I 

115TH CONGRESS 

2D SESSION H. R. 5311 

To reauthorize and expand the Comprehensive Addiction and Recovery Act 

of 2016. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 15, 2018 

Mrs. BLACKBURN (for herself, Mr. RYAN of Ohio, Ms. KUSTER of New Hampshire, and Mr. MACARTHUR) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to 

the Committees on the Judiciary, and Education and the Workforce, for 

a period to be subsequently determined by the Speaker, in each case for 

consideration of such provisions as fall within the jurisdiction of the committee concerned 

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’’. 


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1 SEC. 2. NATIONAL EDUCATION CAMPAIGN. 

2 Section 102 of the Comprehensive Addiction and Re3 covery Act of 2016 (42 U.S.C. 290bb–25g) is amended 

4 by adding at the end the following: 

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

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

7 $10,000,000 for each of fiscal years 2019 through 2023.’’. 

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

9 Section 303 of the Controlled Substances Act (21 

10 U.S.C. 823) is amended by adding at the end the fol11 lowing: 

12 ‘‘(l) THREE-DAY LIMIT ON OPIOID PRESCRIP13 TIONS.— 

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

15 ‘‘(A) the term ‘acute pain’— 

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

17 caused by an injury or other process that 

18 is not ongoing; and 

19 ‘‘(ii) does not include— 

20 ‘‘(I) chronic pain; 

21 ‘‘(II) pain being treated as part 

22 of cancer care; 

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

24 care; or 

25 ‘‘(IV) pain being treated as part 

26 of palliative care; and 


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

2 prescription’ means a prescription— 

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

4 III, or IV approved by the Food and Drug 

5 Administration for an indication for the 

6 treatment of addiction; and 

7 ‘‘(ii) that is for the treatment of ad8 diction. 

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

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

11 practitioner under subsection (f) who is licensed 

12 under State law to prescribe controlled substances in 

13 schedule II, III, or IV, unless the practitioner sub14 mits to the Attorney General, for each such registra15 tion or renewal request, a certification that the prac16 titioner, during the applicable registration period, 

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

18 IV, other than an addiction treatment opioid pre19 scription, for the initial treatment of acute pain in 

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

21 SEC. 4. FIRST RESPONDER TRAINING. 

22 Section 546 of the Public Health Service Act (42 

23 U.S.C. 290ee–1) is amended— 

24 (1) in subsection (c)— 


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

2 the end; 

3 (B) in paragraph (3), by striking the pe4 riod and inserting ‘‘; and’’; and 

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

6 ‘‘(4) train and provide resources for first re7 sponders and members of other key community sec8 tors on safety around fentanyl and other dangerous 

9 illicit drugs to protect themselves from exposure and 

10 respond appropriately when exposure occurs.’’; 

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

12 around fentanyl and other dangerous illicit drugs’’ 

13 before the period; 

14 (3) in subsection (f)— 

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

16 the end; 

17 (B) in paragraph (4), by striking the pe18 riod and inserting a semicolon; and 

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

20 ‘‘(5) the number of first responders and mem21 bers of other key community sectors trained on safe22 ty around fentanyl and other dangerous illicit 

23 drugs.’’; and 


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1 (4) in subsection (g), by inserting before the pe2 riod the following: ‘‘, and $300,000,000 for each of 

3 fiscal years 2019 through 2023’’. 

4 SEC. 5. EVIDENCE-BASED PRESCRIPTION OPIOID AND HER5 OIN TREATMENT AND INTERVENTION DEM6 ONSTRATIONS. 

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

8 U.S.C. 290bb–10) is amended— 

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

10 tribes and tribal organizations (as defined in section 

11 4 of the Indian Self-Determination and Education 

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

13 (2) in subsection (f), by inserting before the pe14 riod the following: ‘‘, and $300,000,000 for each of 

15 fiscal years 2019 through 2023’’. 

16 SEC. 6. BUILDING COMMUNITIES OF RECOVERY. 

17 Section 547 of the Public Health Service Act (42 

18 U.S.C. 290ee–2) is amended— 

19 (1) by striking subsection (c); 

20 (2) by redesignating subsections (d) as sub21 section (c); 

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

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

24 the end; 


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

2 the period and inserting ‘‘; and’’; and 

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

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

5 (d).’’; 

6 (4) by inserting after subsection (c) (as so re7 designated), the following: 

8 ‘‘(d) ESTABLISHMENT OF REGIONAL TECHNICAL AS9 SISTANCE CENTERS.— 

10 ‘‘(1) IN GENERAL.—Grants awarded under sub11 section (b) may be used to provide for the establish12 ment of regional technical assistance centers to pro13 vide regional technical assistance for the following: 

14 ‘‘(A) Implementation of regionally driven 

15 peer delivered addiction recovery support serv16 ices before, during, after, or in lieu of addiction 

17 treatment. 

18 ‘‘(B) Establishment of recovery community 

19 organizations. 

20 ‘‘(C) Establishment of recovery community 

21 centers. 

22 ‘‘(D) Naloxone training and dissemination. 

23 ‘‘(2) ELIGIBLE ENTITIES.—To be eligible to re24 ceive a grant under paragraph (1), an entity shall 

25 be— 


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1 ‘‘(A) a national nonprofit entity with a net2 work of local affiliates and partners that are 

3 geographically and organizationally diverse; or 

4 ‘‘(B) a national nonprofit organization es5 tablished by individuals in personal and family 

6 recovery, serving prevention, treatment, recov7 ery, payor, faith-based, and criminal justice 

8 stakeholders in the implementation of local ad9 diction and recovery initiatives.’’; and 

10 (5) in subsection (e), by inserting before the pe11 riod the following: ‘‘, and $200,000,000 for each of 

12 fiscal years 2019 through 2023’’. 

13 SEC. 7. MEDICATION-ASSISTED TREATMENT FOR RECOV14 ERY FROM ADDICTION. 

15 (a) ALLOWING STATES TO RAISE PATIENT CAPS

16 UNDER CERTAIN CONDITIONS; MAKING NURSE PRACTI17 TIONER AND PHYSICIAN ASSISTANT AUTHORITY PERMA18 NENT.—Section 303(g)(2) of the Controlled Substances 

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

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

21 ‘‘during the period beginning on the date of enact22 ment of the Comprehensive Addiction and Recovery 

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

24 (2) in subparagraph (I)— 


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

2 end; 

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

4 (iii); and 

5 (C) by inserting after clause (i) the fol6 lowing: 

7 ‘‘(ii) permits a qualifying practitioner to 

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

9 combinations of such drugs, for maintenance or 

10 detoxification treatment in accordance with this 

11 paragraph to a total number of patients that is 

12 more than the total number applicable to the 

13 qualifying practitioner under subparagraph 

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

15 the State— 

16 ‘‘(I) enacts a law authorizing such 

17 dispensing to that increased total number, 

18 or unlimited number, of patients; 

19 ‘‘(II) before the increased total num20 ber or elimination of a limit goes into ef21 fect in the State, directs the applicable 

22 State agency or regulatory board to adopt 

23 statewide regulations governing the use of 

24 medications approved by the Food and 

25 Drug Administration for the treatment of 


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1 opioid dependence or for the prevention of 

2 relapse to opioid dependence, consistent 

3 with nationally recognized evidence-based 

4 guidelines produced by a national or inter5 national medical professional association, 

6 public health entity, or governmental body 

7 with the aim of ensuring the appropriate 

8 use of evidence to guide individual diag9 nostic and therapeutic clinical decisions, 

10 including the National Practice Guidelines 

11 For the Use of Medications in the Treat12 ment of Addiction Involving Opioid Use 

13 issued by the American Society of Addic14 tion Medicine; and 

15 ‘‘(III) notifies the Attorney General of 

16 the increased total number or elimination 

17 of a limit; or’’. 

18 (b) REPEAL OF REQUIREMENT TO UPDATE REGULA19 TIONS.—Section 303 of the Comprehensive Addiction and 

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

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

22 (c) DEFINITION OF QUALIFYING OTHER PRACTI23 TIONER.—Section 303(g)(2)(G)(iv) of the Controlled Sub24 stances Act (21 U.S.C. 823(g)(2)(G)(iv)) is amended by 

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


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

2 clinical nurse specialist, certified registered nurse anes3 thetist, certified nurse midwife, or physician assistant’’. 

4 (d) REQUIREMENT TO OFFER 2 TYPES OF MEDICA5 TION-ASSISTED TREATMENT.—Any entity, including a 

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

7 or activity offering medication-assisted treatment shall 

8 offer, or have an affiliation with a provider who can pre9 scribe and discuss with patients the risks of, benefits of, 

10 and alternatives to— 

11 (1) not less than 1 opioid antagonist medication 

12 approved by the Food and Drug Administration; and 

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

14 agonist) medication approved by the Food and Drug 

15 Administration to treat addiction involving opioids. 

16 SEC. 8. NATIONAL YOUTH RECOVERY INITIATIVE. 

17 (a) DEFINITIONS.—In this section: 

18 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti19 ty’’ means— 

20 (A) a high school that has been accredited 

21 as a substance use recovery high school or that 

22 is seeking to establish or expand substance use 

23 recovery support services; 

24 (B) an institution of higher education; 


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1 (C) a recovery program at an institution of 

2 higher education; 

3 (D) a nonprofit organization; or 

4 (E) a technical assistance center that can 

5 help grantees install recovery support service 

6 programs aimed at youth and young adults 

7 which include recovery coaching, job training, 

8 transportation, linkages to community based 

9 services and supports, regularly scheduled alter10 native peer group activities, life-skills education, 

11 and leadership development. 

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

13 has the meaning given the term in section 8101 of 

14 the Elementary and Secondary Education Act of 

15 1965 (20 U.S.C. 7801). 

16 (3) INSTITUTION OF HIGHER EDUCATION.—The 

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

18 meaning given the term in section 101 of the Higher 

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

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

21 program’’ means a program— 

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

23 recovering from substance use disorders to ini24 tiate, stabilize, and maintain healthy and pro25 ductive lives in the community; and 


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1 (B) that includes peer-to-peer support de2 livered by individuals with lived experience in 

3 recovery, and communal activities to build re4 covery skills and supportive social networks. 

5 (b) GRANTS AUTHORIZED.—The Assistant Secretary 

6 for Mental Health and Substance Use, in consultation 

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

8 a competitive basis, to eligible entities to enable the eligi9 ble entities to— 

10 (1) provide substance use recovery support serv11 ices to youth and young adults enrolled in high 

12 school or an institution of higher education; 

13 (2) help build communities of support for youth 

14 and young adults in substance use recovery through 

15 a spectrum of activities such as counseling, job 

16 training, recovery coaching, alternative peer groups, 

17 life-skills workshops, family support groups, and 

18 healthy and wellness-oriented social activities; and 

19 (3) encourage initiatives designed to help youth 

20 and young adults achieve and sustain recovery from 

21 substance use disorders. 

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

23 under this section shall submit to the Assistant Secretary 

24 for Mental Health and Substance Use an application at 


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1 such time, in such manner, and containing such informa2 tion as the Assistant Secretary may require. 

3 (d) USE OF FUNDS.—Grants awarded under sub4 section (b) may be used for activities to develop, support, 

5 or maintain substance use recovery support services for 

6 youth or young adults, including— 

7 (1) the development and maintenance of a dedi8 cated physical space for recovery programs; 

9 (2) hiring dedicated staff for the provision of 

10 recovery programs; 

11 (3) providing health and wellness-oriented social 

12 activities and community engagement; 

13 (4) the establishment of a substance use recov14 ery high school; 

15 (5) the coordination of a peer delivered sub16 stance use recovery program with— 

17 (A) substance use disorder treatment pro18 grams and systems; 

19 (B) providers of mental health services; 

20 (C) primary care providers; 

21 (D) the criminal justice system, including 

22 the juvenile justice system; 

23 (E) employers; 

24 (F) recovery housing services; 

25 (G) child welfare services; 


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1 (H) high schools; and 

2 (I) institutions of higher education; 

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

4 programs or services delivered by individuals with 

5 lived experience in addiction recovery; and 

6 (7) any additional activity that helps youth or 

7 young adults achieve recovery from substance use 

8 disorders. 

9 (e) RESOURCE CENTER.—The Assistant Secretary 

10 for Mental Health and Substance Use shall establish a re11 source center to provide technical support to recipients of 

12 grants under this section. 

13 (f) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section 

15 $10,000,000 for fiscal year 2019 and each of the 4 suc16 ceeding fiscal years. 

17 SEC. 9. NATIONAL RECOVERY RESIDENCE STANDARDS. 

18 (a) BEST PRACTICES FOR OPERATING RECOVERY

19 HOUSING.—The Secretary of Health and Human Serv20 ices, acting through the Director of the Center for Sub21 stance Abuse Treatment of the Substance Abuse and Men22 tal Health Services Administration— 

23 (1) shall publish best practices for operating re24 covery housing, based on— 


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1 (A) the applicable domains, core principles, 

2 and standards of the National Alliance for Re3 covery Residences; and 

4 (B) input from other nationally accredited 

5 recovery housing entities and from stakeholders; 

6 (2) shall disseminate such best practices to each 

7 State; 

8 (3) may provide technical assistance to States 

9 seeking to adopt or implement such best practices; 

10 (4) shall identify barriers with respect to recov11 ery housing, State licensure, zoning restrictions, and 

12 discrimination against individuals receiving medica13 tion assisted treatment for the treatment of opioid 

14 abuse; and 

15 (5) shall develop strategies to address the bar16 riers identified under paragraph (4). 

17 (b) DEFINITIONS.—In this section: 

18 (1) The term ‘‘recovery housing’’ means a fam19 ily-like, shared living environment free from alcohol 

20 and illicit drug use and centered on peer support 

21 and connection to services that promote sustained 

22 recovery from substance use disorders. 

23 (2) The term ‘‘State’’ includes any of the sev24 eral States, the District of Columbia, and any terri25 tory or possession of the United States. 


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1 SEC. 10. IMPROVING TREATMENT FOR PREGNANT AND 

2 POSTPARTUM WOMEN. 

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

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

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

6 $100,000,000 for each of fiscal years 2019 through 

7 2023’’. 

8 SEC. 11. VETERANS TREATMENT COURTS. 

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

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

11 10651(o)(3)) is amended— 

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

13 ‘‘VETERANS’’; 

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

15 the following: 

16 ‘‘(A) LIMITATION.—Not more than’’; 

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

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

19 (1)’’; and 

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

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

22 to the amounts authorized under paragraph (1), 

23 there are authorized to be appropriated to the 

24 Department of Justice to carry out subsection 

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

26 through 2023.’’. 


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1 SEC. 12. INFANT PLAN OF SAFE CARE. 

2 Section 112 of the Child Abuse Prevention and 

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

4 at the end the following: 

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

6 amounts otherwise appropriated to carry out this title, 

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

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

9 for States to collaboratively develop policies and proce10 dures concerning, implement, and develop systems to mon11 itor plans of safe care under section 106(b)(2)(B)(iii).’’. 

12 SEC. 13. REQUIRE THE USE OF PRESCRIPTION DRUG MONI13 TORING PROGRAMS. 

14 (a) DEFINITIONS.—In this section: 

15 (1) CONTROLLED SUBSTANCE.—The term 

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

17 term in section 102 of the Controlled Substances 

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

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

20 State’’ means a State that receives funding under 

21 the Harold Rogers Prescription Drug Monitoring 

22 Program established under the Departments of 

23 Commerce, Justice, and State, the Judiciary, and 

24 Related Agencies Appropriations Act, 2002 (Public 

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

26 amendment made by this Act), or under the conVerDate Sep 11 2014 20:49 Apr 02, 2018 Jkt 079200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H5311.IH H5311

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1 trolled substance monitoring program under section 

2 399O of the Public Health Service Act (42 U.S.C. 

3 280g–3). 

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

5 (A) means a person licensed or otherwise 

6 authorized by a State to deliver a prescription 

7 drug product to a patient or an agent of the pa8 tient; and 

9 (B) does not include a person involved in 

10 oversight or payment for prescription drugs. 

11 (4) PDMP.—The term ‘‘PDMP’’ means a pre12 scription drug monitoring program. 

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

14 means a practitioner registered under section 303(f) 

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

16 to prescribe, administer, or dispense controlled sub17 stances. 

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

19 the several States and the District of Columbia. 

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

21 of enactment of this Act, each covered State shall re22 quire— 

23 (1) each prescribing practitioner within the cov24 ered State or their designee, who shall be licensed or 

25 registered healthcare professionals or other employVerDate Sep 11 2014 20:49 Apr 02, 2018 Jkt 079200 PO 00000 Frm 00018 Fmt 6652 Sfmt 6201 E:\BILLS\H5311.IH H5311

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1 ees who report directly to the practitioner, to consult 

2 the PDMP of the covered State before initiating 

3 treatment with a prescription for a controlled sub4 stance listed in schedule II, III, or IV of section 

5 202(c) of the Controlled Substances Act (21 U.S.C. 

6 812(c)), and every 3 months thereafter as long as 

7 the treatment continues; 

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

9 proactive notification to a practitioner when patterns 

10 indicative of controlled substance misuse, including 

11 opioid misuse, are detected; 

12 (3) each dispenser within the covered State to 

13 report each prescription for a controlled substance 

14 dispensed by the dispenser to the PDMP not later 

15 than 24 hours after the controlled substance is dis16 pensed to the patient; 

17 (4) that the PDMP make available a quarterly 

18 de-identified data set and an annual report for pub19 lic and private use, including use by health care pro20 viders, health plans and health benefits administra21 tors, State agencies, and researchers, which shall, at 

22 a minimum, meet requirements established by the 

23 Attorney General, in coordination with the Secretary 

24 of Health and Human Services; 


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1 (5) each State agency that administers the 

2 PDMP to— 

3 (A) proactively analyze data available 

4 through the PDMP; and 

5 (B) provide reports to law enforcement 

6 agencies and prescriber licensing boards de7 scribing any prescribing practitioner that re8 peatedly falls outside of expected norms or 

9 standard practices for the prescribing practi10 tioner’s field; and 

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

12 covered State be made available to other States. 

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

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

15 Secretary of Health and Human Services may withhold 

16 grant funds from being awarded to the covered State 

17 under the Harold Rogers Prescription Drug Monitoring 

18 Program established under the Departments of Com19 merce, Justice, and State, the Judiciary, and Related 

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

21 115 Stat. 748), under this Act (or an amendment made 

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

23 program under section 399O of the Public Health Service 

24 Act (42 U.S.C. 280g–3). 


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1 SEC. 14. INCREASING CIVIL AND CRIMINAL PENALTIES FOR 

2 OPIOID MANUFACTURERS. 

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

4 U.S.C. 842(c)) is amended— 

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

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

7 not exceed— 

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

9 and 

10 ‘‘(ii) if the violation is committed by a manufac11 turer of opioids and relates to the reporting of sus12 picious orders for opioids or failing to maintain ef13 fective controls against diversion of opioids, 

14 $100,000.’’; and 

15 (2) in paragraph (2)— 

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

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

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

19 ‘‘(D) In the case of a violation referred to in subpara20 graph (A) that was a violation of paragraph (5) or (10) 

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

22 that relates to the reporting of suspicious orders for 

23 opioids or failing to maintain effective controls against di24 version of opioids, the criminal fine under title 18, United 

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

Æ 


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