Congress Passes CARA, States to Strengthen Infrastructure and Provider Capacity to Address Opioid Abuse

Congress passed the final version of the Comprehensive Addiction and Recovery Act of 2016 (CARA) on July 13. Major provisions within CARA will expand access to overdose rescue medication (naloxone) and medication-assisted treatment of opioid use disorders.
CARA authorizes or reauthorizes a number of grant programs for states to build infrastructure and provider capacity to address opioid abuse. Some of the notable grant programs for states, communities, and opioid treatment providers include:
Prevention and Reducing Diversion

• Community-Based Coalition Enhancement Grants to Address Local Drug Crises from the Office of National Drug Control Policy ($5 million annually authorized for FY17-FY21)
• Grants for Establishing, Improving, or Maintaining State Prescription Drug Monitoring Programs ($10 million annually authorized for FY17-FY21)

Overdose Prevention

• Opioid Overdose Reversal Medication Access and Educations Grants for states to implement policies to expand access to naloxone ($5 million total authorized for FY17-FY19)
• First Responder Training Technical Assistance Grants for state and local governments ($12 million annually authorized for FY17-FY21)

Substance Use Disorder Treatment 

• Grants to Expand Access to Treatment Interventions for states and local governments ($25 million annually authorized for FY17-FY21)
• Grants for Reducing Overdose Deaths for federally-qualified health centers and opioid treatment programs, and other entities as appropriate ($5 million annually authorized for FY17-FY21)
• Matching Grants to Build Communities of Recovery for eligible non-profit organizations to develop, expand, and enhance community and statewide recovery support services ($1 million annually authorized for FY17-21)

Alternatives to Incarceration

• Comprehensive Opioid Abuse Grant Program from the Attorney General for state and local governments to develop, implement or expand judicial diversion treatment programs ($103 million annually authorized for FY17-21)

CARA also makes significant changes to federal policies that will ultimately increase states’ capacity to provide medication-assisted treatment. Under current law, providers waivered to prescribe and dispense buprenorphine are limited to treating up to 30 patients in the first year and up to 100 thereafter. While the final bill did not directly raise the cap, it granted new authority for the Secretary of Health and Human Services to exclude individuals who are directly administered the medication in the office setting from the limit (i.e., pending approval, the cap may only apply for individuals who receive take-home medication). Furthermore, a clause allowing the Secretary to raise the limit through regulations remains. CARA also extended prescribing and dispensing authority to nurse practitioners and physicians assistants licensed under state law.
The full text of the final language can be found here. A summary is also available. A statement released by the Office of the Press Secretary confirmed that President Obama will sign the bill.