Comprehensive Addiction Legislation Falls Short, Lacks Needed Funding

That’s the good news.

The other news: While the bill that was approved 407-5 Friday by the U.S. House represents important progress in the federal approach to addiction, it does not accomplish all that it could, or all that is needed.

We sent emails to House and Senate offices late last week with information and resources on the topic of opioids—the class of drugs that includes heroin, fentanyl and prescription pain medications, and that has fueled an epidemic of overdose deaths. In the messages, we expressed support for the conference committee report on the Comprehensive Addiction and Recovery Act (CARA). Recognizing the revised bill’s shortcomings, we also alluded to future Congressional work on this issue, which we hope to see. 

While many advocates are celebrating the bill’s passage by the House, others have decided to oppose the current version of CARA—encouraging the President and members of the Senate to reject the bill unless it is strengthened.

Indeed, CARA presents a classic political conundrum. Support something that falls short of the ideal? Or, voice opposition that could contribute to the worst-case scenario—getting nothing passed at all?

If it is enacted—especially on the heels of the Mental Health Parity and Addiction Equity Act and the Affordable Care Act, both of which significantly expanded access to treatment for substance use disorders—we should recognize how far we have come in a short amount of time

We remain supportive, seeing a do-nothing stalemate as a substantially greater risk than an insufficient bill.

That said, just to get them on the table, here are a few disappointments in the final bill:

It no longer includes an important provision related to Prescription Drug Monitoring Programs (PDMPs). Only eight states require doctors to check a patient’s medication history in the PDMP before writing a prescription for opioids or other addictive drugs. As a result, utilization of these databases is low, making it difficult for prescribers to spot certain signs of misuse and addiction. For example, if someone is “doctor shopping”—or getting prescriptions from multiple doctors—it is much harder to detect in a state where PDMP use is not required. We have been advocating that Congress incentivize PDMP utilization by restricting federal grants to those states that require it. Unfortunately, that significant common sense reform was stripped from the bill in the conference committee.

The bill no longer authorizes any new funding for recovery community organizations, and supports recovery high schools and collegiate recovery programs only by including them in a long list of possible purposes for limited state grants. We know that recovery from substance use disorders only begins during treatment and that robust community and educational support structures are essential to people staying well—every bit as essential as treatment. Even so, public investments have been traditionally minimal when it comes to community-based recovery supports, and yet, unlike treatment, they have limited revenue potential. In other words, recovery supports are not only direly needed in our public health infrastructure, but they also require public assistance.

While the bill authorizes no funding for some provisions, it authorizes inadequate funding for others, and does not include emergency funds to fulfill any of its authorizations. Opioids alone killed almost 30,000 people in 2014, and the death toll has shown few signs yet of letting up. In our view, the opioid epidemic is certainly a national emergency that warrants potent investments in all of CARA’s provisions and the certainty of emergency funding. However, Congressional leaders have rejected emergency spending in favor of funding the bill through the regular appropriations process, i.e. via separate spending bills, meaning CARA programs and grants will compete with other federal priorities as lawmakers divvy up available budget dollars. That’s not to say the regular appropriations process won’t result in increased spending to fight addiction. Key Congressional leaders have pledged to fund CARA’s $187 million in authorizations. But the appropriations process is always vulnerable to political fights that can gum up even the most bipartisan of efforts. And, unfortunately, a more significant investment—certainly anything resembling the President’s $1.1 billion proposal, which would have greatly expanded access to opioid use disorder treatment—is no longer on the table.

While it appeared some Members of Congress were willing to vote against the bill in the absence of emergency funding, the almost unanimous House vote signals that Senate passage is now more likely.

We and our fellow advocates—the millions around the country impacted by substance use and related problems, and knowledgeable about the promise of prevention, treatment, recovery and criminal justice solutions—must continue to lend our voices in the coming weeks, months and years.

It’s worth remembering that this bill has received overwhelming bipartisan support at every stage where a vote has been taken. Prior to each nearly unanimous committee and floor vote, debate has centered on funding—with one camp wanting a huge billion dollar investment, and the other less sure that more money is the answer and wanting to consider funding in the context of other federal priorities. Whichever side of the fence you fall on, those are all legitimate views. And most Americans probably fall somewhere in the middle. So, it is reasonable, in a divided government, to expect a compromise such as that of the final CARA bill. Indeed, most of us have been pining for more compromise among our policymakers. To reject CARA, in our view, would be to reject the idea of collaborative compromise.