Time to Support the Warren Cummings (CARE) Act and End the Opioid Crisis

By Donna Ward

Last week on Facebook, a friend posted a remembrance of the second anniversary of the death of her 32-year-old niece due to a fentanyl overdose. Similarly, one of our neighbors in Montclair lost their 27-year-old son this year to heroin laced with fentanyl.  The opioid epidemic is still wreaking havoc in New Jersey. While the rate of opioid prescriptions in New Jersey declined from 2016 to 2017, (the latest data available) and is below the national average, deaths from drug overdoses skyrocketed +29% to 2,685. The state’s rate of drug overdose deaths of 30.0 per thousand in 2017 is still well above the U.S. average of 21.7. Nationally, deaths have increased six- fold over the past 18 years, and have contributed to a lowering of overall US life expectancy.

The epidemic has proved intractable in part because it has come in waves. The first wave was prescription pain medications, such as OxyContin; then heroin, which replaced pills when they became too expensive; and now fentanyl, which is cheap and easy to produce, but whose potency compared to previous drugs has sparked the surge in overdoses and deaths.

Congress passed bipartisan legislation in 2018 to address the epidemic, including limits to opioid overprescribing, increased access to addiction treatment under Medicare and Medicaid, more coordination among federal agencies to crack down on illicit importation of fentanyl at the border etc. However, many experts felt that it tinkered around the edges and did not provide anywhere near the amount of funding needed to make more than a dent in the problem. Even where the authorized funding has been particularly beneficial such as in the one- time state grants to Republican-led states that decided not to expand Medicaid coverage to low-income adults, there is concern whether these grants will be renewed, since the  Trump administration has not signaled whether the grants will be extended when they expire next year.

That’s why all citizens, including those from New Jersey, should support the recently re-introduced Comprehensive Addiction Resources Emergency (CARE) Act, also known as the Warren Cummings bill. Over 200 organizations, as well as 98 co-sponsors in Congress including Senator Corey Booker, have come out in support of the most comprehensive piece of legislation introduced yet to fight this epidemic. The bill would allocate $100 billion over 10 years to treat the opioid crisis on a scale similar to that used to successfully combat HIV/AIDS in the 90’s. Senator Elizabeth Warren (D-MA) says she and Representative Elijah Cummings (D-MD) see the current opioids epidemic and the HIV/AIDS epidemic as having something in common:  “the federal response was constantly too little, too late.”

Senator Elizabeth Warren and Representative Elijah Cummings

This is not the first time we have faced a public health crisis of this scale.  During the 1980s and 1990s, deaths from HIV/AIDS grew rapidly, and the country’s medical system was ill-equipped to provide effective, evidence-based care. In 1990, Congress passed the bipartisan Ryan White Comprehensive AIDS Resources Emergency Act (Ryan White Act) to provide funding to help state and local governments, and community-based organizations, combat this epidemic.  

The CARE Act is modeled directly on the Ryan White Act, supporting local decision-making and programs to expand access to evidence-based treatments and recovery support services. The CARE Act also recognizes the need for expanded mental health supports, early intervention, and harm reduction tactics.  Finally, this legislation would make it easier to hold corporate executives at pharmaceutical companies accountable for actions that fuel the opioid crisis.

New provisions in the 2019 version of the bill include strengthened standards for services grant program for workers with -- or at risk of developing -- addictions to find employment while in treatment or recovery. The bill would also incentivize states to cover the full range of addiction services in state Medicaid programs.

The CARE Act would provide $4 billion in grants annually to states, territories and tribal governments and $2.7 billion to counties and cities with the highest levels of overdoses. It would also offer $1.7 billion per year for public health surveillance, research and training, $1.1 billion for expanded service delivery and $500 million for increased access to overdose reversal drugs such as naloxone.

New Jersey’s estimated annual share of the bill’s funding, according to the sponsors, would be $119 million, of which $60 million would come via state formula grants and the remainder through an opportunity to apply for additional funding from a $1.6 billion competitive grant program.

One way to pay for this could be via the “ultra-millionaire’s tax”, proposed by Senator Warren, which would include a new 2 percent fee annually on American households’ net worth greater than $50 million that would rise to 3 percent for households on above $1 billion, although there could be other ways to pay for it. While the $100 billion price tag may sound high to some, it pales in comparison to the epidemic’s cost in lives and to our nation’s economy, which lost $500 billion from the impact of the crisis in 2015 alone, according to a 2017 report by Trump’s Council of Economic Advisors. The cost would also be a small fraction of the $2.1 trillion deficit produced by the Trump administration’s tax breaks for corporations and the wealthy -- as well as of the $1 trillion-plus the federal government spends annually on health care.

We can’t afford to let another year go by, while tragic deaths continue. It’s time Congress enacted the CARE act without further delay. Congressional members who are co-sponsoring the House bill (H.R. 2569) include Donald Payne (NJ-10), Albio Sires (NJ-8), Jeff Van Drew (NJ-2), and Andy Kim (NJ-3). Senator Cory Booker is co-sponsoring the Senate bill (S.1365).

Please contact your representatives to either thank them for their support or ask them to do so, if they haven’t already. It’s time to end this epidemic.

More on the CARE ACT:

Fact sheet

Section-by-section summary

Bill text

Donna Ward

Member, Blue Wave Healthcare Committee and former pharmaceutical industry executive