S. 524 – Comprehensive Addiction and Recovery Act of 2016

Noteworthy

Overview of the Issue

In 2014, 61 percent of all drug overdose deaths in the U.S. were related to opioids, primarily prescription pain relievers and heroin. Prescription opioid overdose deaths have quadrupled since 1999, with 44 deaths every day. The Centers for Disease Control and Prevention has found that people in rural counties are almost twice as likely to overdose on prescription painkillers as are people in large cities. 

The ready availability of prescription painkillers is believed to be one of the leading factors in the rise of opioid abuse. When used appropriately, prescription opioids are among the most effective drugs for managing chronic pain – such as from cancer – and severe, acute pain after surgery or an accident. However, when misused, these drugs damage families and communities.

From 1999 to 2013, the sale of prescription painkillers in the United States quadrupled. In 2012, doctors prescribed enough prescription opioids for every adult in the United States to have their own month’s supply. Unsurprisingly, some of this medication is diverted to nonmedical uses. According to the CDC, every day nearly 7,000 people are treated in hospital emergency rooms for using opioids in a manner other than as directed. Nearly 2 million Americans reported opioid abuse or dependency in 2013.

Prescription opioid abuse is also associated with a rise in heroin use and overdoses. From 2002 to 2013, heroin use in the U.S. nearly doubled, and heroin-related overdose deaths nearly quadrupled. According to the CDC, “past misuse of prescription opioids is the strongest risk factor for heroin initiation and use.” A 2013 study from the Substance Abuse and Mental Health Services Administration showed that four out of five new heroin users had abused prescription pain medication before using heroin.

Late last year, Congress passed the Protecting Our Infants Act of 2015. This law will help to improve the prevention and treatment of opioid abuse by pregnant women and help to care for newborns affected by opioid abuse. Congress also included in the omnibus package $123 million – an increase of $91 million – for programs at the CDC and SAMHSA to combat opioid abuse. Additionally, it included $1.86 billion for SAMHSA for the Substance Abuse Prevention and Treatment Block Grant Program. This is a formula block grant for states that can be used for any substance abuse prevention and treatment activities, including for opioids.

Considerations on the Bill

The bill authorizes four different funding sources for the grant programs.

Most of the new grants are authorized under the Omnibus Crime Control and Safe Streets Act, which authorizes a number of criminal justice and substance abuse grant programs, such as the COPS grant program and the Edward Byrne Memorial Justice Assistance grant program. The bill authorizes a total of $62 million to be appropriated to the new grant programs each fiscal year from 2016 to 2020. Administration of these programs is assigned to the attorney general or the HHS secretary.

Two grant programs are authorized to be funded for five years from the funds made available to SAMHSA for criminal justice activities. In fiscal year 2016 SAMHSA received $78 million for criminal justice activities – $60 million of that was directed to drug court activities. The HHS secretary is responsible for administering these programs.

An existing grant program for residential treatment of pregnant and postpartum women with substance abuse disorders is reauthorized at $15.9 million each year from 2016 to 2020. Up to 25 percent of these funds may go toward a newly authorized pilot grant program for family-based treatment.

Lastly, the bill authorizes the attorney general to award grants, as part of a pilot program, to states for comprehensive opioid abuse response programs. The bill authorizes this program to be funded at up to $5 million annually for fiscal years 2016 through 2020 from any unobligated balances appropriated to the Department of Justice for “general administration.”

Three of the grant programs also require that in awarding grants, the agencies give priority to states that provide civil liability protection to first responders, health professionals, and family members who have received appropriate training and who administer the drug naloxone to counteract an opioid overdose. Naloxone is an opioid antagonist that blocks the body’s response to an opioid. If timely administered during an overdose, it can prevent an opioid from causing the slowed breathing that leads to overdose deaths. There is some concern that fear of being sued prevents people in the best position to administer naloxone from doing so. The state priority provisions are designed to encourage states to take steps to counter these fears.

Senate Democrats have said that the bill should include emergency funding to address opioid abuse. They have highlighted Senator Shaheen’s Opioid and Heroin Epidemic Emergency Supplemental Appropriations Act, which would appropriate an additional $600 million in emergency funding to DOJ and HHS.

Notable Bill Provisions

Title I – Prevention and Education

Section 101 – Development of best practices for the prescribing of prescription opioids

Establishes a Pain Management Best Practices Inter-Agency Task Force, headed by the HHS secretary, to review, modify, and update best practices for pain management and prescribing pain medication. Requires the task force to consider the CDC’s Proposed 2016 Guidelines for Prescribing Opioids for Chronic Pain. The task force has no rulemaking authority.

Section 103 – Community-based coalition enhancement grants to address local drug crises

Authorizes the attorney general to award grants under the Omnibus Crime Control and Safe Streets Act to eligible entities for implementing community-wide strategies to address drug crises in areas that: (a) have opioid and methamphetamine abuse rates higher than the national average; and (b) have seen a recent spike in such abuse or higher than average abuse rates for a sustained period of time. Entities must have received a Drug-Free Communities grant previously.

Title II – Law Enforcement and Treatment

Section 201 – Treatment alternative to incarceration programs

Authorizes the HHS secretary to make grants to states, local governments, and nonprofits to implement treatment alternatives to incarceration for people with substance use disorders or co-occurring mental illness and substance use disorder. Authorizes the use of funds made available to SAMHSA for criminal justice activities for five years. Preference must be given to states that provide civil liability protection for the administration of naloxone.

Section 202 – First responder training for the use of drugs and devices that rapidly reverse the effects of opioids

Authorizes the HHS secretary to award grants under the OCCSSA to state, local, and tribal governments for training first responders in the administration of opioid overdose reversal drugs, such as naloxone. Requires 25 percent of grant funds to go toward rural areas.

Section 204 – Heroin and methamphetamine task forces

Authorizes the attorney general to award grants under the OCCSSA to state law enforcement agencies to investigate illegal trafficking and distribution of heroin, fentanyl, and prescription opioids.

Title III – Treatment and Recovery

Section 301 – Evidence-based opioid and heroin treatment and interventions demonstration

Authorizes the attorney general to award grants under the OCCSSA to entities in areas with high levels of heroin or other opioid abuse in order to expand evidence-based activities, including expanding the availability of medication-assisted treatment.

Section 302 – Criminal justice medication-assisted treatment and interventions demonstration

Authorizes the HHS secretary to make grants to state and local governments to implement medication assisted treatment programs through criminal justice agencies. Authorizes the use of funds made available to SAMHSA for criminal justice activities for five years. Preference must be given to states that provide civil liability protection for the administration of naloxone.

Section 303 – National youth recovery initiative

Authorizes the attorney general to award grants under the OCCSSA to high schools, institutions of higher learning, and nonprofit organizations to supply substance abuse recovery services to young people in high school and college.

Section 304 – Building communities of recovery

Authorizes the HHS secretary to make grants under the OCCSSA to recovery community organizations to support people in recovery and expand recovery resources. Recovery community organizations are non-profit organizations run by people recovering from substance abuse to provide support and resources to those who are also struggling with substance abuse.

Title IV – Addressing Collateral Consequences

Section 401 – Correctional education demonstration grant program

Authorizes the attorney general to award grants under the OCCSSA to government entities and nonprofits to expand educational programs for offenders in prisons, jails, and juvenile facilities.

Section 402 – National Task Force on Recovery and Collateral Consequences

Requires the attorney general to establish a 10 member, bipartisan Task Force on Recovery and Collateral Consequences. Collateral consequences are penalties or disabilities imposed as a result of a federal or state conviction. They include things such as ineligibility for licenses, registration, certification, or employment; publication or disclosure of criminal convictions; and suspension or removal from employment or positions.

Title V – Addiction and Treatment Services for Women, Families, and Veterans

Section 501 – Improving treatment for pregnant and postpartum women

Reauthorizes an existing grant program for residential treatment programs for pregnant and postpartum women and authorizes the director of the Center for Substance Abuse Treatment to start a five-year pilot program making competitive grants to state substance abuse agencies for use in enhancing services to pregnant and postpartum women with substance use disorders. Requires the director to specify minimum service requirements to be provided by grant recipients and to solicit recommendations from stakeholders in setting such requirements. Requires the Center for Behavioral Health Statistics and Quality to evaluate and report to congress on the results of the pilot program after one year. Authorizes the appropriation of $15.9 million each fiscal year from 2016 to 2020 for the reauthorized program and the new pilot program. No more than 25 percent of these funds may go toward the pilot program.

Section 502 – Report on grants for family-based substance abuse treatment

Requires the attorney general to submit an annual report to Congress on grants awarded under section 2921 of the OCCSSA for developing and implementing family-based substance abuse treatment programs as alternatives to incarceration for custodial parents.

Section 503 – Veterans’ treatment courts

Clarifies that veterans who were dishonorably discharged because of a substance use disorder are eligible for veterans’ treatment courts. This section amends a provision not yet in law. The amended provision is part of the Comprehensive Justice and Mental Health Act of 2015, S. 993, which passed the Senate earlier this year and is expected to pass the House under suspension in the next few weeks.

Title VI – Incentivizing State Comprehensive Initiatives to Address Prescription Opioid and Heroin Abuse

Section 601 – State demonstration grants for comprehensive opioid abuse response

Authorizes the attorney general to award grants to states for preparation and implementation of an integrated opioid abuse response initiative. These initiatives must include prevention and education efforts; a comprehensive prescription drug monitoring program for schedule II, III, or IV controlled substances; treatment programs for prescription drug and opioid addiction; and programs to prevent overdose deaths. Planning grants are for one year and may not exceed $100,000. Implementation grants are for two years and may not exceed $5 million. Preference must be given to states that provide civil liability protection for the administration of naloxone. Funding for the grants is authorized for 2016-2020 from any unobligated balances made available to DOJ under the heading “general administration” in an appropriations act.

Title VII – Miscellaneous

Section 701 – GAO report on IMD exclusion

Requires the comptroller general to submit a report to Congress on the impact that the Medicaid Institutions for Mental Disease exclusion has on access to treatment for individuals with a substance use disorder. The Medicaid IMD exclusion is the prohibition on federal matching payments under Medicaid for treatment to patients between 22 and 64 years of age in certain non-government psychiatric hospitals for inpatient emergency psychiatric care.

Section 702 – Funding

Authorizes $62 million for each of fiscal years 2016 through 2020 to fund the grants authorized in sections 103, 202, 204, 301, 303, 304, and 401.

Section 704 – Grant accountability

Requires the inspectors general of DOJ and HHS to audit an appropriate number of grant recipients each year for waste, fraud, and abuse. If a grantee is found to have made unauthorized expenditures with grant funds, the grantee is barred from receiving grant funds for the next two years. If DOJ or HHS is found to award a grant to such an entity during those two years, the attorney general or the HHS secretary must deposit the amount of the improperly awarded grant funds into the general fund of the Treasury and seek recoupment from the grantee.

Requires prior written authorization from the attorney general or HHS secretary for any expenditure of grant funds over $20,000 that goes toward conference expenses. Both DOJ and HHS must submit an annual report to Congress on all such approved conference expenditures.

The attorney general and HHS secretary must submit annuals certifications that the auditing, exclusion, and conference requirements have been met.

Administration Position

The administration has not taken a position on this bill at this time.

Cost

A CBO cost available is not available at this time.

Amendments

The amendment situation is unclear at this time.