National Journal Article on How CARA Became a Bill

Last week, the National Journal published an article detailing how the Comprehensive Addiction Recovery Act (CARA) came to be. The piece follows all the key players that worked together to make the bill a reality, including the Partnership for Drug-Free Kids. The setting for CARA to become a bill has been bolstered by the evolving public per­cep­tion of ad­dic­tion – a disease now more commonly viewed as a pub­lic-health problem, rather than a moral failing.

Our President and CEO, Marcia Lee Taylor, talks about how the Partnership has supported and advocated for the passing of the CARA bill in the article. Please read the full text of the National Journal article below:

The National Journal, March 24, 2016

How the Addiction Lobby Got Its Bill

A relatively informal group of advocates has become a coherent D.C. force, and now the Comprehensive Addiction and Recovery Act is nearing the finish line.

The ad­dic­tion com­munity doesn’t ne­ces­sar­ily have the man­power or re­sources of Wash­ing­ton’s power­ful health care lob­by­ing forces, such as the Amer­ic­an Med­ic­al As­so­ci­ation or Blue Cross Blue Shield. But with ma­jor le­gis­la­tion inch­ing closer to pas­sage, it’s co­ales­cing in a way it hasn’t really be­fore.

The Com­pre­hens­ive Ad­dic­tion and Re­cov­ery Act eas­ily passed the Sen­ate 94-1 this month, and now the bill’s in­creas­ingly well-or­gan­ized ad­vocacy co­ali­tion is push­ing for fi­nal ap­prov­al in the House.

“I think this is really the first time we’ve seen this scale of unit­ing be­hind an is­sue with­in the ad­dic­tion field,” said Jes­sica Nick­el, who’s been work­ing on these is­sues for more than two dec­ades and serves as Ad­dic­tion Policy For­um’s ex­ec­ut­ive dir­ect­or.

Those who fo­cus on ad­dic­tion in Wash­ing­ton already have a re­l­at­ively in­form­al group that’s been hold­ing meet­ings for close to 20 years. But Nick­el’s group, a part­ner­ship of poli­cy­makers, stake­hold­ers, and or­gan­iz­a­tions, formed three years ago to add even more struc­ture to the ef­fort.

They were able to cor­ral a ro­bust group of more than 150 na­tion­al or­gan­iz­a­tions—with grass­roots ef­forts to match the D.C. push—be­cause CARA aims to curb a tan­gible prob­lem in Amer­ica: the fre­quency of par­ents, friends, and re­l­at­ives learn­ing that a loved one died of a pre­scrip­tion-paink­iller or heroin over­dose.

Ad­voc­ates say they’ve united be­hind the bill be­cause it’s com­pre­hens­ive, and that means nearly all fa­cets of the com­munity—from dis­trict at­tor­neys to treat­ment pro­viders, pub­lic-health of­fi­cials to those in long-term re­cov­ery—have a stake in the fight for pas­sage.

“What’s dif­fer­ent is [be­fore­hand] we didn’t have thou­sands of people dy­ing—lit­er­ally that was prob­ably the single biggest dif­fer­ence,” said Robert Mor­ris­on, the ex­ec­ut­ive dir­ect­or of the Na­tion­al As­so­ci­ation of State Al­co­hol and Drug Ab­use Dir­ect­ors. “And people bra­cing, know­ing that we do need a com­pre­hens­ive ap­proach.”

That’s one in a con­flu­ence of oth­er reas­ons why ad­voc­ates say so many people and groups are help­ing sup­port CARA: The per­cep­tion of ad­dic­tion has evolved, and it’s now gen­er­ally viewed as a pub­lic-health prob­lem. Par­ents spoke out and told their per­son­al stor­ies of los­ing a child to an over­dose. Stake­hold­ers were in­tim­ately in­volved with help­ing cre­ate the bill. And the Ad­dic­tion Policy For­um helped pull vari­ous or­gan­iz­a­tions to­geth­er.

“I think really hav­ing a piece of le­gis­la­tion that we all be­lieved in, and that we all be­lieved was go­ing to make a dif­fer­ence in this crit­ic­al time, and also that was go­ing some­place” helped, Mar­cia Lee Taylor, pres­id­ent and CEO of Part­ner­ship for Drug-Free Kids, said. “That’s one of the crit­ic­al pieces as well be­cause if you are go­ing to be ral­ly­ing your con­stitu­ency to ad­voc­ate for something, you want to make sure that it has a chance of go­ing some­place.”

The groups were in­volved at the very start of the le­gis­lat­ive pro­cess, which Sen. Rob Port­man de­tailed in a March 3 speech on the Sen­ate floor.

“Two years ago, be­fore Sen­at­or (Shel­don) White­house and I draf­ted this bill, we en­gaged with in­di­vidu­als in the treat­ment and re­cov­ery com­munity, with phys­i­cians and nurses, and with out­side ex­perts,” the Ohio Re­pub­lic­an said. “We met with fam­il­ies who had been im­pacted by the struggle with ad­dic­tion.”

White­house, Port­man, and oth­er mem­bers and ad­voc­ates held a series of for­ums on opioid ab­use. Ad­voc­ates stayed in com­mu­nic­a­tion with Hill staff and began mo­bil­iz­ing those in the pre­ven­tion, treat­ment, re­cov­ery, and law en­force­ment com­munit­ies to rally around CARA.

Fa­cing Ad­dic­tion held a con­cert and rally on the Na­tion­al Mall. There were fly-in days. They’ve sent let­ters to lead­er­ship. The groups have asked their base to con­tact their con­gress ­mem­bers. And the or­gan­iz­a­tions stay up­dated on the state-of-play of CARA—which hasn’t been put to a vote in the House—in Con­gress through the Ad­dic­tion Policy For­um’s email up­dates.

In the past, sub­stance-ab­use is­sues were viewed dif­fer­ently, Taylor said. She re­called work­ing on drug-policy is­sues for nine years for Sen­ate Demo­crats. “What’s in­ter­est­ing is in the time when I was on the Hill—which was the late ‘90s and early 2000s—the per­spect­ive really was crim­in­al-justice first, and pre­ven­tion and treat­ment second,” Taylor said. “And that’s really flip-flopped.”

Yet, in the past, the com­munity has worked to­geth­er on some ma­jor le­gis­la­tion, such as the Men­tal Health Par­ity and Ad­dic­tion Equity Act of 2008, which pre­ven­ted health in­sur­ance plans from provid­ing less be­ne­fits for men­tal-health and sub­stance-use dis­orders than for med­ic­al is­sues. The sub­stance of this le­gis­la­tion was dif­fer­ent than CARA, ac­cord­ing to Patty Mc­Carthy Met­calf, Faces & Voices of Re­cov­ery ex­ec­ut­ive dir­ect­or, and that meant the ad­vocacy was dif­fer­ent.

“The ad­vocacy around the Par­ity bill was a turn­ing point for a move­ment that people got be­hind be­cause of un­just in­sur­ance reg­u­la­tions that pre­ven­ted people from get­ting treat­ment, and that people in re­cov­ery, fam­ily mem­bers, and pro­vider/ad­vocacy or­gan­iz­a­tions had a lot at stake in such a huge shift in the law,” she wrote in an email. “It was driv­en by a call for ac­tion on re­vers­ing dis­crim­in­at­ory prac­tices, which is dif­fer­ent from CARA.”

The broad sup­port for CARA ex­ten­ded to the up­per cham­ber, where only Sen. Ben Sas­se voted against the bill. (Demo­crats ar­gued that fund­ing is needed for the au­thor­iz­a­tion bill, but didn’t hold up its pas­sage.)

Ad­voc­ates say they’re hop­ing to use this mo­mentum to shore up sup­port for the bill in the House—and if pos­sible, for oth­er bills that en­com­pass a wide vari­ety of stake­hold­ers. And, Nick­el said, the Ad­dic­tion Policy For­um aims to keep spread­ing aware­ness of the dis­ease and stay­ing plugged in on is­sues im­pact­ing the com­munity.

“I think it def­in­itely is a great ex­ample of a mod­el of how to get things done,” Met­calf said. “We have an in­cred­ible de­term­in­a­tion to make things hap­pen be­cause really, at the drop of the hat, you can mo­bil­ize thou­sands of people to make calls, send emails, and I’m sure there’s oth­er groups that can do that on oth­er is­sues, but these are people that nor­mally don’t come out about an is­sue that’s very stig­mat­iz­ing, and that’s a very per­son­al is­sue.”


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