The Comprehensive Addiction and Recovery Act of 2016 ( CARA; S. 524 ) aims to address the problem of opioid addiction in the United States. It passed t he Senate ( S. 524 ES) o n March 10, 2016 , and it passed the House with an amendment in the nature of a substitute ( S. 524 EAH) o n May 13, 2016 . The two versions of the bill differ substantially. The scope of the differences may be illustrated by their structures: The Senate bill has 28 sections organized in 8 titles, whereas the House bill has 69 sections organized in 18 titles . This report discusses selected differences and similarities between the Senate- and House-passed versions of S. 524 . Both the House- and Senate-passed bills include provisions that would authorize new activities, provisions that would reauthorize and amend existing activities, and provisions that would codify activities already taking place. Few provisions, however, are directly comparable across the two bills. More often, the two bills include provisions addressing the same theme in different ways. Each bill also includes provisions for which the other bill has no comparable provisions; see Appendix A for a summary of the Senate bill and Appendix B for a summary of the House bill. The bills include two parallel provisions, which share the same headings and would require or authorize similar activities: (1) Pain Management Best Practices Interagency Task Force and (2) Grants for Treatment of Pregnant and Postpartum Women. Both the Senate bill (Section 101) and the House bill (Title I) would require the Secretary of Health and Human Services (HHS) to convene an interagency task force to review, modify, and update best practices for prescribing pain medication and managing chronic and acute pain. Both bills would specify the membership, duties, limitations, and reporting requirements for the task force; however, each bill would specify such factors differently (except for task force limitations). The House version would also specify conditions of participation and consideration of other studies. Both the Senate bill (Section 501) and the House bill (Title X) would reauthorize and amend an existing grant program supporting residential treatment of pregnant and postpartum women with a primary diagnosis of a substance use disorder. Both bills would require the Director of the Center for Substance Abuse Treatment, within the Substance Abuse and Mental Health Services Administration (SAMHSA), to carry out a pilot program, which would be specified somewhat differently in each bill. The two bills would authorize different amounts to be appropriated over different periods. Both would allow up to 25% of the appropriated amount to be used for the pilot program grants; however, the House bill would make this conditional on the amount appropriated. The House bill would also include an offset. The two bills are similar with regard to authorizing comprehensive opioid abuse grants, setting forth provisions to require accountability of grantees, addressing opioid abuse among veterans, including criminal justice provisions, and increasing access to naloxone to reverse opioid overdose. Both bills would amend existing law and authorize new grant activity and funds for states, tribes, and local governments to address opioid abuse. Both bills would authorize funds to be used for first responder training for the administration of opioid overdose reversal; treatment alternatives to incarceration (the bills specifically identify drug courts, veterans treatment courts, and other alternatives); investigative activities to combat the unlawful distribution of opioids; prescription drug monitoring programs (state applicants only); medication-assisted treatment programs; prescription drug take-back activities; programs that address youth or juvenile substance abuse; and comprehensive opioid abuse response plans. Notably, the bills would authorize these activities in different ways. Moreover, the House bill would authorize funds to go toward programs to use technology that provides a secure container for prescription drugs, whereas the Senate bill does not contain such a provision. Both bills authorize funding for programs in HHS and the Department of Justice (DOJ). For further explanation of what grants would be authorized by these bills if enacted, see Appendix A and Appendix B . Both bills would require various measures of grant accountability for programs that would be established by the bills as well as specific requirements for nonprofits. For example, both bills would require annual audits and other accountability of grantees receiving grants from DOJ. The House bill would go further in requiring an evaluation of performance for opioid abuse grant programs at both DOJ and HHS. If enacted, both bills would address the combined mental health and substance abuse treatment needs of justice-involved veterans, but they would do so in different ways. The House bill would amend 42 U.S.C. §3797aa (adult and juvenile collaboration programs) to include authorized assistance for veterans under DOJ. Of note, since FY2013, the DOJ's Bureau of Justice Assistance has funded veterans treatment courts through the Drug Court Discretionary Grant Program. The Senate bill does not have such a provision; rather, Section 503 of the Senate bill would amend 42 U.S.C. §3797aa as it would be amended by a separate bill that has passed the Senate but has not been enacted ( S. 993 ). Section 5 of S. 993 would amend 42 U.S.C. §3797aa by adding a new subsection (j) that would authorize a veterans treatment court program and define the term qualified veteran for participation in the program. Section 503 of CARA would further amend 42 U.S.C. §3797aa by expanding the proposed definition of a qualified veteran for participation in the veterans treatment court program (which would be authorized if S. 993 were enacted) to include those veterans who are discharged or released under dishonorable conditions if the reason, if known, is attributable to a substance use disorder. The House bill would require the Secretary of Veterans Affairs (VA) to expand VA's Opioid Safety Initiative, implement education and training requirements for VA employees who prescribe opioids, establish protocols for the designation of a pain management team at each VA medical facility, ensure access to state prescription drug monitoring program (PDMP) data, maximize availability of naloxone, modify VA's Opioid Therapy Risk Report tool, and flag the health records of veterans at risk of opioid abuse, among other things. See Appendix B for further details on this provision. The Senate bill does not have such provisions. Both bills contain various provisions for federal law enforcement and courts, but not all provisions are opioid-related. For example, the House bill would authorize $20 million in emergency federal law enforcement assistance funds for each fiscal year ending after FY2021. It would eliminate the current authorization (42 U.S.C. 10513(a)) of appropriations of $20 million annually for DOJ to make grants to state and local governments for law enforcement emergencies. The House bill also would amend the Foreign Narcotics Kingpin Designation Act to protect classified information from disclosure in the case of any judicial review in federal court of a determination made pursuant to such classified information. The Senate bill contains neither of these changes. The Senate version of S. 524 would expand federal law to include new drug offenses, wh ereas the House bill does not contain such provisions. Of note , the Transnational Drug Trafficking Act of 2015 ( S. 32 ) passed the Senate on October 7, 2015 , and subsequently passed the House on May 10, 2016. It was incorporated into the Senate-passed CARA ; h owever, its provisions were not included in the House -passed CARA . Both bills aim to increase access to drugs (or devices) that can reverse the effects of an opioid overdose. Naloxone is the only such product currently on the market. The Senate bill includes a single provision (Section 202) focused on supporting administration of naloxone by appropriately trained first responders under specified circumstances. Relative to the Senate bill, the House bill takes a broader approach to increasing access to naloxone. In addition to including first responder training in naloxone administration as one of several allowable uses of grant funds under Title II, the House bill has two titles aimed at encouraging naloxone use by people who need not be first responders. Title IX focuses on co-prescribing naloxone along with prescription opioids. Title XIII would support co-prescribing, the use of standing orders (which allow a prescription drug such as naloxone to be dispensed to anyone meeting specified criteria), and public education about naloxone. Appendix A. Summary of Senate Version of CARA The Comprehensive Addiction and Recovery Act of 2016 ( CARA; S. 524 ES ) , as passed in the Senate, would authorize various initiatives and grants within the Department of Health and Human Services (HHS) and the Department of Justice (DOJ) that would address opioid abuse in the United States. Title I. Prevention and Education Section 101. Development of Best Practices for the Use of Prescription Opioids Section 101 would require the HHS Secretary, in cooperation with the Veterans Affairs (VA) and Defense Secretaries and the Administrator of the Drug Enforcement Administration (DEA), to convene an interagency task force to review, modify, and update best practices for prescribing pain medication and managing chronic and acute pain. Section 101 would specify the membership, duties, limitations, and reporting requirements for the task force. Section 102. Awareness Campaigns Section 102 would require the HHS Secretary, in coordination with the Attorney General, to "advance the education and awareness of the public, providers, patients, consumers, and other appropriate entities" regarding the risk of prescription drug abuse. It would require the Director of the Office of National Drug Control Policy (ONDCP), in coordination with the HHS Secretary, to establish a national drug awareness campaign that takes into account the association between prescription drug abuse and heroin use, emphasizes the effects of and similarities between heroin and prescription opioids, and raises public awareness regarding the dangers of fentanyl. Section 103.