II 

115TH CONGRESS 

2D SESSION S. 2456 

A bill to reauthorize and expand the Comprehensive Addiction and Recovery 

Act of 2016. 

IN THE SENATE OF THE UNITED STATES 

FEBRUARY 27, 2018 

Mr. PORTMAN (for himself, Mr. WHITEHOUSE, Mrs. CAPITO, Ms. KLOBUCHAR, Mr. SULLIVAN, Ms. HASSAN, Mr. CASSIDY, and Ms. CANTWELL) introduced the following bill; which was read twice and referred 

to the Committee on Health, Education, Labor, and Pensions 

A BILL 

A bill to reauthorize and expand the Comprehensive 

Addiction and Recovery Act of 2016. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘CARA 2.0 Act of 

5 2018’’. 

6 SEC. 2. NATIONAL EDUCATION CAMPAIGN. 

7 Section 102 of the Comprehensive Addiction and Re8 covery Act of 2016 (42 U.S.C. 290bb–25g) is amended 

9 by adding at the end the following: 


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1 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section, 

3 $10,000,000 for each of fiscal years 2019 through 2023.’’. 

4 SEC. 3. THREE-DAY LIMIT ON OPIOID PRESCRIPTIONS. 

5 Section 303 of the Controlled Substances Act (21 

6 U.S.C. 823) is amended by adding at the end the fol7 lowing: 

8 ‘‘(l) THREE-DAY LIMIT ON OPIOID PRESCRIP9 TIONS.— 

10 ‘‘(1) DEFINITIONS.—In this subsection— 

11 ‘‘(A) the term ‘acute pain’— 

12 ‘‘(i) means pain with abrupt onset and 

13 caused by an injury or other process that 

14 is not ongoing; and 

15 ‘‘(ii) does not include— 

16 ‘‘(I) chronic pain; 

17 ‘‘(II) pain being treated as part 

18 of cancer care; 

19 ‘‘(III) hospice or other end-of-life 

20 care; or 

21 ‘‘(IV) pain being treated as part 

22 of palliative care; and 

23 ‘‘(B) the term ‘addiction treatment opioid 

24 prescription’ means a prescription— 


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1 ‘‘(i) for an opioid drug in schedule II, 

2 III, or IV approved by the Food and Drug 

3 Administration for an indication for the 

4 treatment of addiction; and 

5 ‘‘(ii) that is for the treatment of ad6 diction. 

7 ‘‘(2) THREE-DAY LIMIT.—The Attorney General 

8 may not register, or renew the registration of, a 

9 practitioner under subsection (f) who is licensed 

10 under State law to prescribe controlled substances in 

11 schedule II, III, or IV, unless the practitioner sub12 mits to the Attorney General, for each such registra13 tion or renewal request, a certification that the prac14 titioner, during the applicable registration period, 

15 will not prescribe any opioid in schedule II, III, or 

16 IV, other than an addiction treatment opioid pre17 scription, for the initial treatment of acute pain in 

18 an amount in excess of a 3-day supply.’’. 

19 SEC. 4. FIRST RESPONDER TRAINING. 

20 Section 546 of the Public Health Service Act (42 

21 U.S.C. 290ee–1) is amended— 

22 (1) in subsection (c)— 

23 (A) in paragraph (2), by striking ‘‘and’’ at 

24 the end; 


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1 (B) in paragraph (3), by striking the pe2 riod and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following: 

4 ‘‘(4) train and provide resources for first re5 sponders and members of other key community sec6 tors on safety around fentanyl and other dangerous 

7 illicit drugs to protect themselves from exposure and 

8 respond appropriately when exposure occurs.’’; 

9 (2) in subsection (d), by inserting ‘‘, and safety 

10 around fentanyl and other dangerous illicit drugs’’ 

11 before the period; 

12 (3) in subsection (f)— 

13 (A) in paragraph (3), by striking ‘‘and’’ at 

14 the end; 

15 (B) in paragraph (4), by striking the pe16 riod and inserting a semicolon; and 

17 (C) by adding at the end the following: 

18 ‘‘(5) the number of first responders and mem19 bers of other key community sectors trained on safe20 ty around fentanyl and other dangerous illicit 

21 drugs.’’; and 

22 (4) in subsection (g), by inserting before the pe23 riod the following: ‘‘, and $300,000,000 for each of 

24 fiscal years 2019 through 2023’’. 


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1 SEC. 5. EVIDENCE-BASED PRESCRIPTION OPIOID AND HER2 OIN TREATMENT AND INTERVENTION DEM3 ONSTRATIONS. 

4 Section 514B of the Public Health Service Act (42 

5 U.S.C. 290bb–10) is amended— 

6 (1) in subsection (d), by inserting ‘‘, and Indian 

7 tribes and tribal organizations (as defined in section 

8 4 of the Indian Self-Determination and Education 

9 Assistance Act)’’ before the first period; and 

10 (2) in subsection (f), by inserting before the pe11 riod the following: ‘‘, and $300,000,000 for each of 

12 fiscal years 2019 through 2023’’. 

13 SEC. 6. BUILDING COMMUNITIES OF RECOVERY. 

14 Section 547 of the Public Health Service Act (42 

15 U.S.C. 290ee–2) is amended— 

16 (1) by striking subsection (c); 

17 (2) by redesignating subsection (d) as sub18 section (c); 

19 (3) in subsection (c) (as so redesignated)— 

20 (A) in paragraph (1), by striking ‘‘and’’ at 

21 the end; 

22 (B) in paragraph (2)(C)(iv), by striking 

23 the period and inserting ‘‘; and’’; and 

24 (C) by adding at the and the following: 

25 ‘‘(3) may be used as provided for in subsection 

26 (d).’’; 


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1 (4) by inserting after subsection (c) (as so re2 designated), the following: 

3 ‘‘(d) ESTABLISHMENT OF REGIONAL TECHNICAL AS4 SISTANCE CENTERS.— 

5 ‘‘(1) IN GENERAL.—Grants awarded under sub6 section (b) may be used to provide for the establish7 ment of regional technical assistance centers to pro8 vide regional technical assistance for the following: 

9 ‘‘(A) Implementation of regionally driven 

10 peer delivered addiction recovery support serv11 ices before, during, after, or in lieu of addiction 

12 treatment. 

13 ‘‘(B) Establishment of recovery community 

14 organizations. 

15 ‘‘(C) Establishment of recovery community 

16 centers. 

17 ‘‘(D) Naloxone training and dissemination. 

18 ‘‘(2) ELIGIBLE ENTITIES.—To be eligible to re19 ceive a grant under paragraph (1), an entity shall 

20 be— 

21 ‘‘(A) a national nonprofit entity with a net22 work of local affiliates and partners that are 

23 geographically and organizationally diverse; or 

24 ‘‘(B) a national nonprofit organization es25 tablished by individuals in personal and family 


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1 recovery, serving prevention, treatment, recov2 ery, payor, faith-based, and criminal justice 

3 stakeholders in the implementation of local ad4 diction and recovery initiatives.’’; and 

5 (5) in subsection (e), by inserting before the pe6 riod the following: ‘‘, and $200,000,000 for each of 

7 fiscal years 2019 through 2023’’. 

8 SEC. 7. MEDICATION-ASSISTED TREATMENT FOR RECOV9 ERY FROM ADDICTION. 

10 (a) ALLOWING STATES TO RAISE PATIENT CAPS

11 UNDER CERTAIN CONDITIONS; MAKING NURSE PRACTI12 TIONER AND PHYSICIAN ASSISTANT AUTHORITY PERMA13 NENT.—Section 303(g)(2) of the Controlled Substances 

14 Act (21 U.S.C. 823(g)(2)) is amended— 

15 (1) in subparagraph (G)(iii)(II), by striking 

16 ‘‘during the period beginning on the date of enact17 ment of the Comprehensive Addiction and Recovery 

18 Act of 2016 and ending on October 1, 2021,’’; and 

19 (2) in subparagraph (I)— 

20 (A) in clause (i), by striking ‘‘or’’ at the 

21 end; 

22 (B) by redesignating clause (ii) as clause 

23 (iii); and 

24 (C) by inserting after clause (i) the fol25 lowing: 


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1 ‘‘(ii) permits a qualifying practitioner to 

2 dispense drugs in schedule III, IV, or V, or 

3 combinations of such drugs, for maintenance or 

4 detoxification treatment in accordance with this 

5 paragraph to a total number of patients that is 

6 more than the total number applicable to the 

7 qualifying practitioner under subparagraph 

8 (B)(ii)(II), including an unlimited number, if 

9 the State— 

10 ‘‘(I) enacts a law authorizing such 

11 dispensing to that increased total number, 

12 or unlimited number, of patients; 

13 ‘‘(II) before the increased total num14 ber or elimination of a limit goes into ef15 fect in the State, directs the applicable 

16 State agency or regulatory board to adopt 

17 statewide regulations governing the use of 

18 medications approved by the Food and 

19 Drug Administration for the treatment of 

20 opioid dependence or for the prevention of 

21 relapse to opioid dependence, consistent 

22 with nationally recognized evidence-based 

23 guidelines produced by a national or inter24 national medical professional association, 

25 public health entity, or governmental body 


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1 with the aim of ensuring the appropriate 

2 use of evidence to guide individual diag3 nostic and therapeutic clinical decisions, 

4 including the National Practice Guidelines 

5 For the Use of Medications in the Treat6 ment of Addiction Involving Opioid Use 

7 issued by the American Society of Addic8 tion Medicine; and 

9 ‘‘(III) notifies the Attorney General of 

10 the increased total number or elimination 

11 of a limit; or’’. 

12 (b) REPEAL OF REQUIREMENT TO UPDATE REGULA13 TIONS.—Section 303 of the Comprehensive Addiction and 

14 Recovery Act of 2016 (Public Law 114–198; 130 Stat. 

15 720) is amended by striking subsection (c). 

16 (c) DEFINITION OF QUALIFYING OTHER PRACTI17 TIONER.—Section 303(g)(2)(G)(iv) of the Controlled Sub18 stances Act (21 U.S.C. 823(g)(2)(G)(iv)) is amended by 

19 striking ‘‘nurse practitioner or physician assistant’’ each 

20 place that term appears and inserting ‘‘nurse practitioner, 

21 clinical nurse specialist, certified registered nurse anes22 thetist, certified nurse midwife, or physician assistant’’. 

23 (d) REQUIREMENT TO OFFER TWO TYPES OF MEDI24 CATION-ASSISTED TREATMENT.—Any entity, including a 

25 prison or jail, that receives Federal funds for a program 


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1 or activity offering medication-assisted treatment shall 

2 offer, or have an affiliation with a provider who can pre3 scribe and discuss with patients the risks of, benefits of, 

4 and alternatives to— 

5 (1) not less than 1 opioid antagonist medication 

6 approved by the Food and Drug Administration; and 

7 (2) not less than 1 opioid agonist (or partial 

8 agonist) medication approved by the Food and Drug 

9 Administration to treat addiction involving opioids. 

10 SEC. 8. NATIONAL YOUTH RECOVERY INITIATIVE. 

11 (a) DEFINITIONS.—In this section: 

12 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti13 ty’’ means— 

14 (A) a high school that has been accredited 

15 as a substance use recovery high school or that 

16 is seeking to establish or expand substance use 

17 recovery support services; 

18 (B) an institution of higher education; 

19 (C) a recovery program at an institution of 

20 higher education; 

21 (D) a nonprofit organization; or 

22 (E) a technical assistance center that can 

23 help grantees install recovery support service 

24 programs aimed at youth and young adults 

25 which include recovery coaching, job training, 


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1 transportation, linkages to community-based 

2 services and supports, regularly scheduled alter3 native peer group activities, life-skills education, 

4 and leadership development. 

5 (2) HIGH SCHOOL.—The term ‘‘high school’’ 

6 has the meaning given the term in section 8101 of 

7 the Elementary and Secondary Education Act of 

8 1965 (20 U.S.C. 7801). 

9 (3) INSTITUTION OF HIGHER EDUCATION.—The 

10 term ‘‘institution of higher education’’ has the 

11 meaning given the term in section 101 of the Higher 

12 Education Act of 1965 (20 U.S.C. 1001). 

13 (4) RECOVERY PROGRAM.—The term ‘‘recovery 

14 program’’ means a program— 

15 (A) to help youth or young adults who are 

16 recovering from substance use disorders to ini17 tiate, stabilize, and maintain healthy and pro18 ductive lives in the community; and 

19 (B) that includes peer-to-peer support de20 livered by individuals with lived experience in 

21 recovery, and communal activities to build re22 covery skills and supportive social networks. 

23 (b) GRANTS AUTHORIZED.—The Assistant Secretary 

24 for Mental Health and Substance Use, in consultation 

25 with the Secretary of Education, shall award grants, on 


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1 a competitive basis, to eligible entities to enable the eligi2 ble entities to— 

3 (1) provide substance use recovery support serv4 ices to youth and young adults enrolled in high 

5 school or an institution of higher education; 

6 (2) help build communities of support for youth 

7 and young adults in substance use recovery through 

8 a spectrum of activities such as counseling, job 

9 training, recovery coaching, alternative peer groups, 

10 life-skills workshops, family support groups, and 

11 healthy and wellness-oriented social activities; and 

12 (3) encourage initiatives designed to help youth 

13 and young adults achieve and sustain recovery from 

14 substance use disorders. 

15 (c) APPLICATION.—An eligible entity desiring a grant 

16 under this section shall submit to the Assistant Secretary 

17 for Mental Health and Substance Use an application at 

18 such time, in such manner, and containing such informa19 tion as the Assistant Secretary may require. 

20 (d) USE OF FUNDS.—Grants awarded under sub21 section (b) may be used for activities to develop, support, 

22 or maintain substance use recovery support services for 

23 youth or young adults, including— 

24 (1) the development and maintenance of a dedi25 cated physical space for recovery programs; 


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1 (2) hiring dedicated staff for the provision of 

2 recovery programs; 

3 (3) providing health and wellness-oriented social 

4 activities and community engagement; 

5 (4) the establishment of a substance use recov6 ery high school; 

7 (5) the coordination of a peer delivered sub8 stance use recovery program with— 

9 (A) substance use disorder treatment pro10 grams and systems; 

11 (B) providers of mental health services; 

12 (C) primary care providers; 

13 (D) the criminal justice system, including 

14 the juvenile justice system; 

15 (E) employers; 

16 (F) recovery housing services; 

17 (G) child welfare services; 

18 (H) high schools; and 

19 (I) institutions of higher education; 

20 (6) the development of peer-to-peer support 

21 programs or services delivered by individuals with 

22 lived experience in addiction recovery; and 

23 (7) any additional activity that helps youth or 

24 young adults achieve recovery from substance use 

25 disorders. 


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1 (e) RESOURCE CENTER.—The Assistant Secretary 

2 for Mental Health and Substance Use shall establish a re3 source center to provide technical support to recipients of 

4 grants under this section. 

5 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated to carry out this section 

7 $10,000,000 for fiscal year 2019 and each of the 4 suc8 ceeding fiscal years. 

9 SEC. 9. NATIONAL RECOVERY RESIDENCE STANDARDS. 

10 (a) BEST PRACTICES FOR OPERATING RECOVERY

11 HOUSING.—The Secretary of Health and Human Serv12 ices, acting through the Director of the Center for Sub13 stance Abuse Treatment of the Substance Abuse and Men14 tal Health Services Administration— 

15 (1) shall publish best practices for operating re16 covery housing, based on— 

17 (A) the applicable domains, core principles, 

18 and standards of the National Alliance for Re19 covery Residences; and 

20 (B) input from other nationally accredited 

21 recovery housing entities and from stakeholders; 

22 (2) shall disseminate such best practices to each 

23 State; 

24 (3) may provide technical assistance to States 

25 seeking to adopt or implement such best practices; 


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1 (4) shall identify barriers with respect to recov2 ery housing, State licensure, zoning restrictions, and 

3 discrimination against individuals receiving medica4 tion assisted treatment for the treatment of opioid 

5 abuse; and 

6 (5) shall develop strategies to address the bar7 riers identified under paragraph (4). 

8 (b) DEFINITIONS.—In this section: 

9 (1) The term ‘‘recovery housing’’ means a fam10 ily-like, shared living environment free from alcohol 

11 and illicit drug use and centered on peer support 

12 and connection to services that promote sustained 

13 recovery from substance use disorders. 

14 (2) The term ‘‘State’’ includes any of the sev15 eral States, the District of Columbia, and any terri16 tory or possession of the United States. 

17 SEC. 10. IMPROVING TREATMENT FOR PREGNANT AND 

18 POSTPARTUM WOMEN. 

19 Section 508(s) of the Public Health Service Act (42 

20 U.S.C. 290bb–1(s)) is amended in the first sentence by 

21 inserting before the period the following: ‘‘, and 

22 $100,000,000 for each of fiscal years 2019 through 

23 2023’’. 


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1 SEC. 11. VETERANS TREATMENT COURTS. 

2 Section 2991(o)(3) of title I of the Omnibus Crime 

3 Control and Safe Streets Act of 1968 (34 U.S.C. 

4 10651(o)(3)) is amended— 

5 (1) by striking ‘‘LIMITATION’’ and inserting 

6 ‘‘VETERANS’’; 

7 (2) by striking ‘‘Not more than’’ and inserting 

8 the following: 

9 ‘‘(A) LIMITATION.—Not more than’’; 

10 (3) in subparagraph (A), as so designated, by 

11 striking ‘‘this section’’ and inserting ‘‘paragraph 

12 (1)’’; and 

13 (4) by adding at the end the following: 

14 ‘‘(B) ADDITIONAL FUNDING.—In addition 

15 to the amounts authorized under paragraph (1), 

16 there are authorized to be appropriated to the 

17 Department of Justice to carry out subsection 

18 (i) $20,000,000 for each of fiscal years 2019 

19 through 2023.’’. 

20 SEC. 12. INFANT PLAN OF SAFE CARE. 

21 Section 112 of the Child Abuse Prevention and 

22 Treatment Act (42 U.S.C. 5106h) is amended by adding 

23 at the end the following: 

24 ‘‘(c) INFANT PLAN OF SAFE CARE.—In addition to 

25 amounts otherwise appropriated to carry out this title, 

26 there is authorized to be appropriated $60,000,000 for 


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1 each of fiscal years 2019 through 2023, to provide funds 

2 for States to collaboratively develop policies and proce3 dures concerning implementing and developing systems to 

4 monitor plans of safe care under section 

5 106(b)(2)(B)(iii).’’. 

6 SEC. 13. REQUIRE THE USE OF PRESCRIPTION DRUG MONI7 TORING PROGRAMS. 

8 (a) DEFINITIONS.—In this section: 

9 (1) CONTROLLED SUBSTANCE.—The term 

10 ‘‘controlled substance’’ has the meaning given the 

11 term in section 102 of the Controlled Substances 

12 Act (21 U.S.C. 802). 

13 (2) COVERED STATE.—The term ‘‘covered 

14 State’’ means a State that receives funding under 

15 the Harold Rogers Prescription Drug Monitoring 

16 Program established under the Departments of 

17 Commerce, Justice, and State, the Judiciary, and 

18 Related Agencies Appropriations Act, 2002 (Public 

19 Law 107–77; 115 Stat. 748), under this Act (or an 

20 amendment made by this Act), or under the con21 trolled substance monitoring program under section 

22 399O of the Public Health Service Act (42 U.S.C. 

23 280g–3). 

24 (3) DISPENSER.—The term ‘‘dispenser’’— 


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1 (A) means a person licensed or otherwise 

2 authorized by a State to deliver a prescription 

3 drug product to a patient or an agent of the pa4 tient; and 

5 (B) does not include a person involved in 

6 oversight or payment for prescription drugs. 

7 (4) PDMP.—The term ‘‘PDMP’’ means a pre8 scription drug monitoring program. 

9 (5) PRACTITIONER.—The term ‘‘practitioner’’ 

10 means a practitioner registered under section 303(f) 

11 of the Controlled Substances Act (21 U.S.C. 823(f)) 

12 to prescribe, administer, or dispense controlled sub13 stances. 

14 (6) STATE.—The term ‘‘State’’ means each of 

15 the several States and the District of Columbia. 

16 (b) IN GENERAL.—Beginning 1 year after the date 

17 of enactment of this Act, each covered State shall re18 quire— 

19 (1) each prescribing practitioner within the cov20 ered State or their designee, who shall be licensed or 

21 registered healthcare professionals or other employ22 ees who report directly to the practitioner, to consult 

23 the PDMP of the covered State before initiating 

24 treatment with a prescription for a controlled sub25 stance listed in schedule II, III, or IV of section 


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1 202(c) of the Controlled Substances Act (21 U.S.C. 

2 812(c)), and every 3 months thereafter as long as 

3 the treatment continues; 

4 (2) the PDMP of the covered State to provide 

5 proactive notification to a practitioner when patterns 

6 indicative of controlled substance misuse, including 

7 opioid misuse, are detected; 

8 (3) each dispenser within the covered State to 

9 report each prescription for a controlled substance 

10 dispensed by the dispenser to the PDMP not later 

11 than 24 hours after the controlled substance is dis12 pensed to the patient; 

13 (4) that the PDMP make available a quarterly 

14 de-identified data set and an annual report for pub15 lic and private use, including use by healthcare pro16 viders, health plans and health benefits administra17 tors, State agencies, and researchers, which shall, at 

18 a minimum, meet requirements established by the 

19 Attorney General, in coordination with the Secretary 

20 of Health and Human Services; 

21 (5) each State agency that administers the 

22 PDMP to— 

23 (A) proactively analyze data available 

24 through the PDMP; and 


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1 (B) provide reports to law enforcement 

2 agencies and prescriber licensing boards de3 scribing any prescribing practitioner that re4 peatedly fall outside of expected norms or 

5 standard practices for the prescribing practi6 tioner’s field; and 

7 (6) that the data contained in the PDMP of the 

8 covered State be made available to other States. 

9 (c) NONCOMPLIANCE.—If a covered State fails to 

10 comply with subsection (a), the Attorney General or the 

11 Secretary of Health and Human Services may withhold 

12 grant funds from being awarded to the covered State 

13 under the Harold Rogers Prescription Drug Monitoring 

14 Program established under the Departments of Com15 merce, Justice, and State, the Judiciary, and Related 

16 Agencies Appropriations Act, 2002 (Public Law 107–77; 

17 115 Stat. 748), under this Act (or an amendment made 

18 by this Act), or under the controlled substance monitoring 

19 program under section 399O of the Public Health Service 

20 Act (42 U.S.C. 280g–3). 

21 SEC. 14. INCREASING CIVIL AND CRIMINAL PENALTIES FOR 

22 OPIOID MANUFACTURERS. 

23 Section 402(c) of the Controlled Substances Act (21 

24 U.S.C. 842(c)) is amended— 


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1 (1) in paragraph (1)(B), by striking ‘‘shall not 

2 exceed $10,000.’’ and inserting the following: ‘‘shall 

3 not exceed— 

4 ‘‘(i) except as provided in clause (ii), $10,000; 

5 and 

6 ‘‘(ii) if the violation is committed by a manufac7 turer of opioids and relates to the reporting of sus8 picious orders for opioids or failing to maintain ef9 fective controls against diversion of opioids, 

10 $100,000.’’; and 

11 (2) in paragraph (2)— 

12 (A) in subparagraph (A), by inserting ‘‘or 

13 (D)’’ after ‘‘subparagraph (B)’’; and 

14 (B) by adding at the end the following: 

15 ‘‘(D) In the case of a violation referred to in subpara16 graph (A) that was a violation of paragraph (5) or (10) 

17 of subsection (a) committed by a manufacturer of opioids 

18 that relates to the reporting of suspicious orders for 

19 opioids or failing to maintain effective controls against di20 version of opioids, the criminal fine under title 18, United 

21 States Code, shall not exceed $500,000.’’. 

Æ 


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