With Obama’s signature, expansive opioid policies become law

Comprehensive Addiction and Recovery Act recognizes pharmacists as key players in fight against the opioid epidemic

President Barack Obama has signed sweeping legislation aimed at tackling the nation’s opioid addiction crisis. The Comprehensive Addiction and Recovery Act of 2016 (CARA) provides a framework for opioid abuse prevention and treatment and includes provisions that highlight pharmacists’ role in curbing the epidemic. The law enjoyed massive bipartisan support, passing 407–5 in the U.S. House and 92–2 in the U.S. Senate.

Pharmacists are part of the solution
CARA comprises 18 separate acts, several of which leverage pharmacists’ services to prevent opioid-related deaths. A provision known as Lali’s Law makes available to states federal grants to fund programs that allow pharmacists to dispense naloxone without prescriptions. The Co-Prescribing to Reduce Overdoses Act encourages health care providers who prescribe opioids to simultaneously prescribe opioid overdose reversal drugs, including naloxone. The act also calls for expanded access to opioid overdose antidote medications for caregivers of at-risk individuals.

Other provisions allow partial fills for Schedule II controlled substances and create a federal pain management task force to identify inconsistencies between best practices for pain management and opioid prescribing guidelines. The task force will include a pharmacist.

CARA will also require FDA to work with an advisory committee before approving opioids that are not abuse-deterrent. Nurse practitioners and physician assistants are eligible to prescribe certain medication-assisted treatment under the new law, and the Secretary of the U.S. Department of Health & Human Services may, by regulation, revise the requirements for practitioner eligibility to prescribe such treatment. The law lays out several initiatives specifically targeting babies, pregnant and postpartum women, veterans, and juveniles.

In April, APhA sent a letter to the leadership of the House Energy & Commerce and Judiciary Committees urging one provision to be amended to remove language that would have required pharmacists to review patients’ records in prescription drug monitoring programs before filling Schedule II, III, and IV prescriptions. The House subsequently removed the requirement and the language does not appear in the final bill.

Law lacks funding
President Obama signed the law on July 22, but not without reservations. “Given the scope of this crisis, some action is better than none,” he said in his signing statement.

“However, I am deeply disappointed that Republicans failed to provide any real resources for those seeking addiction treatment to get the care that they need. In fact, they blocked efforts by Democrats to include $920 million in treatment funding.”

Despite near universal support, the lack of funding for CARA’s initiatives has led to frustration and anger from advocates and other stakeholders. They claim that without financial resources, the law will have very little real impact.

“It’s window dressing without the resources that will be required,” Rep. Paul Tonko (D-NY), a member of the U.S. House addiction caucus, said on July 15 to student pharmacists attending the APhA Academy of Student Pharmacists Summer Leadership Institute. Still, even skeptical legislators decided that any step forward was a good one and ultimately voted in favor of the law.

Republican leadership said that additional funding will be considered during fiscal year 2017 appropriations committee considerations if cuts are made elsewhere to offset the costs.