What law was passed in 2016 to address the opioid epidemic?

The Comprehensive Addiction and Recovery Act (CARA) Was Passed in 2016 to Address the Opioid Epidemic

The Comprehensive Addiction and Recovery Act (CARA) was passed by Congress and signed into law by President Obama in July 2016 as the primary federal legislative response to the opioid epidemic. 1 This landmark legislation represented the first major federal addiction legislation in over 40 years and took a comprehensive approach to addressing the growing opioid crisis in the United States.

Key Components of CARA

CARA directed the Department of Health and Human Services and other federal agencies to implement several critical initiatives:

1. Development of Best Practices for Pain Management

   • Convening a task force to develop evidence-based approaches to pain management
   • Supporting safer prescribing practices to reduce inappropriate opioid use

2. Expanded Access to Life-Saving Treatments

   • Providing grants to increase availability of naloxone, a life-saving opioid antagonist that can reverse overdoses
   • Authorizing grants for law enforcement agencies to purchase naloxone and train first responders in its use

3. Alternative Approaches to Incarceration

   • Developing treatment alternatives to incarceration programs
   • Shifting from a punitive to a treatment-focused approach for non-violent drug offenders

4. Comprehensive State Response

   • Distributing grants to states for comprehensive opioid abuse response initiatives
   • Supporting state-level prevention, treatment, and recovery programs

5. Additional Provisions

   • Expanding prescription drug take-back programs
   • Authorizing funding for family-based treatment of substance use disorders
   • Initiating demonstration projects for evidence-based opioid treatment and interventions

Funding and Implementation Challenges

While CARA authorized more than $181 million annually for two years to fund these initiatives, the legislation faced implementation challenges:

• Funds required yearly appropriation through the regular budget process
• Budget constraints and "pay-for" requirements created barriers to full implementation
• The trend toward deficit reduction complicated consistent funding

Complementary Legislation

The 21st Century Cures Act, signed into law in December 2016, provided an additional $1 billion specifically for state efforts to combat the opioid epidemic, supplementing CARA's initiatives 1.

Impact on Medication-Assisted Treatment

CARA helped expand access to medication-assisted treatment (MAT) for opioid use disorder:

• Supported the expansion of buprenorphine prescribing capabilities
• By 2016, the federal government had increased the patient limit for qualified physicians prescribing buprenorphine from 100 to 275 patients 1
• Supported pilot projects allowing nurse practitioners and physician assistants to prescribe buprenorphine where permitted by state law

Public Health Significance

CARA represented a shift in federal policy toward viewing substance use disorders as public health issues rather than criminal justice problems. This approach aligned with evidence showing that medication-assisted treatment combined with behavioral therapies is the most effective approach for reducing mortality and improving quality of life for individuals with opioid use disorder 1, 2.

Pitfalls and Limitations

Despite its comprehensive approach, CARA faced several limitations:

• Funding constraints limited full implementation of authorized programs
• Persistent stigma around medication-assisted treatment remained a barrier
• Workforce shortages in addiction medicine limited treatment expansion
• Geographic disparities in treatment access persisted, particularly in rural areas

CARA marked a significant step forward in addressing the opioid epidemic through a comprehensive, public health-oriented approach, but required ongoing funding commitments and complementary initiatives to achieve its full potential in reducing opioid-related morbidity and mortality.