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A bipartisan Senate bill takes another shot at addressing the opioid crisis

Congressional efforts are mounting. Will they be enough?

Sen. Rob Portman (R-OH) is among the bipartisan group of senators proposing CARA 2.0.
Sen. Rob Portman (R-OH) is among the bipartisan group of senators proposing CARA 2.0.
Alex Wong/Getty Images

A bipartisan group of senators has introduced a bill that would add $1 billion to fighting the opioid epidemic.

The bill is being sold as CARA 2.0 — a follow-up to 2016’s Comprehensive Addiction and Recovery Act (CARA). The new bill would impose new rules to restrict access to opioid painkillers and open up access for opioid addiction treatment while adding $1 billion to facilitate those ideas.

Here are the bill’s new rules, as outlined by Sen. Rob Portman’s (R-OH) office:

  • Establish a three-day limit on initial opioid prescriptions for acute pain, with exceptions for chronic pain or pain for other ongoing illnesses
  • Permanently let physician assistants and nurse practitioners prescribe buprenorphine, a highly effective treatment for opioid addiction, with guidance from a qualified physician
  • Let states waive the cap on how many patients each doctor can prescribe buprenorphine to
  • Require doctors and pharmacists to use prescription drug monitoring programs before prescribing or dispensing opioids
  • Increase civil and criminal penalties for opioid manufacturers if they fail to report suspicious orders or don’t do enough to prevent diversion
  • Create a national standard for addiction recovery housing

The $1 billion in the bill would go to various efforts: $300 million to medications for opioid addiction (the gold standard of care), $300 million to expand first responder training and access to the opioid overdose antidote naloxone, $200 million to better support people moving from treatment into long-term recovery, $100 million to expand treatment for pregnant and postpartum women, and another $100 million would go to a variety of treatment, criminal justice, and education programs.

The measure is supported by Sens. Portman, Sheldon Whitehouse (D-RI), 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).

CARA 2.0 is the latest in a salvo of proposals that has come out of Congress to address the opioid crisis. Earlier this month, Congress agreed to allocate $6 billion over two years to combat the epidemic. The previous largest measure, the 21st Century Cures Act, added $1 billion over two years.

There is solid evidence that more funding for opioid addiction medications in particular could be highly effective. The research shows these medications, such as buprenorphine and methadone, cut mortality among opioid addiction patients by half or more. Since opioid overdoses are linked to tens of thousands of deaths a year in the US, this treatment has the potential to literally save thousands of lives.

It would also address a major gap: According to a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment, in large part due to a lack of supply in care. And other data shows that even when drug addiction treatment is available, fewer than half of facilities offer medications like methadone and buprenorphine as an option.

The bill, by cutting back the supply of painkillers and combating diversion, could also tackle a root cause of the crisis — as many people began misusing opioids through painkillers before they transitioned to opioids like heroin and fentanyl.

It’s not clear if CARA 2.0 will pass. Given that it’s suggesting new funding and Congress is currently working on a large budget measure, it’s possible that the bill or parts of it will be rolled into the budget package.

Still, CARA 2.0’s introduction and other recent actions offer a sign that Congress is, after two decades of this epidemic, finally starting to take the crisis seriously.

But while the attention and changes are welcome, experts have questioned whether the recent moves are still at the level they need to be to end the opioid crisis — which is the deadliest drug addiction epidemic in US history and has already been linked to hundreds of thousands of deaths over the past 20 years.

Congress needs to commit a lot more money

Experts argue that the opioid crisis will require as much as tens of billions of dollars a year to fully address.

In a recent analysis, the New York Times asked 30 experts how they’d spend $100 billion over five years to combat the opioid crisis. On average, experts said that they’d put nearly half the money to treatment — which is the focus of CARA 2.0’s spending. But some of the experts also said that the $100 billion may not be enough.

For reference, a 2016 study estimated the total economic burden of prescription opioid overdose, misuse, and addiction at $78.5 billion in 2013, about a third of which was due to higher health care and addiction treatment costs. So even an investment of tens of billions could save money in the long run by preventing even more in costs.

In 2016, there were nearly 64,000 drug overdose deaths in the US — an all-time high — and at least two-thirds were linked to opioids. The rise in drug overdose deaths was a big reason that life expectancy fell for the second year in a row in the US, which had not happened since the early 1960s.

The early data suggests that 2017 was worse: According to preliminary figures from the Centers for Disease Control and Prevention, there were nearly 67,000 drug overdose deaths in the 12-month period through July 2017, up from more than 58,000 in the 12-month period through July 2016.

To put that in context, drug overdoses in 2016 — or 2017 if the current trends continue — killed more people than guns, car crashes, and HIV/AIDS ever killed in one year in the US, and either year’s death toll is higher than all US military casualties in the Vietnam and Iraq wars combined. Addressing that requires a serious financial commitment.

Congress is stepping up with more proposals that get closer to that kind of commitment. But it’s probably not enough yet.

For more on the opioid epidemic, read Vox’s explainer.