What Is CARA (The Comprehensive Addiction and Recovery Act of 2016)?

By now, you may have heard of the Comprehensive Addiction and Recovery Act (CARA) of 2016. Designed to establish “a comprehensive, coordinated, balanced strategy through enhanced grant programs that would expand prevention and education efforts while also promoting treatment and recovery,” the bill passed the U.S. Senate on March 10, 2016 by a nearly unanimous vote. However, funding for the bill has not yet been approved as I write this blog.

Increasing Access to Treatment for Opioid Addiction 

CARA contains many provisions that are very welcome. These include making naloxone available to law enforcement agencies and other first responders to help reverse overdoses, creating new disposal sites for unwanted prescription medication to keep pills out of the wrong hands and prevent them from being diverted, and expanding prescription drug monitoring programs to help track prescription drugs so they’re not misused.

Essentially, CARA is designed to increase access to treatment for opioid addiction. That’s good, but it should have done more. It should have focused on alternative ways to treat pain patients. This would prevent some opioid addiction by limiting the number of people whose only option for pain relief are opioids and are vulnerable to addiction. It should have provided a more comprehensive approach to the problem by providing more treatment options that are affordable.

Decriminalizing the Disease of Addiction 

In addition, the bill should have taken steps to decriminalize the disease of addiction. The stigma and cost of admitting to an addiction prevents many people from accessing treatment earlier in the disease process. An earlier diagnosis potentially could save them, and their loved ones, years of needless suffering.

In my book, The Painful Truth, I tell the true story of my patient, Rachel Hutchins (which is a pseudonym). She slid into using opioids to treat her pain and despair, and then couldn’t escape its hold because of the shame associated with seeking treatment for her addiction. She tried an herbal-like treatment that she bought via spam emails, and she self-medicated with diverted methadone to avoid the legal ramifications and shame of admitting to an opioid addiction.

As Rachel’s story illustrates, we need to reduce the barriers to treatment. We can do this partly by decriminalizing addiction which, among other benefits, would help remove the stigma that society places on people who are addicted.

This means conducting a public awareness campaign and changing the laws that prevent people from seeking treatment.

Opioid addiction costs America about 70 billion dollars annually. The proposed funding for CARA may increase access for some people to treatment programs (it’s not a foregone conclusion that it will for everyone since the bill does not decriminalize addiction), but it will probably also increase the annual cost of addiction in America.

It would seem prudent to place as much, if not more, emphasis on preventing the terrible disease of addiction from occurring as it would on treating addiction once it has a hold on an individual. Here is where there could be a rub:

Many people feel that reducing access to opioids is the best way to prevent exposure which, for some people, can lead to overuse and addiction. The challenge is to do this while still allowing people with pain who benefit from using opioids access to the medication.

Three Fundamental Approaches That Could Prevent Opioid Addiction: 

There are three fundamental approaches that I feel could prevent opioid addiction and enhance the care for people in pain.

• Expand pain and addiction education in medical, dental, and nursing schools. Don’t limit education to only addiction. Include pain assessment and treatment education, too.
• Ensure that insurance coverage and provider reimbursement allow for evidence-based alternatives to opioid medications for the treatment of pain. In other words, be sure that health insurance covers alternative pain treatments so they’ll be affordable for patients with pain. Payers should be required to provide a set of minimum benefits to people in pain.
• Support more funding through the National Institutes of Health to discover safer, more effective alternatives to opioids for the treatment of severely painful conditions.

The CARA legislation is a good step forward, but it is only a partial solution to the current opioid crisis. Next, there should be legislation that addresses the needs of people in pain with the same degree of urgency. The opioid crisis cannot be solved without simultaneously solving the needs of people in pain.

 

Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD