CARA 2.0 Act of 2020

II 116TH CONGRESS 2D SESSION S. 5000 To provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder. IN THE SENATE OF THE UNITED STATES DECEMBER 10, 2020 Mr. PORTMAN (for himself, Mr. WHITEHOUSE, Ms. KLOBUCHAR, Ms. CANT- WELL, and Mrs. SHAHEEN) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions A BILL To provide support with respect to the prevention of, treatment for, and recovery from, substance use disorder. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘CARA 2.0 Act of 2020’’. 5 (b) TABLE OF CONTENTS.—The table of contents for 6 this Act is as follows: 7 Sec. 1. Short title; table of contents. Sec. 2. Findings. TITLE I—RESEARCH, EDUCATION, AND PREVENTION VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6211 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 5000 IS Sec. 101. National Education Campaign. Sec. 102. Research into non-opioid pain management. Sec. 103. Long-term treatment outcomes research. Sec. 104. National Commission for Excellence on Post-Overdose Response. Sec. 105. Workforce for prevention. Sec. 106. Reauthorization of community-based coalition enhancement grants to address local drug crises. TITLE II—TREATMENT Sec. 201. Three-day limit on opioid prescriptions. Sec. 202. Evidence-based substance use disorder treatment and intervention demonstrations. Sec. 203. National youth and young adult recovery initiative. Sec. 204. Improving treatment for pregnant, postpartum, and parenting women. Sec. 205. Require the use of prescription drug monitoring programs. Sec. 206. Prescriber education. Sec. 207. Prohibition of utilization control policies or procedures for medica- tion-assisted treatment under Medicaid. Sec. 208. Pilot program on expanding access to treatment. Sec. 209. Reauthorization of PRAC Ed grant program. TITLE III—RECOVERY Subtitle A—General Provisions Sec. 301. Building communities of recovery. Sec. 302. Medication-assisted treatment for recovery from substance use dis- order. Sec. 303. Recovery in the workplace. Sec. 304. Telehealth for recovery support services. Subtitle B—Recovery Housing Sec. 311. Clarifying the role of SAMHSA in promoting the availability of high- quality recovery housing. Sec. 312. Developing guidelines for States to promote the availability of high- quality recovery housing. Sec. 313. Coordination of Federal activities to promote the availability of high- quality recovery housing. Sec. 314. NAS study. Sec. 315. Grants for States to promote the availability of high quality recovery housing. Sec. 316. Authorization of appropriations. Sec. 317. Reputable providers and analysts of recovery housing services defini- tion. Sec. 318. Technical correction. TITLE IV—CRIMINAL JUSTICE Sec. 401. Medication-assisted Treatment Corrections and Community Reentry Program. Sec. 402. Deflection and pre-arrest diversion. Sec. 403. Housing. Sec. 404. Veterans treatment courts. VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6211 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 5000 IS SEC. 2. FINDINGS. 1 Congress finds as follows: 2 (1) In the 1980s and 1990s, pharmaceutical 3 companies began developing new drugs for pain 4 treatment, including extended release oxycodone. 5 These companies aggressively marketed these drugs 6 to the medical community as a way to address 7 ‘‘under-treatment’’ of physical pain. Drug companies 8 distributed 76,000,000,000 oxycodone and 9 hydrocodone pain pills nationwide from 2006 to 10 2012. 11 (2) The combination of a rising number of pre- 12 scriptions, misinformation about the addictive prop- 13 erties of prescription opioids, and the perception 14 that prescription drugs are less harmful than illicit 15 drugs has caused an increase in drug misuse. 16 (3) As legitimate production and illegal diver- 17 sion of opioids skyrocketed, so did the number of 18 opioid overdose deaths. From 1999 to 2017, almost 19 218,000 people died in the United States from 20 overdoses related to prescription opioids. More re- 21 cently, fentanyl, a powerful synthetic opioid, sur- 22 passed prescription opioids as the most lethal over- 23 dose substance and now is linked to nearly 3 times 24 as many deaths. 25 (4) The scale of the opioid crisis is staggering: 26 VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 5000 IS (A) In 2018, approximately 10,300,000 1 people in the United States age 12 and older 2 misused opioids. 3 (B) On average, 130 people in the United 4 States die every day from an opioid overdose. 5 (C) The opioid crisis has cost the United 6 States economy at least $631,000,000,000. 7 (D) From 2013 to 2017, the number of 8 children in foster care nationwide increased 10 9 percent to nearly 442,995. Parental drug use 10 was cited as a factor in 36 percent of cases. 11 (5) The opioid crisis has also led to a cascade 12 of other negative health impacts. For example, sy- 13 ringe sharing among people who inject drugs has led 14 to increases in hepatitis C virus infections and infec- 15 tive endocarditis, as well as localized HIV outbreaks. 16 (6) The United States health care system has 17 struggled to catch up to the crisis: 18 (A) The majority of people in the United 19 States with an opioid use disorder do not re- 20 ceive substance use treatment, and many who 21 do receive such treatment do not receive evi- 22 dence-based treatment. Although medication-as- 23 sisted treatment has been endorsed by the Na- 24 tional Institutes of Health and the World 25 VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 5000 IS Health Organization, only one-third of treat- 1 ment programs offer any of the 3 drugs ap- 2 proved by the Food and Drug Administration 3 for the treatment of opioid use disorder, and 4 just 6 percent of medication-offering facilities 5 provide all 3. 6 (B) Facilities that provide medications for 7 the treatment of opioid disorder are con- 8 centrated in the Northeast and Southwest, leav- 9 ing many of the areas hit hardest by the opioid 10 crisis without access to evidence-based treat- 11 ment. The need is particularly acute in rural 12 areas, which often do not have enough providers 13 to meet the demand. 14 (C) Unlike other health care needs, sub- 15 stance use treatment is largely funded by State 16 and local revenues and Federal block grants, 17 rather than the Medicare program, the Med- 18 icaid program, and private insurance. 19 (D) While new substances, particularly 20 synthetic drugs, continue to make inroads into 21 communities in the United States, funding 22 streams are often dedicated to particular sub- 23 stances, limiting providers’ ability to adapt to 24 changing needs. 25 VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 5000 IS (E) The stigma associated with substance 1 use disorder prevents people from seeking treat- 2 ment. Too often, people enter substance use 3 treatment only after committing a criminal of- 4 fense, whether through a court mandate, as a 5 condition of parole or probation supervision, or 6 as a condition of regaining employment after 7 conviction. In 2003, 36 percent of all substance 8 use treatment admissions, 40 percent of all al- 9 cohol abuse treatment admissions, and 57 per- 10 cent of all marijuana use treatment admissions 11 were referrals from the criminal justice system. 12 (F) The stigma of substance use disorder 13 also limits people’s ability to find jobs and 14 housing. These obstacles are exacerbated by the 15 criminalization of substance use disorder—even 16 convictions for drug possession for personal use 17 can create lifelong collateral consequences. The 18 absence of stable housing and employment 19 make it even more difficult for people to live 20 drug free. 21 (7) Not all people in the United States have 22 equal access to substance use treatment in the com- 23 munity. Current research has found that Black and 24 Latinx Americans are less likely to receive substance 25 VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 5000 IS use treatment when controlling for other relevant 1 factors, like socioeconomic status. 2 (8) Inadequate access to substance use treat- 3 ment can exacerbate other health disparities. Indi- 4 viduals with substance use disorders have higher 5 rates of suicide attempts than individuals in the gen- 6 eral population, high health care expenses, and sig- 7 nificant disability. 8 (9) A comprehensive public health approach 9 that tackles both the causes and the consequences of 10 substance use disorder is necessary to stem the tide. 11 TITLE I—RESEARCH, 12 EDUCATION, AND PREVENTION 13 SEC. 101. NATIONAL EDUCATION CAMPAIGN. 14 Section 102 of the Comprehensive Addiction and Re- 15 covery Act of 2016 (42 U.S.C. 290bb–25g) is amended— 16 (1) in subsection (a), by inserting ‘‘or other 17 controlled substances (as defined in section 102 of 18 the Controlled Substances Act (21 U.S.C. 802))’’ 19 after ‘‘opioids’’ each place such term appears; 20 (2) in subsection (b), by striking ‘‘opioid’’ each 21 place it appears and inserting ‘‘substance’’; 22 (3) in subsection (c)— 23 (A) in paragraph (2), by striking ‘‘and’’ at 24 the end; 25 VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 5000 IS (B) in paragraph (3), by striking the pe- 1 riod and inserting a semicolon; and 2 (C) by adding at the end the following: 3 ‘‘(4) use destigmatizing language promoting hu- 4 mane and culturally competent (as defined in section 5 102 of the Developmental Disabilities Assistance 6 and Bill of Rights Act of 2000 (42 U.S.C. 15002)) 7 treatment of all individuals who face substance use 8 disorder, including such individuals who use medica- 9 tion-assisted treatment for recovery purposes; 10 ‘‘(5) educate stakeholders on the evidence base 11 and validation of harm reduction and where to ob- 12 tain harm reduction services; 13 ‘‘(6) include information about polysubstance 14 use; and 15 ‘‘(7) include information about prevention and 16 treatment using medication-assisted treatment and 17 recovery.’’; and 18 (4) by adding at the end the following: 19 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 20 is authorized to be appropriated to carry out this section 21 such sums as may be necessary for each of fiscal years 22 2021 through 2026.’’. 23 VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 5000 IS SEC. 102. RESEARCH INTO NON-OPIOID PAIN MANAGE- 1 MENT. 2 (a) IN GENERAL.—The Secretary of Health and 3 Human Services, acting through the Director of the Na- 4 tional Institutes of Health and the Director of the Centers 5 for Disease Control and Prevention, shall carry out re- 6 search with respect to non-opioid methods of pain manage- 7 ment, including non-pharmaceutical remedies for pain and 8 integrative medicine solutions. 9 (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 10 out this section, there are authorized to be appropriated 11 such sums as may be necessary for each of fiscal years 12 2021 through 2026. 13 SEC. 103. LONG-TERM TREATMENT OUTCOMES RESEARCH. 14 (a) IN GENERAL.—The Secretary of Health and 15 Human Services shall award grants to eligible entities to 16 carry out evidence-based, long-term outcomes research, 17 over 5-year periods, for different modalities of treatment 18 for substance use disorder. Such research shall measure 19 mortality, morbidity, physical and emotional health, em- 20 ployment, stable housing, criminal justice involvement, 21 family relationships, and other quality-of-life measures. 22 Such research shall distinguish outcomes based on race, 23 gender, and socioeconomic status, as well as any other rel- 24 evant characteristics. 25 VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 5000 IS (b) AUTHORIZATION OF APPROPRIATIONS.—To carry 1 out this section, there are authorized to be appropriated 2 such sums as may be necessary. 3 SEC. 104. NATIONAL COMMISSION FOR EXCELLENCE ON 4 POST-OVERDOSE RESPONSE. 5 (a) IN GENERAL.—The Assistant Secretary of Health 6 and Human Services for Mental Health and Substance 7 Use (referred to in this section as the ‘‘Assistant Sec- 8 retary’’), in consultation with the Director of the Office 9 of National Drug Control Policy, and the President of the 10 National Academy of Medicine, shall establish an advisory 11 commission, to be known as the ‘‘National Commission for 12 Excellence on Post-Overdose Response’’, that— 13 (1) provides evidence, practical tools, and other 14 resources for researchers and evaluators, clinicians 15 and clinical teams, quality improvement experts, and 16 healthcare decision makers to improve the quality 17 and safety of care for drug overdoses and substance 18 use disorder; 19 (2) advises the individuals described in para- 20 graph (1) on— 21 (A) how to achieve equitable outcomes 22 across race and socioeconomic status; and 23 (B) how to effectively and appropriately 24 control avoidable hospital admissions, emer- 25 VerDate Sep 11 2014 22:48 Dec 22, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S5000.IS S5000 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 5000 IS gency department admissions, and other ad- 1 verse events related to substance use disorder 2 care; and 3 (3) develops culturally competent (as defined in 4 section 102 of the Developmental Disabilities Assist- 5 ance and Bill of Rights Act of 2000 (42 U.S.C. 6 15002)) best practices and clinical practice guide- 7 lines. 8 (b) MEMBERSHIP.—The members of the commission 9 established under subsection (a) shall include— 10 (1) a representative of the Substance Abuse 11 and Mental Health Services Administration; 12 (2) a representative of the Office of National 13 Drug Control Policy; 14 (3) a representative of the National Academy of 15 Medicine; 16 (4) a representative of the National Institute on 17 Drug Abuse; [Text truncated for display. Full text available on Congress.gov.]