,,ii #aaeth ,,congress #b;d ,session ,s4 #bdef ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #bg1 #bjah ,mr4 ,portman 7for himself1 ,mr4 ,whitehouse1 ,mrs4 ,capito1 ,ms4 ,klobuchar1 ,mr4 ,sullivan1 ,ms4 ,hassan1 ,mr4 ,cassidy1 and ,ms4 ,cantwell7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,a bill to reauthorize and expand the ,comprehensive ,addiction and ,recovery ,act of #bjaf4 #a4 ,short title ,this ,act may be cited as the ,,cara #b4j ,act of #bjah4 #b4 ,national ,education ,campaign ,section #ajb of the ,comprehensive ,addiction and ,recovery ,act of #bjaf 7#db ,u4,s4,c4 #bij;bb-#be;g7 is amended by adding at the end the following3 7d7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #aj1jjj1jjj for each of fiscal years #bjai through #bjbc4 4 #c4 ,three-day limit on opioid prescriptions ,section #cjc of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7 is amended by adding at the end the following3 7l7 ,three-,day limit on opioid prescriptions 7#a7 ,definitions ,in this subsection-- 7,a7 the term acute pain-- 7i7 means pain with abrupt onset and caused by an injury or other process that is not ongoing2 and 7ii7 does not include-- 7,i7 chronic pain2 7,,ii7 pain being treated as part of cancer care2 7,,iii7 hospice or other end-of-life care2 or 7,,iv7 pain being treated as part of palliative care2 and 7,b7 the term addiction treatment opioid prescription means a prescription-- 7i7 for an opioid drug in schedule ,,ii1 ,,iii1 or ,,iv approved by the ,food and ,drug ,administration for an indication for the treatment of addiction2 and 7ii7 that is for the treatment of addiction4 7#b7 ,three-day limit ,the ,attorney ,general may not register1 or renew the registration of1 a practitioner under subsection 7f7 who is licensed under ,state law to prescribe controlled substances in schedule ,,ii1 ,,iii1 or ,,iv1 unless the practitioner submits to the ,attorney ,general1 for each such registration or renewal request1 a certification that the practitioner1 during the applicable registration period1 will not prescribe any opioid in schedule ,,ii1 ,,iii1 or ,,iv1 other than an addiction treatment opioid prescription1 for the initial treatment of acute pain in an amount in excess of a #c-;day supply4 4 #d4 ,first responder training ,section #edf of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;ee-#a7 is amended-- 7#a7 in subsection 7c7-- 7,a7 in paragraph 7#b71 by striking and at the end2 7,b7 in paragraph 7#c71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following3 7#d7 train and provide resources for first responders and members of other key community sectors on safety around fentanyl and other dangerous illicit drugs to protect themselves from exposure and respond appropriately when exposure occurs4 2 7#b7 in subsection 7d71 by inserting 1 and safety around fentanyl and other dangerous illicit drugs before the period2 7#c7 in subsection 7f7-- 7,a7 in paragraph 7#c71 by striking and at the end2 7,b7 in paragraph 7#d71 by striking the period and inserting a semicolon2 and 7,c7 by adding at the end the following3 7#e7 the number of first responders and members of other key community sectors trained on safety around fentanyl and other dangerous illicit drugs4 2 and 7#d7 in subsection 7g71 by inserting before the period the following3 1 and #cjj1jjj1jjj for each of fiscal years #bjai through #bjbc4 #e4 ,evidence-based prescription opioid and heroin treatment and intervention demonstrations ,section #ead;,b of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;bb-#aj7 is amended-- 7#a7 in subsection 7d71 by inserting 1 and ,indian tribes and tribal organizations 7as defined in section #d of the ,indian ,self-,determination and ,education ,assistance ,act7 before the first period2 and 7#b7 in subsection 7f71 by inserting before the period the following3 1 and #cjj1jjj1jjj for each of fiscal years #bjai through #bjbc4 #f4 ,building communities of recovery ,section #edg of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;ee-#b7 is amended-- 7#a7 by striking subsection 7c72 7#b7 by redesignating subsection 7d7 as subsection 7c72 7#c7 in subsection 7c7 7as so redesignated7-- 7,a7 in paragraph 7#a71 by striking and at the end2 7,b7 in paragraph 7#b77;,c77iv71 by striking the period and inserting 2 and2 and 7,c7 by adding at the and the following3 7#c7 may be used as provided for in subsection 7d74 2 7#d7 by inserting after subsection 7c7 7as so redesignated71 the following3 7d7 ,establishment of regional technical assistance centers 7#a7 ,in general ,grants awarded under subsection 7b7 may be used to provide for the establishment of regional technical assistance centers to provide regional technical assistance for the following3 7,a7 ,implementation of regionally driven peer delivered addiction recovery support services before1 during1 after1 or in lieu of addiction treatment4 7,b7 ,establishment of recovery community organizations4 7,c7 ,establishment of recovery community centers4 7,d7 ,naloxone training and dissemination4 7#b7 ,eligible entities ,to be eligible to receive a grant under paragraph 7#a71 an entity shall be-- 7,a7 a national nonprofit entity with a network of local affiliates and partners that are geographically and organizationally diverse2 or 7,b7 a national nonprofit organization established by individuals in personal and family recovery1 serving prevention1 treatment1 recovery1 payor1 faith-based1 and criminal justice stakeholders in the implementation of local addiction and recovery initiatives4 2 and 7#e7 in subsection 7e71 by inserting before the period the following3 1 and #bjj1jjj1jjj for each of fiscal years #bjai through #bjbc4 #g4 ,medication-assisted treatment for recovery from addiction 7a7 ,allowing ,states ,to raise patient caps under certain conditions2 making nurse practitioner and physician assistant authority permanent ,section #cjc7;g77#b7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77 is amended-- 7#a7 in subparagraph 7,g77iii77,,ii71 by striking during the period beginning on the date of enactment of the ,comprehensive ,addiction and ,recovery ,act of #bjaf and ending on ,october #a1 #bjba12 and 7#b7 in subparagraph 7,i7-- 7,a7 in clause 7i71 by striking or at the end2 7,b7 by redesignating clause 7ii7 as clause 7iii72 and 7,c7 by inserting after clause 7i7 the following3 7ii7 permits a qualifying practitioner to dispense drugs in schedule ,,iii1 ,,iv1 or ,v1 or combinations of such drugs1 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 7,b77ii77,,ii71 including an unlimited number1 if the ,state-- 7,i7 enacts a law authorizing such dispensing to that increased total number1 or unlimited number1 of patients2 7,,ii7 before the increased total number or elimination of a limit goes into effect in the ,state1 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 opioid dependence or for the prevention of relapse to opioid dependence1 consistent with nationally recognized evidence-based guidelines produced by a national or international medical professional association1 public health entity1 or governmental body with the aim of ensuring the appropriate use of evidence to guide individual diagnostic and therapeutic clinical decisions1 including the ,national ,practice ,guidelines ,for the ,use of ,medications in the ,treatment of ,addiction ,involving ,opioid ,use issued by the ,american ,society of ,addiction ,medicine2 and 7,,iii7 notifies the ,attorney ,general of the increased total number or elimination of a limit2 or 4 7b7 ,repeal of requirement ,to update regulations ,section #cjc of the ,comprehensive ,addiction and ,recovery ,act of #bjaf 7,public ,law #aad-aih2 #acj ,stat4 #gbj7 is amended by striking subsection 7c74 7c7 ,definition of qualifying other practitioner ,section #cjc7;g77#b77;,g77iv7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;g77#b77;,g77iv77 is amended by striking nurse practitioner or physician assistant each place that term appears and inserting nurse practitioner1 clinical nurse specialist1 certified registered nurse anesthetist1 certified nurse midwife1 or physician assistant4 7d7 ,requirement ,to offer two types of medication-,assisted treatment ,any entity1 including a prison or jail1 that receives ,federal funds for a program or activity offering medication-assisted treatment shall offer1 or have an affiliation with a provider who can prescribe and discuss with patients the risks of1 benefits of1 and alternatives to-- 7#a7 not less than #a opioid antagonist medication approved by the ,food and ,drug ,administration2 and 7#b7 not less than #a opioid agonist 7or partial agonist7 medication approved by the ,food and ,drug ,administration to treat addiction involving opioids4 #h4 ,national youth recovery initiative 7a7 ,definitions ,in this section3 7#a7 ,eligible entity ,the term eligible entity means-- 7,a7 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 services2 7,b7 an institution of higher education2 7,c7 a recovery program at an institution of higher education2 7,d7 a nonprofit organization2 or 7,e7 a technical assistance center that can help grantees install recovery support service programs aimed at youth and young adults which include recovery coaching1 job training1 transportation1 linkages to community-based services and supports1 regularly scheduled alternative peer group activities1 life-skills education1 and leadership development4 7#b7 ,high school ,the term high school has the meaning given the term in section #haja of the ,elementary and ,secondary ,education ,act of #aife 7#bj ,u4,s4,c4 #ghja74 7#c7 ,institution of higher education ,the term institution of higher education has the meaning given the term in section #aja of the ,higher ,education ,act of #aife 7#bj ,u4,s4,c4 #ajja74 7#d7 ,recovery program ,the term recovery program means a program-- 7,a7 to help youth or young adults who are recovering from substance use disorders to initiate1 stabilize1 and maintain healthy and productive lives in the community2 and 7,b7 that includes peer-to-peer support delivered by individuals with lived experience in recovery1 and communal activities to build recovery skills and supportive social networks4 7b7 ,grants authorized ,the ,assistant ,secretary for ,mental ,health and ,substance ,use1 in consultation with the ,secretary of ,education1 shall award grants1 on a competitive basis1 to eligible entities to enable the eligible entities to-- 7#a7 provide substance use recovery support services to youth and young adults enrolled in high school or an institution of higher education2 7#b7 help build communities of support for youth and young adults in substance use recovery through a spectrum of activities such as counseling1 job training1 recovery coaching1 alternative peer groups1 life-skills workshops1 family support groups1 and healthy and wellness-oriented social activities2 and 7#c7 encourage initiatives designed to help youth and young adults achieve and sustain recovery from substance use disorders4 7c7 ,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 such time1 in such manner1 and containing such information as the ,assistant ,secretary may require4 7d7 ,use of funds ,grants awarded under subsection 7b7 may be used for activities to develop1 support1 or maintain substance use recovery support services for youth or young adults1 including-- 7#a7 the development and maintenance of a dedicated physical space for recovery programs2 7#b7 hiring dedicated staff for the provision of recovery programs2 7#c7 providing health and wellness-oriented social activities and community engagement2 7#d7 the establishment of a substance use recovery high school2 7#e7 the coordination of a peer delivered substance use recovery program with-- 7,a7 substance use disorder treatment programs and systems2 7,b7 providers of mental health services2 7,c7 primary care providers2 7,d7 the criminal justice system1 including the juvenile justice system2 7,e7 employers2 7,f7 recovery housing services2 7,g7 child welfare services2 7,h7 high schools2 and 7,i7 institutions of higher education2 7#f7 the development of peer-to-peer support programs or services delivered by individuals with lived experience in addiction recovery2 and 7#g7 any additional activity that helps youth or young adults achieve recovery from substance use disorders4 7e7 ,resource center ,the ,assistant ,secretary for ,mental ,health and ,substance ,use shall establish a resource center to provide technical support to recipients of grants under this section4 7f7 ,authorization of appropriations ,there are authorized to be appropriated to carry out this section #aj1jjj1jjj for fiscal year #bjai and each of the #d succeeding fiscal years4 #i4 ,national recovery residence standards 7a7 ,best practices for operating recovery housing ,the ,secretary of ,health and ,human ,services1 acting through the ,director of the ,center for ,substance ,abuse ,treatment of the ,substance ,abuse and ,mental ,health ,services ,administration-- 7#a7 shall publish best practices for operating recovery housing1 based on-- 7,a7 the applicable domains1 core principles1 and standards of the ,national ,alliance for ,recovery ,residences2 and 7,b7 input from other nationally accredited recovery housing entities and from stakeholders2 7#b7 shall disseminate such best practices to each ,state2 7#c7 may provide technical assistance to ,states seeking to adopt or implement such best practices2 7#d7 shall identify barriers with respect to recovery housing1 ,state licensure1 zoning restrictions1 and discrimination against individuals receiving medication assisted treatment for the treatment of opioid abuse2 and 7#e7 shall develop strategies to address the barriers identified under paragraph 7#d74 7b7 ,definitions ,in this section3 7#a7 ,the term recovery housing means a family-like1 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 disorders4 7#b7 ,the term ,state includes any of the several ,states1 the ,district of ,columbia1 and any territory or possession of the ,united ,states4 #aj4 ,improving treatment for pregnant and postpartum women ,section #ejh7s7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bij;bb-#a7s77 is amended in the first sentence by inserting before the period the following3 1 and #ajj1jjj1jjj for each of fiscal years #bjai through #bjbc4 #aa4 ,veterans treatment courts ,section #biia7o77#c7 of title ,i of the ,omnibus ,crime ,control and ,safe ,streets ,act of #aifh 7#cd ,u4,s4,c4 #ajfea7o77#c77 is amended-- 7#a7 by striking ,limitation and inserting ,veterans2 7#b7 by striking ,not more than and inserting the following3 7,a7 ,limitation ,not more than 2 7#c7 in subparagraph 7,a71 as so designated1 by striking this section and inserting paragraph 7#a72 and 7#d7 by adding at the end the following3 7,b7 ,additional funding ,in addition to the amounts authorized under paragraph 7#a71 there are authorized to be appropriated to the ,department of ,justice to carry out subsection 7i7 #bj1jjj1jjj for each of fiscal years #bjai through #bjbc4 4 #ab4 ,infant plan of safe care ,section #aab of the ,child ,abuse ,prevention and ,treatment ,act 7#db ,u4,s4,c4 #eajf;h7 is amended by adding at the end the following3 7c7 ,infant plan of safe care ,in addition to amounts otherwise appropriated to carry out this title1 there is authorized to be appropriated #fj1jjj1jjj for each of fiscal years #bjai through #bjbc1 to provide funds for ,states to collaboratively develop policies and procedures concerning implementing and developing systems to monitor plans of safe care under section #ajf7;b77#b77;,b77iii74 4 #ac4 ,require the use of prescription drug monitoring programs 7a7 ,definitions ,in this section3 7#a7 ,controlled substance ,the term controlled substance has the meaning given the term in section #ajb of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hjb74 7#b7 ,covered ,state ,the term covered ,state means a ,state that receives funding under the ,harold ,rogers ,prescription ,drug ,monitoring ,program established under the ,departments of ,commerce1 ,justice1 and ,state1 the ,judiciary1 and ,related ,agencies ,appropriations ,act1 #bjjb 7,public ,law #ajg-gg2 #aae ,stat4 #gdh71 under this ,act 7or an amendment made by this ,act71 or under the controlled substance monitoring program under section #cii,o of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g-#c74 7#c7 ,dispenser ,the term dispenser-- 7,a7 means a person licensed or otherwise authorized by a ,state to deliver a prescription drug product to a patient or an agent of the patient2 and 7,b7 does not include a person involved in oversight or payment for prescription drugs4 7#d7 ,,pdmp ,the term ,,pdmp means a prescription drug monitoring program4 7#e7 ,practitioner ,the term practitioner means a practitioner registered under section #cjc7;f7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hbc7;f77 to prescribe1 administer1 or dispense controlled substances4 7#f7 ,state ,the term ,state means each of the several ,states and the ,district of ,columbia4 7b7 ,in general ,beginning #a year after the date of enactment of this ,act1 each covered ,state shall require-- 7#a7 each prescribing practitioner within the covered ,state or their designee1 who shall be licensed or registered healthcare professionals or other employees who report directly to the practitioner1 to consult the ,,pdmp of the covered ,state before initiating treatment with a prescription for a controlled substance listed in schedule ,,ii1 ,,iii1 or ,,iv of section #bjb7;c7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hab7;c771 and every #c months thereafter as long as the treatment continues2 7#b7 the ,,pdmp of the covered ,state to provide proactive notification to a practitioner when patterns indicative of controlled substance misuse1 including opioid misuse1 are detected2 7#c7 each dispenser within the covered ,state to report each prescription for a controlled substance dispensed by the dispenser to the ,,pdmp not later than #bd hours after the controlled substance is dispensed to the patient2 7#d7 that the ,,pdmp make available a quarterly de-identified data set and an annual report for public and private use1 including use by healthcare providers1 health plans and health benefits administrators1 ,state agencies1 and researchers1 which shall1 at a minimum1 meet requirements established by the ,attorney ,general1 in coordination with the ,secretary of ,health and ,human ,services2 7#e7 each ,state agency that administers the ,,pdmp to-- 7,a7 proactively analyze data available through the ,,pdmp2 and 7,b7 provide reports to law enforcement agencies and prescriber licensing boards describing any prescribing practitioner that repeatedly fall outside of expected norms or standard practices for the prescribing practitioner's field2 and 7#f7 that the data contained in the ,,pdmp of the covered ,state be made available to other ,states4 7c7 ,noncompliance ,if a covered ,state fails to comply with subsection 7a71 the ,attorney ,general or the ,secretary of ,health and ,human ,services may withhold grant funds from being awarded to the covered ,state under the ,harold ,rogers ,prescription ,drug ,monitoring ,program established under the ,departments of ,commerce1 ,justice1 and ,state1 the ,judiciary1 and ,related ,agencies ,appropriations ,act1 #bjjb 7,public ,law #ajg-gg2 #aae ,stat4 #gdh71 under this ,act 7or an amendment made by this ,act71 or under the controlled substance monitoring program under section #cii,o of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bhj;g-#c74 #ad4 ,increasing civil and criminal penalties for opioid manufacturers ,section #djb7;c7 of the ,controlled ,substances ,act 7#ba ,u4,s4,c4 #hdb7;c77 is amended-- 7#a7 in paragraph 7#a77;,b71 by striking shall not exceed #aj1jjj4 and inserting the following3 8shall not exceed-- 7i7 except as provided in clause 7ii71 #aj1jjj2 and 7ii7 if the violation is committed by a manufacturer of opioids and relates to the reporting of suspicious orders for opioids or failing to maintain effective controls against diversion of opioids1 #ajj1jjj4 2 and 7#b7 in paragraph 7#b7-- 7,a7 in subparagraph 7,a71 by inserting or 7,d7 after subparagraph 7,b72 and 7,b7 by adding at the end the following3 7,d7 ,in the case of a violation referred to in subparagraph 7,a7 that was a violation of paragraph 7#e7 or 7#aj7 of subsection 7a7 committed by a manufacturer of opioids that relates to the reporting of suspicious orders for opioids or failing to maintain effective controls against diversion of opioids1 the criminal fine under title #ah1 ,united ,states ,code1 shall not exceed #ejj1jjj4 4