The Comprehensive Addiction and Recovery Act (CARA), headed to the the President for signature, is a step in the right direction but still falls short on a number of important provisions to adequately address the scope of the problem.
We are encouraged that the bill authorizes nurse practitioners and physician assistants to prescribe medication for recovery, which will help ease some of the waiting list issues patients face. It also authorizes the Department of Health and Human Services (HHS) to exempt certain forms of recovery medications, such as implantable devices, from the arbitrary caps on the number of patients that health providers can treat– an immediate action that we urge HHS to take. However, the fact remains that we should not have these caps at all for any certified providers. Public policy that prevents healthcare providers from practicing medicine according to the clinical guidelines, which includes buprenorphine, is an injustice.
Because the CARA bill does not include any new funds to implement the interventions it contains, Congress should and must act through the appropriations process, including state block grants, to ensure the programs authorized in the bill can be implemented. However, granting money to states to treat those in need should be a bridge solution to the real barrier, which is a lack of insurance coverage in both the public and private insurance markets. Congress should use its leverage when appropriating to require Medicaid and other state-run insurance programs to cover recovery medication, as many states currently do not. Florida, for example, is among the leading prescribers of buprenorphine, but only eight percent of those prescriptions are paid for by Medicare or Medicaid.
The CARA bill falls short in many areas due to the fear, bias and stigma many have about treating addiction. If we are serious about addressing the opioid epidemic, we will eliminate barriers to effective recovery treatment and treat the addicted brain the same way we treat any other organ in the body – with medication that has been scientifically proven to work.