February 27, 2018

Whitehouse, Portman Introduce Bipartisan CARA 2.0 Act to Bolster Fight Against Opioid Epidemic

CARA 2.0 increases authorization for opioid funding, limits opioid prescriptions to three days, enhances prescription drug monitoring effort

Washington, D.C. – U.S. Senators Sheldon Whitehouse (D-RI), Rob Portman (R-OH), Shelley Moore Capito (R-WV), Amy Klobuchar (D-MN), Dan Sullivan (R-AK), Maggie Hassan (D-NH), Bill Cassidy (R-LA) and Maria Cantwell (D-WA) today introduced the Comprehensive Addiction and Recovery Act (CARA) 2.0 Act to increase the funding authorization levels for the CARA programs enacted in 2016 and put in place additional policy reforms to help combat the opioid epidemic — including limiting opioid prescriptions to three days.  CARA was a bipartisan, national effort designed to ensure that federal resources were devoted to evidence-based education, treatment and recovery programs that work.  CARA 2.0 builds on this effort by increasing the funding authorization levels to better coincide with the recent budget agreement while laying out new policy reforms to strengthen the federal government’s response to this crisis.  

“Senator Portman’s and my comprehensive addiction bill was an important step forward in our battle against addiction,” said Whitehouse.  “It treats addiction for the disease that it is, and provides support for those walking the long, noble path of recovery.  States like Rhode Island are already putting CARA funding and programs to good use.  Now it’s time to extend CARA’s reach deeper into communities where the opioid crisis rages, and, given what we learned from people on the front lines of that crisis, add new policy reforms we know can make a difference.  I’m pleased to join Senator Portman and this bipartisan group of cosponsors to meld the commitments we made in the funding deal with the progress we enacted in CARA.”

“Now that CARA has been implemented and is starting to help communities around the country, it’s time to start the discussion about reauthorizing this important federal law,” said Portman.  “Passage of CARA was a historic moment, the first time in decades that Congress passed comprehensive addiction legislation, and the first time Congress has ever supported long-term addiction recovery.  Now we have the opportunity to build on this effort, increasing funding levels for programs we know work and implementing additional policy reforms that will make a real difference in combatting this epidemic.  I want to thank Senators Whitehouse and my bipartisan colleagues for their leadership and partnership on this important national effort.”

Beginning in 2014, as part of the process of drafting CARA, Portman and Whitehouse hosted five forums in Rhode Island and across the country with experts and practitioners from the prevention, treatment, law enforcement, and recovery communities to share best practices in their fields.  The objective was to write a bill to incentivize best practices and authorize funding for evidence-based education, treatment and recovery programs that work.  CARA, which became law on July 22, 2016, authorized an additional $181 million for these evidence-based programs, and were funded at $267 million for FY 2017.  There is bipartisan agreement that more resources will be necessary to help turn the tide of this epidemic.  The recent budget agreement includes $6 billion in additional resources for FYs 2018-2019. 

“The Rhode Island Police Chiefs’ Association would like to commend Senator Sheldon Whitehouse for his authoring the original Comprehensive Addiction and Recovery Act which was signed into law back in 2016 and for now asking for an additional $300 million to expand first responder training and access to Naloxone,” said Colonel James J. Mendonca, President of the Rhode Island Police Chiefs Association.  “Rhode Island has recently seen a large number of deaths attributed to substance addiction – specifically opioids – and welcomes the proposed funding to help Rhode Island’s commitment to address opioid addiction.”

As a result of CARA, Rhode Island has received $3 million over three years to create ten Centers of Excellence for Opioid Use Disorders, which are a cornerstone of Governor Gina Raimondo’s action plan to address opioid addiction.  The Centers provide rapid access to treatment and comprehensive services for people struggling with opioid addiction.

CARA 2.0 will build on the original law by increasing the funding authorization levels for CARA’s evidence-based programs to better coincide with the recent budget agreement and laying out new policy reforms to strengthen the federal government’s response to this crisis.  CARA 2.0 will authorize $1 billion in dedicated resources to evidence-based prevention, enforcement, treatment, and recovery programs.

CARA 2.0 Policy Reforms:

  • Imposes three-day limit on initial opioid prescriptions for acute pain as recommended by the Centers for Disease Control and Prevention (CDC), with exceptions for chronic pain or pain for other ongoing illnesses.
  • Makes permanent Section 303 of CARA which allows physician assistance and nurse practitioners to prescribe buprenorphine under the direction of a qualified physician.
  • Allows states to waive the limit on the number patients a physician can treat with buprenorphine so long as they follow evidence-based guidelines. There is currently a cap of 100 patients per physician.
  • Require physicians and pharmacists use their state PDMP upon prescribing or dispensing opioids.
  • Increases civil and criminal penalties for opioid manufacturers that fail to report suspicious orders for opioids or fail to maintain effective controls against diversion of opioids.
  • Creates a national standard for recovery residence to ensure quality housing for individuals in long-term recovery.

CARA 2.0 Authorization Levels:

  • $10 million to fund a National Education Campaign on the dangers of prescription opioid misuse, heroin, and lethal fentanyl (up from $5 million in the original CARA).
  • $300 million to expand evidence-based medication-assisted treatment (up from $25 million in the original CARA).
  • $300 million to expand first responder training and access to naloxone (up from $12 million in the original CARA).
  • $200 million to build a national infrastructure for recovery support services to help individuals move successfully from treatment into long-term recovery (up from $1 million in the original CARA).
  • $20 million to expand Veterans Treatment Courts (up from 6$ million in the original CARA).
  • $100 million to expand treatment for pregnant and postpartum women, including facilities that allow children to reside with their mothers (up from $17.9 million in the original CARA).
  • $60 million to help states develop an Infant Plan of Safe Care to assist states, hospitals and social services to report, track and assist newborns exposed to substances and their families (no authorization in the original CARA).
  • $10 million for a National Youth Recovery Initiative to develop, support, and maintain youth recovery support services (no authorization in the original CARA).


Press Contact

Meaghan McCabe, (202) 224-2921