President Signs Opioid Misuse Bill

Saying it would still provide only "modest" steps against opioid misuse in the United States, President Barack Obama signed into law the Comprehensive Addiction and Recovery Act (CARA) on July 22.1

The measure passed overwhelmingly in both houses of Congress earlier that month, but with far less than the $1 billion requested by the president. Republicans wanted to cut the figure because, they said, another recently released draft of a bill would include $581 million toward such efforts. Although Democrats opposed not funding the full amount requested by the president in the original law, they agreed to the cuts because recently announced actions by the US Department of Health and Human Services would cover some of those needs.

The newly signed CARA makes $181 million available to states that request grants for programs that:

* Create alternatives to jailing opioid misusers;

* Examine how to reduce illegal distribution; and

* Train first responders to treat opioid overdoses.

CARA gives a wider range of health professionals and first responders a role in direct action to reduce misuse-or, at least, to reduce deaths.

For example, the law will help make naloxone available to first responders (in addition to providing grants to states to train them). Some nurse practitioners and physician assistants will be able to prescribe buprenorphine. And both physicians and pharmacists will be called upon to use prescription drug monitoring programs before prescribing opioids, in order to catch patients who are abusing the drug by obtaining opioids from multiple providers.

In an effort to bolster existing efforts, the new law will require the federal government and all states to follow a 2003 mandate for hospitals and social service agencies to report, assist, and follow up with drug-dependent infants and their families.

Burwell Announces New Actions

Meanwhile, earlier in July, US Secretary of Health and Human Services (HHS) Sylvia M. Burwell announced several new actions that lawmakers said would mitigate the cuts to the amount requested by the president in the CARA.2 These actions include:

* Expanded access to buprenorphine;

* A proposal to eliminate any potential financial incentive for physicians to prescribe opioids based on patient-experience survey results;

* A requirement that Indian Health Service prescribers and pharmacists check state prescription drug monitoring program databases before prescribing or dispensing opioids for pain; and

* More than a dozen new scientific studies on opioid misuse and pain management.

"At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention,"2 Burwell said in a press release on the HHS website on July 6. "These actions build on this approach. However, if we truly want to turn the tide on this epidemic, Congress should approve the President's $1.1 billion budget request for this work."

Research Priorities

As part of the announcement, the department released a report and inventory on the opioid misuse and pain treatment research being conducted or funded by its agencies. This will provide policy-makers, researchers, and other stakeholders with the full scope of HHS activities in this area. The report is intended to help avoid unnecessarily duplication of research that is currently underway.

For more information, download the HHS infographic on the department's research priorities at http://www.hhs.gov/sites/default/files/opioid-infographic-v6-remediated.pdf.

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