New Addiction and Recovery Law Targets Opioid Overdoses

Medicines in blister packaging and brown glass bottlesSince 2000, the number of Americans who overdose each year on opioids has quadrupled. According to the Centers for Disease Control and Prevention (CDC), opioids killed a record 28,000 people in 2014 alone, with more than half resulting from prescription medications.

A divergent national effort to combat those numbers now includes new legislation signed into law by President Barack Obama in July. The Comprehensive Addiction and Recovery Act, commonly referred to as CARA, is intended to establish “enhanced grant programs that would expand prevention and education efforts, while also promoting treatment and recovery.”

One major change the law allows is easing the availability restrictions on opioid antidote naloxone nationwide. Targeted educational programs, increased treatment resources, and stronger drug monitoring are also included in the law’s language.

However, clinicians, industry watchers, and even the White House have criticized the law for not going far enough. As opioid overdoses now annually claim more lives in the U.S. than car accidents, the law’s successes or shortcomings could impact thousands of families each year.

The Modern Opioid Overdose

An overdose of opioids is life threatening as it can radically slow breathing, which reduces or prevents oxygen intake. By blocking opioid receptors in the brain, naloxone can help return breathing to a safer level and save someone’s life in an emergency situation.

With more and more Americans coming into contact with powerful opioids, often by way of a pharmacy, emergency rooms have seen dramatic upticks in overdose admissions. When the CDC published findings from 2014 earlier this year, it noted the current epidemic features two distinct trends: “a 15-year increase in overdose deaths involving prescription opioid pain relievers, and a recent surge in illicit opioid overdose deaths, driven largely by heroin.”

What Is Naloxone?

Naloxone is distributed under the brand name Narcan and is used by emergency room staff, paramedics, and some police departments as a quick and reliable treatment for an overdose in progress. It works as an antagonist to opioids like heroin and Vicodin, blocking the opioids from affecting the brain at the molecular level. It can be administered as an inhalant or by injection, including a simplified auto-injector recently developed for easier use by untrained individuals. An improved formulation of the drug also now allows it to survive at higher temperatures.

Prior to CARA, naloxone was already allowed in many states, though under differing scenarios and authority. Some states allow police or paramedics to have the tool on hand, while other states enforce tighter restrictions, including requiring an individual prescription for each dose.

Making naloxone more widely and quickly available is largely seen in the medical community as a positive step, as minutes can be crucial during an active overdose. However, the new changes to federal law have been characteristically outpaced by local government. Last year, 14 different states passed legislation to broaden naloxone use. In many states, a prescription is no longer necessary to release the drug. Several states also added protection to shield prescribers and administering laypersons from civil liability.

CARA’s revisions are already affecting communities across the country. Within a week of the law’s signing, Florida began allowing pharmacies to distribute naloxone without an individual prescription. In Texas, the CVS drug store chain announced the availability of prescription-free doses statewide, with plans to expand the service to 30 other states by August of next year.

Other Changes as a Result of CARA

Aimed at spotting addictions early and curtailing the practice of doctor shopping, CARA will allow physicians to access a patient’s prescription history before determining a course of treatment.

Aside from naloxone, the use of other medication-assisted treatments is also authorized, included methadone and buprenorphine. For instance, nurse practitioners and physician assistants will now also be able to prescribe buprenorphine.

As opioid overdoses now annually claim more lives in the U.S. than car accidents, the law’s successes or shortcomings could impact thousands of families each year.The law also encourages greater use of diversion programs with certain drug offenses as a possible alternative to incarceration. For those eligible, however, consent may be necessary from both the prosecuting and defense attorneys, as well as corrections officials. Those who do participate will be required to provide periodic updates on their progress.

CARA will also challenge the importing of illicit drugs across U.S. borders—including counterfeit prescriptions—by creating new offenses. One such addition makes it a crime to manufacture or distribute a Schedule I or Schedule II controlled substance with the knowledge it will be imported to the U.S. It is now also illegal to knowingly enter the U.S. with certain counterfeit drugs.

When the bill was passed in the Senate, Grant Smith, the deputy director of national affairs for the Drug Policy Alliance, urged lawmakers not to become complacent on the issue.

“Lawmakers in Congress should be looking at ways to build upon the bipartisan political will that CARA has cultivated,” Smith said in a statement. “Important work underway in Congress right now to reduce draconian mandatory drug sentences, roll back collateral consequences of a drug law conviction, and enhance funding for evidence-based treatment and overdose prevention present critical opportunities to continue building upon the political momentum for change to our nation’s drug policies.”

References:

  1. American Pharmacists Association. (2016). CVS Health makes naloxone available without a prescription in Texas. Retrieved from http://www.pharmacist.com/cvs-health-makes-naloxone-available-without-prescription-texas
  2. Carney, J. (2016, March 10). Dems drop opposition to House opioid bill. Retrieved from http://thehill.com/policy/healthcare/286999-house-dems-drop-opposition-to-gop-opioids-bill
  3. Drug Policy Alliance. (2016, March 10). Republican controlled senate overwhelmingly passes landmark opioid bill. Retrieved from http://www.drugpolicy.org/news/2016/03/republican-controlled-senate-overwhelmingly-passes-landmark-opioid-bill-comprehensive-a
  4. Drug Policy Alliance. (2016). Map of state laws regulating naloxone. Retrieved from http://www.drugpolicy.org/resource/map-state-laws-regulating-naloxone
  5. Gordon, E. (2014, July 11). The overdose ‘antidote’: How Narcan works. Retrieved from http://www.newsworks.org/index.php/local/the-pulse/69881-the-overdose-antidote-how-narcan-works
  6. How to administer naloxone. (n.d.). Retrieved from http://www.getnaloxonenow.org/info-on-how-to-administer-naxolone.pdf
  7. Injury prevention & control: opioid overdose. (2016, March 16). Retrieved from http://www.cdc.gov/drugoverdose/index.html
  8. Kerr, D. (2016). Will the new opioid bill cara reach those in need? Retrieved from http://blog.nj.com/njv_david_kerr/2016/07/will_the_new_opioid_bill_cara.html
  9. Naloxone overdose prevention laws map. (n.d.). Retrieved from http://lawatlas.org/query?dataset=laws-regulating-administration-of-naloxone
  10. Overview of an epidemic. (2016, March 14). Retrieved from http://www.cdc.gov/drugoverdose/data/
  11. Rudd, R. (2016, January 1). Increases in drug and opioid overdose deaths — United States, 2000–2014. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm
  12. Suntrup, J. (2016, July 25). Overdose-reversal drug naloxone now available in Florida. Retrieved from http://www.tampabay.com/news/health/medicine/overdose-reversal-drug-naloxone-now-available-in-florida-without-an/2286681

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  • Clara

    Clara

    August 9th, 2016 at 11:17 AM

    I guess that this can be such a cheap and easy high to obtain this is why the numbers of overdoses have gone through the roof? It really is quite frightening to think that this is so mainstream now, something that used to be considered so outside of the box is kind of the new norm today.

  • Jayden

    Jayden

    August 9th, 2016 at 2:17 PM

    What happens when this is only available to certain communities while poorer communities will have alot of people who could also benefit?

  • Matt

    Matt

    August 10th, 2016 at 9:30 AM

    There are so many people who are in need of the benefits that this law could provide, I hope that it really has some far reaching and all encompassing effects on peoples lives. It amazes me that there are this many people who have a problem with opiate abuse and yet here it is in black and white. I think that the president has done a very courageous thing bringing attention to this issue, and hopefully the conversation is just beginning.

  • kev

    kev

    August 10th, 2016 at 1:59 PM

    Substitute for methadone? More or less effective?

  • Carol

    Carol

    August 11th, 2016 at 7:32 AM

    The problem is that unless you are in a small little field of people there is very little understanding of what addiction is and how it should be treated. I think that there are still a lot of people who think that this is something that you should be able to quit on your own and they think that addicts are somehow unworthy of getting help.

  • heidi

    heidi

    August 12th, 2016 at 2:11 PM

    While I agree that something has to be done to stop this growth of addiction and this law could be a great step in the right direction I think that there is something much deeper that needs to be addressed too.

    It is obvious to me that there are too many medical doctors who are just too freely giving out these prescriptions and getting people hooked on pain medicine that they may or may not actually need to take. I think that a lack of education in this field has somehow taken hold and this feels like the easiest thing to do, given them the drugs, when really this is causing even bigger problems than what we have ever seen.

  • Yusef

    Yusef

    August 13th, 2016 at 7:41 AM

    So many lives are being lost to something that could have at one time been so preventable. It is always a shame to me to look at the number of people losing their lives to this addiction and they don’t ever get any help or even know that there could be something out there that is available to them.

  • Virginia

    Virginia

    August 15th, 2016 at 7:52 AM

    We are making some headway, but I am sorry but I feel like laws are not the answer. They get the national conversation started but this is something that goes far deeper than just the legal system.
    There is something inherently worn in our society and the medical community in how pain is being managed and then how we treat and react to the ensuing drug addictions.
    I think that the legal system has to protect those who don’t really deserve to be caught up in it, but we have to fight back with more work on the ground and definitely more education on the front end of this battle.

  • Ted

    Ted

    August 16th, 2016 at 7:16 AM

    I am sure that there are people who are fighting back against this because of access to patient records.

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