Breaking Down the 'Comprehensive Addiction and Recovery Act'

A brief bill history and condensed section-by-section analysis of the final conference committee report

It's no secret that America is facing a public health crisis involving opioids and other substance use, and that it is taking hundreds of lives every day. With awareness rapidly increasing in recent years, we have seen a public outcry over this issue in communities throughout the country. As a result, advocates—including grassroots individuals, coordinated groups and organizations like the Hazelden Betty Ford Institute for Recovery Advocacy—have helped propel movement toward policy solutions.

Beginning in 2014, the Comprehensive Addiction and Recovery Act (CARA) was sponsored by Sens. Rob Portman (R-OH) and Sheldon Whitehouse (D-RI). At inception, the bill received limited support on Capitol Hill, though the recovery community provided steadfast backing right away.

CARA of 2014 ultimately stalled in committee, and the Congressional session ended without much ado concerning substance use. However, at the onset of the 2015-16 session, CARA was re-introduced, this time in both the Senate and House. Due to the tenacity of advocate voices, the leaders behind the legislation, and the dramatic increase in opioid-related overdose deaths in virtually every Congressional district in America, CARA began to collect a large number of bipartisan sponsors. And when the addiction crisis became a significant issue in the early presidential primaries, it began to look like a rare opportunity for the parties to accomplish something together.

In March 2016, the Senate passed CARA on a 94-1 vote. In the House, however, CARA stalled and a package of related opioid bills was passed instead. Because the House package, approved almost unanimously in May, covered the same legislative territory as the Senate-passed CARA, both chambers agreed to combine all of the bills and reconcile the differences in what's called a conference committee. Members of both the Senate and House met together to come up with a single new compromise bill, also known as a conference report, which was issued July 5 under the name of the original proposal, the Comprehensive Addiction and Recovery Act.

On July 8, the full House voted 407-5 to accept the conference report. Senators followed suit with a 92-2 vote on July 13, sending the bill to President Obama. He signed it into law on July 22, despite misgivings about funding. (See why we supported his decision to sign.)

Below is our section-by-section description of the final version of CARA. We examined the 217-page bill (another version is crammed into 104!) and whittled it down for easy consumption.

The column at right indicates any new federal funding that was authorized, and we've highlighted in yellow all of the sections with authorized funding. In total, the bill authorizes $187 million in new annual spending to address addiction, most of which is authorized through 2021. Congress still needs to be persuaded to include the funding in later "appropriations," or spending, bills. Sections or provisions of CARA with no new funding authorized will need to be executed using existing funding sources, or not executed at all. Some provisions, you'll note, do not require funding.


Sec. 101. Creates a federal interagency task force to study and make recommendations on safe and effective pain management.

Sec. 102. Allows the U.S. Health and Human Services Department (HHS) to conduct public awareness campaigns on the risks of prescription drugs.

Sec. 103. Allows federal grants to community-based coalitions addressing local drug crises. .

Authorizes $5M/year in new funding for 2017-2021

Sec. 104. Allows HHS to create materials and resources aimed at preventing youth injured in sports from becoming addicted to pain pills.

Sec. 105. Allows federal demonstration grants to help states streamline processes by which military veterans trained in emergency services can attain civilian licenses and certifications.

Sec. 106. Instructs the Food and Drug Administration to look at improving the opioid warning labels regarding use by children, and to make recommendations on prescriber education, among other provisions.

Sec. 107. Allows grants to federally qualified health centers, addiction treatment programs and other entities to expand the availability and use of medications to reverse opioid overdoses (i.e. naloxone).

Authorizes $5M/year in new funding for 2017-2021

Sec. 108. Allows the National Institutes of Health to expand research on pain and the safe treatment of it.

Sec. 109. Reauthorizes the National All Schedules Prescription Electronic Reporting Act (NASPER), which provides grants to states for establishing or improving their prescription drug monitoring programs.

Authorizes $10M/year in new funding for 2017-2021

Sec. 110. Allows federal grants to states for expanding access to opioid overdose reversal medications (i.e. naloxone).

Authorizes $5M/year in new funding for 2017-2019


Sec. 201. Allows federal grants to states, local governments and American Indian tribes for the following purposes:

  • Expand alternatives to incarceration
  • Promote criminal justice and addiction treatment collaborations
  • Train police and first responders on using opioid reversal drugs, i.e. naloxone
  • Crack down on illicit opioid distribution activities
  • Expand or develop medication-assisted treatment programs to be used or operated by criminal justice agencies
  • Strengthen state Prescription Drug Monitoring Programs
  • Develop or expand opioid prevention and treatment programs for youth
  • Develop more child-resistant medication containers
  • Conduct prescription drug “take-back days”
  • Develop, implement or expand an integrated and comprehensive opioid misuse response program.

Authorizes $103M/year in new funding for 2017-2021

Sec. 202. Allows federal grants to states, local governments and American Indian tribes to train first responders on using opioid reversal drugs (i.e. naloxone) AND to “establish processes, protocols and mechanisms for referral to appropriate treatment, which may include an outreach coordinator or team to connect individuals receiving opioid reversal drugs to follow-up services.”

Authorizes $12M/year in new funding for 2017-2021

Sec. 203. Allows the federal government to work with state and local governments to coordinate prescription drug “take-back day” efforts.


Sec. 301. Allows federal grants, contracts and cooperative agreements to states, local governments, nonprofit organizations and American Indian tribes to expand access to evidence-based addiction treatments, including medication-assisted treatment for opioids. (This is the funding the White House and Congressional Democrats have sought to increase.)

Authorizes $25M/year in new funding for 2017-2021

Sec. 302. Allows federal grants to recovery community organizations to support their operations. Also requires that RCOs receiving federal grants obtain at least 50 percent of their funding from other sources.

Sec. 303. Allows nurse practitioners and physician assistants to become certified to prescribe medications like buprenorphine to treat opioid use disorders.

Also requires that those who prescribe medications to treat opioid use disorders have the capacity to provide directly, or by referral, appropriate counseling and other appropriate ancillary services.

And it clarifies the Administration may, by regulation, increase the maximum number of patients to which a single prescriber may provide medications for opioid use disorder. (In fact, the Administration already used that authority to increase the maximum from the statutory limit of 100 to now 275).


Sec. 401. Commissions a government study and report with recommendations on how to ensure those convicted of nonviolent drug offenses are not unintentionally impeded from resuming personal and professional activities.


Sec. 501. Allows grants to support programs that improve addiction treatment for pregnant and postpartum women.

Authorizes $17M/year in new funding for 2017-2021

Sec. 502. Allows grants to establish or expand drug courts for military veterans, peer-to-peer support services for veterans, and other related veteran services.

Sec. 503. Establishes new guidelines for states that receive federal grants to help provide care for infants affected by addiction.

Sec. 504. Commissions a federal study and report with recommendations on how to ensure access to treatment for babies born with neonatal abstinence syndrome.


Sec. 601. Allows demonstration grants to support state efforts to develop a comprehensive response to the prescription opioid crisis. These grants can support a number of different efforts, including public education on opioids and related issues, PDMP improvements, expanded access to treatment, recovery high schools, collegiate recovery programs, screening for Hepatitis C and HIV, and prevention of overdose deaths.

Authorizes $5M/year in new funding for 2017-2021


Secs. 701-707. Among other things, these sections allow partial refills of certain prescription drugs, request an assessment of “Good Samaritan” laws, promote Medicare administrative practices that prevent prescription drug misuse, and appear to make routine deposits into the Medicare and Medicaid Improvement Funds.

One other provision would exempt opioid manufacturers from having to charge lower prices to the Medicaid program, so long as they have new abuse-deterrent formulations. We agree with a gentleman quoted in Modern Healthcare, who said drug-makers should not need a financial incentive like that to make safer products. It’s likely to cost the Medicaid program a lot of money, for no apparent reason.


Sec. 801. Protects classified information in federal court challenges related to the Narcotics Kingpin Designation Act.


Secs. 901-902, 911-915, 921-923, 931-932, 941-943 and 951. This part of CARA is known as the Jason Simcakoski Memorial and Promise Act. Simcakoski was a 35-year-old Marine Corps vet who died at the Tomah Veteran's Administration in Wisconsin from a toxic combination of prescription medications. His death prompted a 17-month investigation and calls for the VA to overhaul the way it works with opioids and treats pain.

These sections cover a lot of ground, requiring that veterans receiving opioids be subjected to random drug tests at least once a year, that VA pharmacies make the overdose reversal drug naloxone available to outpatients receiving opioids and that VA prescribers participate in state drug monitoring programs. They also require the VA to update its guidelines for opioid therapy and pain management, provide additional training for VA prescribers, give lawmakers more direct oversight of the department and create a new office of patient advocacy so that people who are supposed to intervene on behalf of veterans don't report to the directors of their particular facility.

Jeremiah Gardner, Mgr of Public Affairs and AdvocacyJeremiah Gardner, manager of public affairs and advocacy at the Hazelden Betty Ford Foundation, is a person in long-term recovery with a master's degree in addiction studies and a background in journalism, public affairs, business and music.
Robert Ashford Robert Ashford, graduate student at the University of Pennsylvania School of Social Policy and Practice, is a person in long-term recovery who contributes regularly to the Huffington Post, Renew Magazine, Addiction Unscripted and our Institute for Recovery Advocacy.
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