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 Hamp-
shire, and Mr. MACARTHUR) introduced the following bill; which was re-
ferred 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 com-
mittee concerned 
A BILL 
To reauthorize and expand the Comprehensive Addiction and 
Recovery Act of 2016. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘CARA 2.0 Act of 
2018’’. 
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SEC. 2. NATIONAL EDUCATION CAMPAIGN. 
Section 102 of the Comprehensive Addiction and Re-
covery Act of 2016 (42 U.S.C. 290bb–25g) is amended 
by adding at the end the following: 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section, 
$10,000,000 for each of fiscal years 2019 through 2023.’’. 
SEC. 3. THREE-DAY LIMIT ON OPIOID PRESCRIPTIONS. 
Section 303 of the Controlled Substances Act (21 
U.S.C. 823) is amended by adding at the end the fol-
lowing: 
‘‘(l) THREE-DAY
LIMIT
ON
OPIOID
PRESCRIP-
TIONS.— 
‘‘(1) DEFINITIONS.—In this subsection— 
‘‘(A) the term ‘acute pain’— 
‘‘(i) means pain with abrupt onset and 
caused by an injury or other process that 
is not ongoing; and 
‘‘(ii) does not include— 
‘‘(I) chronic pain; 
‘‘(II) pain being treated as part 
of cancer care; 
‘‘(III) hospice or other end-of-life 
care; or 
‘‘(IV) pain being treated as part 
of palliative care; and 
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‘‘(B) the term ‘addiction treatment opioid 
prescription’ means a prescription— 
‘‘(i) for an opioid drug in schedule II, 
III, or IV approved by the Food and Drug 
Administration for an indication for the 
treatment of addiction; and 
‘‘(ii) that is for the treatment of ad-
diction. 
‘‘(2) THREE-DAY LIMIT.—The Attorney General 
may not register, or renew the registration of, a 
practitioner under subsection (f) who is licensed 
under State law to prescribe controlled substances in 
schedule II, III, or IV, unless the practitioner sub-
mits to the Attorney General, for each such registra-
tion or renewal request, a certification that the prac-
titioner, during the applicable registration period, 
will not prescribe any opioid in schedule II, III, or 
IV, other than an addiction treatment opioid pre-
scription, for the initial treatment of acute pain in 
an amount in excess of a 3-day supply.’’. 
SEC. 4. FIRST RESPONDER TRAINING. 
Section 546 of the Public Health Service Act (42 
U.S.C. 290ee–1) is amended— 
(1) in subsection (c)— 
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(B) in paragraph (2)(C)(iv), by striking 
the period and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(3) may be used as provided for in subsection 
(d).’’; 
(4) by inserting after subsection (c) (as so re-
designated), the following: 
‘‘(d) ESTABLISHMENT OF REGIONAL TECHNICAL AS-
SISTANCE CENTERS.— 
‘‘(1) IN GENERAL.—Grants awarded under sub-
section (b) may be used to provide for the establish-
ment of regional technical assistance centers to pro-
vide regional technical assistance for the following: 
‘‘(A) Implementation of regionally driven 
peer delivered addiction recovery support serv-
ices before, during, after, or in lieu of addiction 
treatment. 
‘‘(B) Establishment of recovery community 
organizations. 
‘‘(C) Establishment of recovery community 
centers. 
‘‘(D) Naloxone training and dissemination. 
‘‘(2) ELIGIBLE ENTITIES.—To be eligible to re-
ceive a grant under paragraph (1), an entity shall 
be— 
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‘‘(A) a national nonprofit entity with a net-
work of local affiliates and partners that are 
geographically and organizationally diverse; or 
‘‘(B) a national nonprofit organization es-
tablished by individuals in personal and family 
recovery, serving prevention, treatment, recov-
ery, payor, faith-based, and criminal justice 
stakeholders in the implementation of local ad-
diction and recovery initiatives.’’; and 
(5) in subsection (e), by inserting before the pe-
riod the following: ‘‘, and $200,000,000 for each of 
fiscal years 2019 through 2023’’. 
SEC. 7. MEDICATION-ASSISTED TREATMENT FOR RECOV-
ERY FROM ADDICTION. 
(a) ALLOWING STATES TO RAISE PATIENT CAPS 
UNDER CERTAIN CONDITIONS; MAKING NURSE PRACTI-
TIONER AND PHYSICIAN ASSISTANT AUTHORITY PERMA-
NENT.—Section 303(g)(2) of the Controlled Substances 
Act (21 U.S.C. 823(g)(2)) is amended— 
(1) in subparagraph (G)(iii)(II), by striking 
‘‘during the period beginning on the date of enact-
ment of the Comprehensive Addiction and Recovery 
Act of 2016 and ending on October 1, 2021,’’; and 
(2) in subparagraph (I)— 
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(A) in clause (i), by striking ‘‘or’’ at the 
end; 
(B) by redesignating clause (ii) as clause 
(iii); and 
(C) by inserting after clause (i) the fol-
lowing: 
‘‘(ii) permits a qualifying practitioner to 
dispense drugs in schedule III, IV, or V, or 
combinations of such drugs, for maintenance or 
detoxification treatment in accordance with this 
paragraph to a total number of patients that is 
more than the total number applicable to the 
qualifying practitioner under subparagraph 
(B)(ii)(II), including an unlimited number, if 
the State— 
‘‘(I) enacts a law authorizing such 
dispensing to that increased total number, 
or unlimited number, of patients; 
‘‘(II) before the increased total num-
ber or elimination of a limit goes into ef-
fect in the State, directs the applicable 
State agency or regulatory board to adopt 
statewide regulations governing the use of 
medications approved by the Food and 
Drug Administration for the treatment of 
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opioid dependence or for the prevention of 
relapse to opioid dependence, consistent 
with nationally recognized evidence-based 
guidelines produced by a national or inter-
national medical professional association, 
public health entity, or governmental body 
with the aim of ensuring the appropriate 
use of evidence to guide individual diag-
nostic and therapeutic clinical decisions, 
including the National Practice Guidelines 
For the Use of Medications in the Treat-
ment of Addiction Involving Opioid Use 
issued by the American Society of Addic-
tion Medicine; and 
‘‘(III) notifies the Attorney General of 
the increased total number or elimination 
of a limit; or’’. 
(b) REPEAL OF REQUIREMENT TO UPDATE REGULA-
TIONS.—Section 303 of the Comprehensive Addiction and 
Recovery Act of 2016 (Public Law 114–198; 130 Stat. 
720) is amended by striking subsection (c). 
(c) DEFINITION
OF QUALIFYING OTHER PRACTI-
TIONER.—Section 303(g)(2)(G)(iv) of the Controlled Sub-
stances Act (21 U.S.C. 823(g)(2)(G)(iv)) is amended by 
striking ‘‘nurse practitioner or physician assistant’’ each 
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place that term appears and inserting ‘‘nurse practitioner, 
clinical nurse specialist, certified registered nurse anes-
thetist, certified nurse midwife, or physician assistant’’. 
(d) REQUIREMENT TO OFFER 2 TYPES OF MEDICA-
TION-ASSISTED TREATMENT.—Any entity, including a 
prison or jail, that receives Federal funds for a program 
or activity offering medication-assisted treatment shall 
offer, or have an affiliation with a provider who can pre-
scribe and discuss with patients the risks of, benefits of, 
and alternatives to— 
(1) not less than 1 opioid antagonist medication 
approved by the Food and Drug Administration; and 
(2) not less than 1 opioid agonist (or partial 
agonist) medication approved by the Food and Drug 
Administration to treat addiction involving opioids. 
SEC. 8. NATIONAL YOUTH RECOVERY INITIATIVE. 
(a) DEFINITIONS.—In this section: 
(1) ELIGIBLE ENTITY.—The term ‘‘eligible enti-
ty’’ means— 
(A) a high school that has been accredited 
as a substance use recovery high school or that 
is seeking to establish or expand substance use 
recovery support services; 
(B) an institution of higher education; 
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(C) a recovery program at an institution of 
higher education; 
(D) a nonprofit organization; or 
(E) a technical assistance center that can 
help grantees install recovery support service 
programs aimed at youth and young adults 
which include recovery coaching, job training, 
transportation, linkages to community based 
services and supports, regularly scheduled alter-
native peer group activities, life-skills education, 
and leadership development. 
(2) HIGH
SCHOOL.—The term ‘‘high school’’ 
has the meaning given the term in section 8101 of 
the Elementary and Secondary Education Act of 
1965 (20 U.S.C. 7801). 
(3) INSTITUTION OF HIGHER EDUCATION.—The 
term ‘‘institution of higher education’’ has the 
meaning given the term in section 101 of the Higher 
Education Act of 1965 (20 U.S.C. 1001). 
(4) RECOVERY PROGRAM.—The term ‘‘recovery 
program’’ means a program— 
(A) to help youth or young adults who are 
recovering from substance use disorders to ini-
tiate, stabilize, and maintain healthy and pro-
ductive lives in the community; and 
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(B) that includes peer-to-peer support de-
livered by individuals with lived experience in 
recovery, and communal activities to build re-
covery skills and supportive social networks. 
(b) GRANTS AUTHORIZED.—The Assistant Secretary 
for Mental Health and Substance Use, in consultation 
with the Secretary of Education, shall award grants, on 
a competitive basis, to eligible entities to enable the eligi-
ble entities to— 
(1) provide substance use recovery support serv-
ices to youth and young adults enrolled in high 
school or an institution of higher education; 
(2) help build communities of support for youth 
and young adults in substance use recovery through 
a spectrum of activities such as counseling, job 
training, recovery coaching, alternative peer groups, 
life-skills workshops, family support groups, and 
healthy and wellness-oriented social activities; and 
(3) encourage initiatives designed to help youth 
and young adults achieve and sustain recovery from 
substance use disorders. 
(c) APPLICATION.—An eligible entity desiring a grant 
under this section shall submit to the Assistant Secretary 
for Mental Health and Substance Use an application at 
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such time, in such manner, and containing such informa-
tion as the Assistant Secretary may require. 
(d) USE OF FUNDS.—Grants awarded under sub-
section (b) may be used for activities to develop, support, 
or maintain substance use recovery support services for 
youth or young adults, including— 
(1) the development and maintenance of a dedi-
cated physical space for recovery programs; 
(2) hiring dedicated staff for the provision of 
recovery programs; 
(3) providing health and wellness-oriented social 
activities and community engagement; 
(4) the establishment of a substance use recov-
ery high school; 
(5) the coordination of a peer delivered sub-
stance use recovery program with— 
(A) substance use disorder treatment pro-
grams and systems; 
(B) providers of mental health services; 
(C) primary care providers; 
(D) the criminal justice system, including 
the juvenile justice system; 
(E) employers; 
(F) recovery housing services; 
(G) child welfare services; 
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(H) high schools; and 
(I) institutions of higher education; 
(6) the development of peer-to-peer support 
programs or services delivered by individuals with 
lived experience in addiction recovery; and 
(7) any additional activity that helps youth or 
young adults achieve recovery from substance use 
disorders. 
(e) RESOURCE CENTER.—The Assistant Secretary 
for Mental Health and Substance Use shall establish a re-
source center to provide technical support to recipients of 
grants under this section. 
(f) AUTHORIZATION
OF APPROPRIATIONS.—There 
are authorized to be appropriated to carry out this section 
$10,000,000 for fiscal year 2019 and each of the 4 suc-
ceeding fiscal years. 
SEC. 9. NATIONAL RECOVERY RESIDENCE STANDARDS. 
(a) BEST PRACTICES FOR OPERATING RECOVERY 
HOUSING.—The Secretary of Health and Human Serv-
ices, acting through the Director of the Center for Sub-
stance Abuse Treatment of the Substance Abuse and Men-
tal Health Services Administration— 
(1) shall publish best practices for operating re-
covery housing, based on— 
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(A) the applicable domains, core principles, 
and standards of the National Alliance for Re-
covery Residences; and 
(B) input from other nationally accredited 
recovery housing entities and from stakeholders; 
(2) shall disseminate such best practices to each 
State; 
(3) may provide technical assistance to States 
seeking to adopt or implement such best practices; 
(4) shall identify barriers with respect to recov-
ery housing, State licensure, zoning restrictions, and 
discrimination against individuals receiving medica-
tion assisted treatment for the treatment of opioid 
abuse; and 
(5) shall develop strategies to address the bar-
riers identified under paragraph (4). 
(b) DEFINITIONS.—In this section: 
(1) The term ‘‘recovery housing’’ means a fam-
ily-like, shared living environment free from alcohol 
and illicit drug use and centered on peer support 
and connection to services that promote sustained 
recovery from substance use disorders. 
(2) The term ‘‘State’’ includes any of the sev-
eral States, the District of Columbia, and any terri-
tory or possession of the United States. 
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SEC. 14. INCREASING CIVIL AND CRIMINAL PENALTIES FOR 
OPIOID MANUFACTURERS. 
Section 402(c) of the Controlled Substances Act (21 
U.S.C. 842(c)) is amended— 
(1) in paragraph (1)(B), by striking ‘‘shall not 
exceed $10,000.’’ and inserting the following: ‘‘shall 
not exceed— 
‘‘(i) except as provided in clause (ii), $10,000; 
and 
‘‘(ii) if the violation is committed by a manufac-
turer of opioids and relates to the reporting of sus-
picious orders for opioids or failing to maintain ef-
fective 
controls 
against 
diversion 
of 
opioids, 
$100,000.’’; and 
(2) in paragraph (2)— 
(A) in subparagraph (A), by inserting ‘‘or 
(D)’’ after ‘‘subparagraph (B)’’; and 
(B) by adding at the end the following: 
‘‘(D) In the case of a violation referred to in subpara-
graph (A) that was a violation of paragraph (5) or (10) 
of subsection (a) committed by a manufacturer of opioids 
that relates to the reporting of suspicious orders for 
opioids or failing to maintain effective controls against di-
version of opioids, the criminal fine under title 18, United 
States Code, shall not exceed $500,000.’’. 
Æ 
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