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PERSISTING

IN THE FIGHT
AN UPDATE TO THE
COMMUNITY ACTION PLAN
TO COMBAT HEROIN AND OPIOID ABUSE
hultgren.house.gov

TABLE OF CONTENTS
Executive Summary........................................................................................................................................... 4
Background ........................................................................................................................................................ 6
Illinois working together to prevent abuse, save lives and offer treatment options ............................ 7
14th District.................................................................................................................................................... 7
Illinois and Nationwide ................................................................................................................................ 7
Allocating resources at all stages of addiction prevention and treatment: education, treatment and
long-term recovery ........................................................................................................................................... 9
Funding ........................................................................................................................................................... 9
Education ........................................................................................................................................................ 9
Opioid Abuse .............................................................................................................................................. 10
Fentanyl ........................................................................................................................................................ 10
Treatment ..................................................................................................................................................... 10
Recovery ...................................................................................................................................................... 11
Recommendations: Community collaboration to fight heroin and opioid abuse in northern Illinois. 12
Local Level ................................................................................................................................................... 12
In-patient treatment is not always enough ........................................................................................ 12
Focus on prevention................................................................................................................................ 12
State Level ................................................................................................................................................... 12
Improve Access........................................................................................................................................ 12
Track overdoses ...................................................................................................................................... 12
Narcan should not be a prescription drug ........................................................................................ 13
Federal Level .............................................................................................................................................. 13
Change the way hospitals manage pain ........................................................................................... 13
Change the way hospitals are able to treat people suffering from addiction .......................... 13
Materials Distributed at Forum .................................................................................................................... 14

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CONGRESSMAN RANDY HULTGREN (ILLINOIS - 14)

January 4, 2017

Hello,

This summer, I convened a series of meetings with men and women in the 14th District who are on
the front lines of the fight against heroin and opioid abuse. We came together to talk candidly
about the problem in our communities, to celebrate our successes and to work together to take the
next steps forward.
I am proud of their accomplishments and the commitment of people in northern Illinois to address a
problem that is stealing the lives of our young people and causing suffering to our neighbors and
loved ones. I look forward to continuing to partner with people throughout the state in this fight and
to make northern Illinois a model for drug abuse prevention and addiction treatment and recovery.

Thank you,

A
Randy Hultgren
Member of Congress

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EXECUTIVE SUMMARY
On March 7, 2014, I convened a Community Leadership Forum on Heroin Prevention in the 14th
Congressional District in an effort to bring people together to discuss and address the heroin and
opioid epidemic raging across northern Illinois.
Since that first forum, I have spent time talking to people in our communities who have been
devastated by this epidemic and organizations throughout the state that are doing everything they
can to prevent drug abuse and effectively treat the men and women who need a way out of
addiction. I have worked with colleagues in the U.S. House of Representatives to share information
about what is happening with heroin and opioid abuse nationally and to discuss best prevention,
treatment and recovery practices across states.
Over the summer I held four meetings with those in my district on the front lines of the heroin
epidemicissue and patient advocates, law enforcement, treatment centers, and local and state
government officials. Our objectives were to reassess where we are in this fight, to have candid
conversations about what problems still exist, to highlight successful approaches, and to discuss
openly what we can be doing to more effectively fight this problem. We also talked about how
new programs and grants under the Comprehensive Addiction and Recovery Act can help the 14th
Congressional District, and where the gaps remain.
I was inspired to hear about the 14th Districts success stories and how these groups are working
together to save lives and give people hope through access to treatment.
County anti-drug initiatives are partnering with non-profit organizations and law
enforcement to prevent drug abuse and addiction and give individuals seeking help a way
out.
Drug take-back days are getting unused prescription painkillers out of peoples homes.
Law enforcement has launched programs to allow people suffering from drug abuse to turn
in drugs and drug paraphernalia without fear of arrest and get information and
recommendations on treatment options.
County Narcan programs are continuing to save lives.
Counties across northern Illinois are partnering with each other to create better reporting
mechanisms to more effectively differentiate between heroin and fentanyl deaths and
better understand how trends in prescribing opioids are influencing the heroin epidemic.
The treatment community is at the forefront of prevention through education and efforts to
reduce hospital and treatment center readmissions.
Groups identified the following as the remaining barriers they face:
Lack of funding for treatment beds and long-term sober living facilities to prevent relapse
after detox and treatment.
Insufficient and poorly attended initiatives in our school system among administrators,
teachers, parents and students.
The increase in prescriptions of opioid painkillers and prescription opioid abuse. Eighty
percent of heroin use begins as prescription drug use.

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CONGRESSMAN RANDY HULTGREN (ILLINOIS - 14)

Potent and dangerous fentanyl-laced heroin, which is especially deadly for the individuals
who relapse after treatment.
The effectiveness of drug addiction treatment being compromised by lack of long-term
beds, insurance coverage, insufficient oversight during medication-assisted detox and
widespread mental health issues.
Lack of stepping stones, such as sober living facilities between receiving treatment and
returning home, the absence of which often leads to relapse.
Below is a sampling of recommendations that came out of our community meetings this summer:
Provide or reallocate funding for inpatient addiction treatment in Illinois.
Find ways to supplement treatment with long-term sober living arrangements to prevent
relapse.
Expand the reach of prevention efforts by incentivizing attendance at education initiatives
across communities and school systems.
Implement standards for better tracking of overdoses in hospitals.
Increase access to Narcan, and offer treatment options to individuals who overdose.
Rethink pain management and hospital pain management ratings to prevent excess or
unnecessary opioid prescriptions.

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BACKGROUND
National news headlines now regularly confirm the existence of a devastating problem: young
people are losing their futures and neighbors are losing their children to heroin. The number of
people over the age of 12 using heroin nearly doubled between 2007 and 2012, and more than
three quarters of these heroin users are under the age of 26. Young adults in northern Illinois are
dying every year of heroin and opioid overdoses, and they are dying in greater numbers as a
result of new drugs like fentanyl. This problem is not going away.
On March 7, 2014, I convened a Community Leadership Forum on Heroin Prevention in Kane County.
The meeting brought together leaders, experts and stakeholders in the collar counties and across
Illinois, including law enforcement, drug courts, elected officials, educators, health care providers
and treatment centers. The objective was to discuss the problem in our communities and to encourage
participants to share resources and best practices to tackle the growing threat of heroin and opioid
addiction in northern Illinois. You can read a full report on the forum and our findings here.
Two years after I hosted the heroin prevention forum, Congress passed and the president signed
the Comprehensive Addiction and Recovery Act of 2016 (CARA). The law authorizes the Attorney
General and Secretary of Health and Human Services to award grants to address the national
epidemics of prescription opioid and heroin abuse and establishes and interagency task force to
review, modify and update best practices for pain management and prescribing pain medication.
I wanted to know how CARA could help the 14th Congressional District; where the gaps in
prevention, treatment and recovery remain; if and how the scope of the problem and community
approaches have changed; and how stakeholders across the state are working together to tackle
it. I wanted a candid assessment of the problem and the coalitions that exist to address it. And so,
over the summer of 2016 I brought together four groups of people engaged on this issue to learn
from them and offer me an update on how our 2014 report has been used in their efforts, where
lines of communication and partnership are missing, and what we can and should do going forward.

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CONGRESSMAN RANDY HULTGREN (ILLINOIS - 14)

ILLINOISANS WORKING TOGETHER TO PREVENT ABUSE, SAVE


LIVES AND OFFER TREATMENT OPTIONS
14TH DISTRICT
County initiatives across the 14th District have shown great progress and promise in combatting the
heroin epidemic in northern Illinois. The Lake County Underage Drinking and Drug Abuse Program
is partnering with Live for Lali and law enforcement to address the problem. Drug take-back days
are limiting the amount of prescription painkillers in area medicine cabinets. Lake Countys drug
disposal program was used by the Drug Enforcement Agency as a national model, and DuPage
County has collected 70,000 pounds of unused prescription opioids.
Lake County has also launched A Way Out, allowing addicts to come to a police station and
bring drug paraphernalia without any questions asked. These individuals are offered treatment
options, and 15 people at eight different police departments have taken advantage of the initiative
so far. Project Connect has successfully launched a pre-arrest program through which individuals
who have been saved with Narcan or are admitted to DuPage hospitals are given treatment
opportunities and case managers by the county health department. Lake and DuPage Counties are
creating a Chicago Opioid Awareness Task Force and involving Cook, Kane, Will, and McHenry
Counties. Their objectives are to better classify heroin vs. fentanyl deaths, promote mechanisms for
more accurate reporting from coroners, and collaborate with Drug-Free Communities.
Narcan continues to save lives across the state. DuPage County has launched its own Narcan
program, and the health department is tracking overdoses and emergency visits to educate officials
and inform actions. Kane Countys Narcan program is responsible for 32 saves, and county officials
are working hard to coordinate efforts to tackle the many pieces of potential solutions necessary
to our success. Lake County has 94 Narcan saves. DuPage County has launched its own Narcan
program, and the health department is tracking overdoses and emergency visits to educate officials
and inform actions. Kane Countys Narcan program is responsible for 32 saves, and county officials
are working hard to coordinate efforts to tackle the many pieces of potential solutions necessary
to our success.

ILLINOIS AND NATIONWIDE


Other state and national efforts are prioritizing education and prevention and improving
prescription and overdose reporting. Programs like D.A.R.E. are teaching students how to recognize
and combat drug use and addiction. Prevention is paramount because many people are unaware
of the addictive properties of heroin and, consequently, how difficult and expensive it is to treat
users and get them into recovery. Illinois is leading the county in its Prescription Monitoring Program,
which was intended to keep the state aware of the number and frequency of painkillers being
prescribed and to cut down on over-prescribing of opioids. The National Safety Councils
Prescription Drug Overdose Initiative is working to educate physicians, promote a national
education campaign, and expand access to safe and effective treatment.

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In northern Illinois A Man in Recovery is aiming to guide and direct individuals who need effective
and lasting treatment. Despite frequent insurance issues, the group can usually get someone into a
treatment facility within 24-48 hours. Often without A Man in Recovery, people with state insurance
are unable to access treatment for 12-24 weeks. One important objective of the group is to get
people in treatment centers away from the individuals they are using with to prevent relapse after
treatment. Ninety-four percent of funds come from loved ones who donate on behalf of someone
they lost.
The treatment community is saving the lives of the people in our communities suffering from addiction
and doing what they can to prevent hospital and center readmissions. Treatment centers are
offering education programs, like webinars, to inform people about the dangers of opioid abuse,
drug trends, and the dangers of heroin and fentanyl-laced heroin. The treatment community is
leading efforts to talk about oral surgery and sports injuries and encouraging parents, schools, and
communities to understand that no child is immune to addiction. Some of the most important education
treatment centers engage in is informing recovering addicts about their options and overdose
prevention after they have been taken off all opiates to prevent relapses.

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CONGRESSMAN RANDY HULTGREN (ILLINOIS - 14)

ALLOCATING RESOURCES AT ALL STAGES OF ADDICTION


PREVENTION AND TREATMENT: EDUCATION, TREATMENT
AND LONG-TERM RECOVERY
FUNDING
While we celebrated our successes, work remains left to be done. Everyone agreed that funding
for prevention, treatment and sober living facilities remains the most prominent missing piece of a
long-term solution. For example, funding remains a barrier to treatment access, and the treatment
community is often unsure whom to write to and what they need to do to discuss possible funding
increases. Many are interested in but unsure how to get access to money from the Illinois Department
of Human Services Division of Alcoholism and Substance Abuse. Illinois remains near the bottom of
the state list when it comes to drug addiction treatment funding, despite the fact that the epidemic
is hitting the state hard. Funding gaps exist for both prevention and treatment.
For instance, communities need more dollars for after-school programs that keep kids off the streets
and out of empty homes while parents are working. At the same time, people suffering from drug
abuse who are seeking help are asking for inpatient services, and Illinois is not adequately funding
beds for treatment centers. Improving access to effective treatment is critical to preventing these
individuals from relapse. Groups are looking for new opportunities to reallocate, reprioritize and
create new funding mechanisms, which will require them to identify their top needs, come up with a
dollar amount and determine state and federal agencies and other places from which they can
add to their funding.

EDUCATION
Experts agreed that education, the first defense against addiction, is still lacking. Educating the
public is difficult because many communities, schools and parents do not want to admit they have a
problem. Overdose is an end point in a five to 10 year drug use problem, and parents and
communities are nave to that reality. Thus, much of the problem is a matter of getting to the parents,
as times have changed and families arent spending as much time with their children. There are very
limited resources on the front end to support the loose network of parents educating other parents,
and HIPPA does not allow parents to be notified when a child overdoses. We are looking at what
is coming toward us instead of focusing on the root cause of the problem. We need to understand
and prevent heroin use. There needs to be a commitment to full prevention, instead of just in time
education.
Prevention programs do a good job with marijuana and alcohol we need to gain a better
understanding of what moves people from other drugs to heroin. Furthermore, we are often
targeting the wrong people. Opioid abuse is a young adult problem, not just a youth problem, and
prevention measures should target all age groups that are susceptible to drug use. We need to
talk about what causes these young men and women to use in the first place. If people do not want
treatment, they are not going to get it. Opiates are powerful drugs, and people suffering from

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drug addiction know the risk they are taking. We need to focus on the root cause of the problem
and challenge it before individuals start using and enter into the legal system. On a related note,
support and advocacy groups for parents are limited or nonexistent. There is no Mothers Against
Drunk Driving (MADD) equivalent for parents and loved ones of people who have overdosed on
heroin.

OPIOID ABUSE
Without a doubt one of the greatest problems nationally and one of the root causes of heroin
addiction is prescription opioid abuse. Eighty percent of heroin use starts as prescription drug use,
either prescribed, used at parties or sold on the black market. The current culture of pain
encourages providers to go to great lengths to make sure a patient is never in pain, and it has
turned out to be harmful for patients who later get addicted to pain medication. Miracle drug
oxytocin played a significant role in this cultural change. We are now reacting to this cultural
change, which has led to an emergency situation. Oral surgery in particular poses a threat to young
people who are then exposed to or possibly over-prescribed opioids. Over-prescription for sports
injuries and surgeries is also common. Hospitals are now rated on their ability to manage pain,
incentivizing providers to prescribe more painkillers. We are learning just how dangerous it is to
over-prescribe opioids for young people whose brains are still developing.

FENTANYL
Individuals in our communities are dying faster and overdosing easier because of post-treatment
relapses and the rise of fentanyl-laced heroin. Heroin is easily accessible, and fentanyl can be
bought on the internet. This is right in our communities, and many people arent willing to admit it.
Overdosing is now more common and more deadly because fentanyl has made it significantly more
difficult for first responders to save people. Fentanyl requires more Narcan than heroin does by
itself. Fentanyl is hundreds to thousands times stronger than heroin is. For people who have sought
help, it often takes three to four treatments for someone to finally break free of addiction, and
some police officers have reported saving the same individual with Narcan as many as three times.
People are very vulnerable when they come out of rehab, and many overdose right after treatment.

TREATMENT
There are also shortfalls when it comes to treatment both in terms of how patients are detoxed
and how long they are able to stay in an in-patient setting. Medicaid has nominally given more
people access to treatment, but payments are late and beds are still very limited. Medicaid also
typically pushes patients into programs similar to Alcoholics Anonymous, despite the evidence that
shows opioid addicts need more serious treatment. Insurance companies also tend to dictate
treatment by only covering certain care options. For example, many plans are not authorizing
opiate detox, and the cost of many detox drugs is prohibitive for patients without that financial
support.
Medication-assisted treatment has long been an effective but controversial way to treat individuals
suffering from opioid addiction. Lack of oversight in these settings is a chief concern. Concurrent

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CONGRESSMAN RANDY HULTGREN (ILLINOIS - 14)

drug use requires thorough assessment, or training wheels as patients get started in the recovery
process. Access is also a problem with medication-assisted treatment, as Medicaid is often not an
accepted form of payment for these providers. Patients are often limited where they can go for
this kind of treatment and are forced to commute from the collar counties into the city. Medication-
assisted treatment can be very expensive, as it is most effective if patients remain monitored in a
treatment facility, and there are added expenses for treatment centers to accept patients from
methadone clinics. This is certainly not the answer for patients who are medically indigent.
Treatment is also complicated by widespread mental health issues. Mental health is becoming a
significant driver of heroin use, as people suffering from mental health issues are using the drug to
self-medicate. Heroin is a strong anti-depressant and is being used as such. The more rural the
county is, the less likely it is to be getting funds for mental and behavior health treatment. Statewide,
there are minimal mental illness treatment options for these individuals who often end up homeless
and return to using and/or selling drugs. Jail is often the only hope for them.

RECOVERY
One of the biggest problems people in recovery face is finding a stepping stone between treatment
and returning to their homes where many are likely to use again. States need more funding for
sober living facilities like community centers, sober homes, and other community-based programs to
solve transportation and reintegration problems because three weeks is not enough to fully transition
a patient into recovery. The treatment window is so small and closes so quickly, so it becomes a
revolving door as addicts continue to relapse. There are currently a number of restrictions on sober
homes, including: zoning laws and lack of community support, cost-prohibitive building and staffing
needs, and waiting periods. These individuals need to have a place to go and live safely after
treatment, and many communities do not want sober homes in their neighborhoods.
The root of the issue is changing this perception. Individuals who have undergone treatment are
especially in need of tools to prevent relapses, and harm reduction cannot come without some level
of treatment, administered in a sober home or community living facility. The problem is that these
centers run into a shortage of days allotted for treatment or to detox a patient, and limited hospital
observation days compound the problem. Detox and treatment are limited but available; the
missing piece is long-term sober living. Individuals who do not get enough detox days and are not
offered a sober home living option are the most likely to overdose and die.

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RECOMMENDATIONS: COMMUNITY COLLABORATION TO


FIGHT HEROIN AND OPIOID ABUSE IN NORTHERN ILLINOIS.
LOCAL LEVEL
IN-PATIENT TREATMENT IS NOT ALWAYS ENOUGH
We need more long-term sober living facilities. We must look at this problem as a continuum
prevention, treatment, all the way through sober homes and recovery. Look at existing rules that
restrict housing for people in recovery, especially those individuals who have been arrested and no
longer have access to public housing. Work with the Substance Abuse and Mental Health
Administration to find or reallocate funding for sober living facilities.

FOCUS ON PREVENTION
Find ways to incentivize education programs. Think about linking access to grant funding to addiction
training and education. Work with schools to make addiction education part of the program on
parent orientation night. Work with elected officials to talk about the benefits of school-required
education for parents and students. Promote education in the local school systems by pushing on
educators to include it in sports orientation, high school orientation, parent nights, parent/teacher
conferences, etc. Think about ways to work with elected officials, law enforcement, schools, parents,
and students to get engagement through elective programs and, potentially, education through non-
elective programs. Communities need more funding for after-school programs that keep kids off
the streets and out of empty homes when parents are working. For effective prevention, we need
to start with the youngest people first. Treatment centers in particular can continue to educate the
public by sending email blasts about education events, especially for students, parents, and school
administrators.

STATE LEVEL
IMPROVE ACCESS
Individuals who are abusing these drugs and are seeking help are asking for inpatient services, and
Illinois is not adequately funding beds for treatment centers. We need to find a way to improve
access to effective treatment and keep these individuals in treatment long enough to prevent
relapse. Find ways to finance more beds. We cannot have people walking into police stations
seeking help and be turned away because they do not have enough space in treatment centers.
Think about creative ways to fund expanded access to treatment.

TRACK OVERDOSES
Track overdoses in hospitals and emergency rooms to reduce the existing discrepancies in county
data and get health providers, law enforcement and treatment centers on the same page.

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CONGRESSMAN RANDY HULTGREN (ILLINOIS - 14)

NARCAN SHOULD NOT BE A PRESCRIPTION DRUG


Narcan should not be a prescription drug. It has no side effects; all law enforcement can do is save
a life. There is no protection to the public by making it a prescription-only medication. However,
we must also go deeper than Narcan. We need to keep these individuals alive, but we need more
than four hours to prevent someone from going back to using. A legislative solution could include
requiring anyone administered Narcan in an emergency room to immediately get recommendations
for treatment centers.

FEDERAL LEVEL
CHANGE THE WAY HOSPITALS MANAGE PAIN
Change the way hospitals manage pain. Since pain was named the fifth vital sign, opioid
prescriptions have increased tremendously. The Affordable Care Acts hospital ratings for pain
control actually incentivize doctors to prescribe more opioid painkillers. We need to address
overprescribing. Over-the-counter drugs such as Sudafed are heavily regulated, but less so with
opiates we need consistency. Kentucky has a mandatory prescription monitoring program that
has yielded a lot of good data and success. The program in Illinois is voluntary, and only one in six
physicians use it. We can rely on SAMSA and Centers for Disease Control and Prevention messaging
the more evidence-based these practices are, the better. Expand the Illinois Prescription
Monitoring Program to specialists and sub-specialists who prescribe painkillers.

CHANGE THE WAY HOSPITALS ARE ABLE TO TREAT PEOPLE SUFFERING FROM ADDICTION
Hospital reimbursement is tied in some part to scores from the patients on pain relief, and
emergency rooms that do not use opioids will get rated as poor for not adequately treating pain.
On a related note, hospitals and emergency rooms need to be able to hold people who have
overdosed for some time after they are saved with Narcan, and HIPPA currently prevents them
from doing so.

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MATERIALS DISTRIBUTED AT FORUM

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Meeting on Combating Heroin in the 14th Congressional District
Agenda

Welcome and Introductory Remarks by Congressman Randy Hultgren


Discussion
Update on the Problem
Update on Progress
Update on Coalitions
Update on Comprehensive Addiction and Recovery Act
Closing Remarks
Comprehensive Addiction and Recovery Act of 2016 (CARA - S. 524)

Heroin, prescription drugs and opioid pain relief overdoses have more than tripled in the last
five years.
Drug overdoses are the leading cause of injury-related deaths, surpassing car accidents in
2015.
CARA authorizes the Attorney General and Secretary of Health and Human Services (HHS) to
award grants to address the national epidemics of prescription opioid abuse and heroin use
and establishes an interagency task force to review, modify, and update best practices for
pain management and prescribing pain medication.

Conference Report Summary

Title I: Prevention and Education

Section 101: Task force on Pain Management


Requires Secretary of HHS to convene a task force to identify, review, and determine
whether there are gaps or inconsistencies between best practices for chronic and acute pain
management.
Section 102: Awareness campaigns
Requires HHS and the Attorney General to advance the education and awareness of the
public of the risk of abuse of prescription opioid drugs if they are not taken properly.
Establishes a national drug awareness campaign led by the Office of National Drug Control
Policy (ONDCP) to bring attention to the association between prescription opioid abuse and
heroin use, as well as focus on the dangers of fentanyl - a potent, synthetic drug used to
relieve pain.
Section 103: Community-based coalition enhancement grants to address local drug crises
Authorizes the ONDCP to award grants to implement community-wide prevention strategies
for addressing the local drug crisis or emerging drug abuse issue in areas with high rates of
opioid or methamphetamine abuse.
It authorizes the appropriation of $5 million for each of fiscal years 2017 through 2021, and
allows ONDCP to delegate authority for carrying out the grant program.
Section 104: Information materials and resources to prevent addiction related to youth sports injuries
Teenage athletes who are prescribed an opioid are uniquely susceptible to opioid addiction.
This section directs the Secretary of HHS to make publically available a report determining
the extent of informational materials and resources available to youth sports injuries for
which opioids are potentially prescribed.
Section 105: Assisting veterans with military emergency medical training to meet requirement for
becoming civilian health care professionals
Awards demonstration grants to states to streamline licensure requirements for veterans
who held military medical expertise or who completed certain military medical training to
more easily meet civilian health care licensure requirements.
Section 106: FDA opioid action plan
Requires the FDA consult with advisory committees prior to approval or labeling of certain
new opioids in pediatric populations.
Section 107: Improving access to overdose treatment
Allow the Secretary of HHS, the Secretary of Veterans Affairs (VA), Secretary of Defense, 180
days after enactment, to provide information to prescribers on co-prescribing or prescribing
a drug or device for emergency treatment of known or suspected opioid overdose.
Establishes a grant program to increase access to opioid overdose treatment.
Section 108: NIH opioid research

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Allows the National Institute of Health (NIH) to intensify and coordinate fundamental,
translational, and clinical research with respect to the understanding of pain, the discovery
and development of therapies for chronic pain, and the development of alternatives to
opioids for effective pain treatments in order to advance the discovery and development of
novel, safe, non-addictive, effective, and affordable pharmaceuticals and other therapies for
chronic pain.
Section 109: National All Schedules Prescription Electronic Reporting Reauthorization
Reauthorizes the National All Schedules Prescription Electronic Reporting (NASPER) Act and
provides grants to states to establish, implement, and improve state-based prescription drug
monitoring programs (PDMPDs).
NASPER became law in 2005, but expired in 2010. CARA will extend funding for NASPER for
five years at $10 million a year for FY 2017 through FY 2021.
Section 110: Opioid overdose reversal medication access and education grant programs
Allows the Secretary of Health and Humans Services to make grants available for states to
implement standing orders for opioid reversal drugs. These grants may target states that
have a significantly higher per-capita rate of opioid overdoses than the national average.
Each state that is awarded a grant under this program must submit a report to the Secretary
of HHS evaluating the grant and the services that were provided.

Title II: Law Enforcement and Treatment

Section 201: Comprehensive Opioid Abuse Grant Program


Creates a comprehensive grant program at the Department of Justice to address the
problems of opioid addiction and abuse. The Conference Report authorizes $103 million for
each of fiscal years 2017 through 2021, which is fully offset and in accordance with House
Cut-as-you-go procedures
Section 202: First responder training
Codifies an existing grant program at the Substance Abuse and Mental Health Services
Administration (SAMHSA) to expand access to life-saving opioid overdose reversal drugs by
supporting the purchase and distribution of opioid overdose reversal drugs and training for
first responders.
Section 203: Prescription drug take back expansion
Authorizes the Attorney General to coordinate with certain entities in expanding or making
available disposal sites for unwanted prescription medications.

Title III: Treatment and Recovery

Section 301: Evidence-based prescription opioid and heroin treatment and interventions
demonstration
Codifies an existing grant program at SAMSHA to support states in expanding access to
addiction treatment services for individuals with an opioid use disorder.
Section 302: Building communities of recovery
Allows HHS to provide grants to community organizations to develop, expand, and enhance
recovery services and build connection between recovery networks, including physicians,
the criminal justice system, employers, and other recovery support systems.
Section 303: Medication-assisted treatment for recovery from addiction
Amends the Controlled Substances Act to expand access to medication-assisted treatment
by authorizing nurse practitioners and physician assistants to prescribe buprenorphine,
while ensuring that patients receive the full array of quality evidence-based services and
minimizing the potential for diversion.

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Title IV: Addressing collateral consequences

Section 401: GAO report on recovery and collateral consequences


Directs GAO to submit a report on recovery and collateral consequences of drug-related
criminal convictions.

Title V: Addiction and treatment services for women, families, and veterans

Section 501: Improving treatment for pregnant and postpartum women


Reauthorizes a grant program for residential treatment for pregnant and postpartum
women who have an opioid use disorder.
Section 502: Veterans treatment courts
Makes necessary definitions to qualified veterans and programs available to help veterans
through Veterans Treatment Courts.
Section 503: Infant plan of safe care
Requires HHS to review and confirm states have Child Abuse Prevention and Treatment Act
policies in place as required under the law, strengthens protections for infants born with
substance exposure by clarifying the intent of safe care plans, and requires HHS to share
best practices for developing plans to keep infants and their caregivers safe and healthy.
Section 504: GAO report on neonatal abstinence syndrome (NAS)
Requires a GAO report on neonatal abstinence syndrome

Title VI: Incentivizing state comprehensive initiatives to address prescription opioid abuse

Section 601: State demonstration grants for comprehensive opioid abuse response
Authorizes HHS to awards grants to states to carry out a comprehensive opioid abuse
response, including education, treatment, and recovery efforts, maintaining prescription
drug monitoring programs, and effort to prevent overdose deaths.

Title VII: Miscellaneous

Section 701: Grant accountability and evaluations


Authorizes DOJ and HSS to evaluate grants authorized by this Act. It prohibits grantees with
unresolved audit findings from receiving grants in the following fiscal year, and prioritizes
grantees that do not have unresolved audit findings.
Section 702: Partial fills of schedule II controlled substances
Clarifies that pharmacists coordinating with a patient and their doctor in accordance with
state law, do not need to fill the entire amount of a prescription for a Schedule II substance,
such as opioids. This change could lead to fewer opioids being dispensed.
Section 703: Good Samaritan assessment
Directs GAO to study and report to Congress on the effects of the various Good Samaritan
laws at the state level, and efforts by ONDCP to address opioid overdose.
Section 704: Programs to prevent prescription drug abuse under Medicare parts C and D
Allows prescription drug plans in Medicare to develop a safe prescribing and dispensing
program for beneficiaries that are at risk of abuse or diversion of drugs that are frequently
abused or diverted.
Allows the Secretary of HHS to work with private drug plan sponsors to facilitate the creation
and management of lock-in programs to curb identified fraud, abuse, and misuse of
prescribed medications while at the same time ensuring that legitimate beneficiary access to
needed medications is not impeded. Such controls would prevent doctor/pharmacy

3
shopping as well as duplicative and inappropriate drug therapies that can lead to
prescription drug abuse.
Section 705: Excluding abuse-deterrent formulations of prescription drugs from the Medicaid
additional rebate requirement for new formulations of prescription drugs
Corrects an unintended consequence in current law, which subjects abuse-deterrent
formulations of drugs to a higher rebate under the Medicaid program.
Section 706: Limiting disclosure of predictive modeling and other analytics technologies to identify
and prevent waste, fraud, and abuse
Section 707: Medicaid Improvement Fund
Prevents the disclosure of anti-fraud tools through FOIA-related laws while still allowing CMS
and state Medicaid and CHIP programs to freely share algorithms and other predictive
analytical tools.
Section 708: Sense of the Congress regarding treatment of substance abuse epidemics

Title VIII: Kingpin designation improvement

Section 801: Protection of classified information in Federal court challenges relating to designations
under the Narcotics Kingpin Designation Act
Incorporates the text of H.R. 4985, the Kingpin Designation Improvement Act of 2016, which
protects classified information from disclosure during a federal court challenge to kingpin
designations.

Title IX: Department of Veterans Affairs

Section 901: Short title


Includes the title Jason Simcaskoski Memorial and Promise Act.
Section 902: Definitions
Includes various definitions of terms used throughout Title IX

Subtitle AOpioid Therapy and Pain Management

Section 911: Improvement of opioid safety measures by Department of Veterans Affairs.


Requires the Secretary of Veterans Affairs (VA) to include all VA medical facilities in the
Opioid Safety Initiative and establish enhanced standards with respect to the use of routine
and random drug tests for all patients before and during opioid therapy.
Section 912: Strengthening of joint working group on pain management of the Department of
Veterans Affairs and the Department of Defense
Directs the VA and DOD to ensure opioid use and prescribing practices is a focus of the
Health Executive Committees Pain Management Working Group, and requires an update of
the VA/DOD Clinical Practice Guideline for Management of Opioid Therapy for Chronic Pain.
Section 913: Review, investigation, and report on use of opioids in treatment by Department of
Veterans Affairs
Directs GAO to report on the Opioid Safety Initiative.
Section 914: Mandatory disclosure of certain veteran information to State controlled substance
monitoring programs
Requires the VA to disclose certain veteran information to state controlled substance
monitoring programs.
Section 915: Elimination of co-payment requirement for veterans receiving opioid antagonists or
education on use of opioid antagonists

Subtitle BPatient Advocacy

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Section 921: Community meetings on improving care furnished by Department of Veterans Affairs

Requires that, within 90 days of the enactment of this act, and quarterly thereafter, each VA
medical facility hosts a public community meeting on improving VA health care; and within
one year of the enactment of this act, and at least annually thereafter, that each
community-based outpatient clinic (CBOC) hosts such a community meeting.
Section 922: Improvement of awareness of patient advocacy program and patient bill of rights of
Department of Veterans Affairs
Improves awareness of the Patient Advocacy Program and Patient Bill of Rights of the
Department of Veterans Affairs.
Section 923: Comptroller General Report on Patient Advocacy Programs of Department of Veterans
Affairs
Require that, within two years of the enactment of this act, GAO submit a report on the VA
Patient Advocacy Program to the Committees on Veterans Affairs of the House and of the
Senate. The report will include: (1) a description of the Program, including the Programs
purpose, activities, and sufficiency in achieving its purpose; (2) an assessment of the
sufficiency of the Programs staffing; (3) an assessment of the Programs employee training;
(4) an assessment of veterans and family members awareness of and utilization of the
Program; (5) recommendations for improving the Program; and (6) any other information
the GAO considers appropriate.
Section 924: Establishment of Office of Patient Advocacy of the Department of Veterans Affairs
Establishes an office of patient advocacy within the Office of the Undersecretary for Health
of the Department of Veterans Affairs.
Section 931: Expansion of Research and Education on and Delivery of Complementary and Integrative
Health to Veterans
Establishes a Commission to examine the evidence-based therapy treatment model used by
the VA for treating mental health conditions of veterans and the potential benefits of
incorporating complementary and integrative health as standards practice throughout the
Department.
Section 932: Pilot Program on Integration of Complementary and Integrative Health and Related
Issues for Veterans and Family Members of Veterans
Creates a pilot program on the integration of complementary and integrative health and
related issues for veterans and family members of veterans.
Section 941: Additional Requirements for Hiring of Health Care Providers by Department of Veterans
Affairs
Require that, as part of the hiring process for all health care providers considered for a
position after the date of the enactment of this act, that the Secretary require from the
medical board of the State in which the applicant is licensed: (1) information on any
violations of the requirements of medical license over the previous 20 years; and (2)
information on whether the provider has entered into any settlement agreements for
disciplinary charges related to the practice of medicine.
Section 942: Provision of Information on Health Care Providers of Department of Veterans Affairs to
State Medical Boards
This provision would require that VA provide to the medical board of each State in which the
provider is licensed information regarding violations, regardless of whether the board has
requested such information.
Section 943 Report on Compliance by Department of Veterans Affairs with Reviews of Health Care
Providers Leaving the Department or Transferring to Other Facilities
Require that, within 180 days of the enactment of this act, that the Secretary submit to the
Committees on Veterans Affairs of the House and of the Senate a report on VAs compliance
with VA policy to conduct a review of each provider who transfers from another VA medical

5
facility, retires, or is terminated, and to take appropriate actions with respect to any
concerns, complaints, or allegations against the provider.
Section 951 Modification to Limitation on Bonus and Awards
Limits the amounts of funds available for payment as bonuses and awards.

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