Why CARA Is a Failure and How Recovery Advocates Were Duped

On Wednesday, the Comprehensive Addiction and Recovery Act (CARA) passed the Senate 92-2 and was sent to President Obama’s desk. Advocacy groups lit up social media with praise for the bi-partisan legislation which expands Naloxone training for first responders, provides more funding for buprenorphine for people with opiate disorders, and grants some meager funds to find alternatives to incarceration.

While the bill offers up a few good solutions, it’s far more of a failure than a success.

1) The Senate version of the bill called for a mandated prescription drug monitoring program (PMP). The House rejected it after doctors and pharmacists lobbied that it would be burdensome. The final language just suggests that doctors and pharmacists use it. “Suggests” has not worked when it comes to public policy and addiction treatment issues.

2) Case in point. CARA calls for over $900 million to go towards expanded buprenorphine for individuals with opiate misuse disorders. It does not address the key flaw regarding buprenorphine, which I have been writing about for years. Buprenorphine has proven to be effective when combined with weekly therapy sessions and weekly drug screening. The Drug Abuse Treatment Act of 2000 introduced buprenorphine to America and despite the trials and evidence, merely suggested it be accompanied with therapy and drug screens rather than required it. As a result, buprenorphine has been less effective in America than in other countries and has gotten a bad reputation in some treatment programs and 12-step rooms because it is viewed as swapping one drug for another. Without a requirement for drug screens and counseling, it isn’t medication assisted therapy. It’s just medication.

3) The $1.1 billion bill has little funding. This is a political trick. Pass the bill. Get applauded by people in recovery, family members and advocates. Congress will now go on break for the next seven weeks and everyone’s attention will turn elsewhere for the rest of the summer. Advocates will calm down. Then Congress will return after Labor Day. At that point, schools will be back in session, the NFL will be on TV, and the Presidential election will be in full swing. Voting on funding for CARA will most likely be buried. Even if CARA does not get funding, 92 Senators in June and 400 House members in March voted in favor of it. One third of those Senators and all of the House members are up for reelection this fall. Even without funding the bill, they can all claim that they voted for CARA and that they really, truly, deeply care about addiction.

Maybe (hopefully) I’m wrong about the third point and Congress will somehow find the $1.1 billion to make it work. Even so, it would still fail on points one and two.