment for pregnant and postpartum women, including facilities that allow children to reside with their mothers.
  • $20 million to expand Veterans Treatment Courts.
  • $10 million for a National Youth Recovery Initiative to develop, support, and maintain youth recovery support services.
  • $50 million to provide quality treatment for addiction in correctional facilities and in community reentry programs. 
  • $30 million for deflection and pre-arrest diversion programs in the criminal justice system.

Senator Shaheen has led efforts in the Senate to respond to the substance use disorder epidemic. In 2018, Senator Shaheen helped negotiate a bipartisan agreement that resulted in a large national increase in opioid treatment funding through the State Opioid Response (SOR) grant program over two years – including $28 million this year. The Senators helped negotiate a 15 percent set-aside of federal funding for hardest hit states, which has helped states hardest hit, like New Hampshire. These combined efforts led to a 1000% increase in federal treatment and prevention funding for New Hampshire. Last year, Senator Shaheen spearheaded new legislation—the Turn the Tide Act —to increase the availability of substance use disorder treatment. A key component of her legislation to allow treatment providers to use SOR grants to treat help patients suffering from methamphetamine and cocaine dependency, in addition to opioid use disorder, was included in funding legislation signed into law in 2019. In the Commerce, Justice Science and Related Agencies (CJS) government funding legislation for fiscal year (FY) 2021, Shaheen – who is the Vice Chair of the subcommittee – successfully added measures that increased federal support for key programs that respond to the substance use disorder crisis, including $50 million for the Drug Enforcement Agency (DEA) to construct a new drug laboratory in New England, which presently does not have one, to improve lab testing in the region. As the COVID-19 pandemic continues to impact New Hampshire, the congressional delegation has repeatedly called for additional funding for substance use disorder services in a COVID-19 relief package. In October,  Shaheen and the New Hampshire Congressional delegation announced $1.75 million to fund a Family Treatment Court (FTC) pilot project – the state’s first FTC – in Sullivan County to help enhance access to services for children and families experiencing abuse and neglect, and those impacted by substance use disorder (SUD) and/or mental illness.