As we all know far too well, the crisis surrounding substance use and mental health in New Hampshire and across the nation has significantly worsened over the past year, with the coronavirus pandemic creating more loneliness and despair, more substance use, and more barriers for those seeking treatment. Following promising news that the 2018 overdose death rate declined for the first time in decades, last year’s rate was the worst in U.S. history. The pandemic has led to increased risk factors for depression, suicide, and addiction along with spikes in anxiety and trauma, all of which have contributed to higher rates of substance use in our communities.

But there is reason for hope, in the form of new federal legislation that proposes to extend the 2016 Comprehensive Addiction and Recovery Act (CARA) that was signed into law by former President Barack Obama. CARA 3.0, sponsored by Senators Jeanne Shaheen (D-NH), Rob Portman (R-OH), Sheldon Whitehouse (D-RI), and Amy Klobuchar (D-MN), promises to make much-needed progress in the battle against opioid addiction through policy reforms and increased funding.

Our organization, Better Life Partners, wishes to thank and applaud the sponsors and supporters of CARA 3.0 for offering a comprehensive approach to fighting the opioid epidemic. Our elected officials in New Hampshire and Vermont have been active supporters of CARA 3.0 and prior legislation supporting access to treatment, and we urge lawmakers across the country to advance this important bill to help prevent opioid addiction and increase access to treatment.

Better Life Partners is a physician-led organization based in Hanover and serving members across New Hampshire and Vermont. We are a leading provider of medication-assisted treatment (MAT) for opioid use disorder, providing effective, accessible, and high-quality medical and behavioral health care and care coordination. We work primarily with underserved populations and communities, with nearly 90 percent of our members uninsured or covered by Medicare or Medicaid. Since our founding in 2018, our mission has been to help any underserved individual achieve a healthier life filled with belonging, love, and purpose.

CARA 3.0 would help like-minded organizations to continue delivering effective evidence-based care in ways that work best for our members. One of the most promising developments of the past year has been the rapid expansion of telehealth for both medical and behavioral health care. Seeing the urgent need for remote care at the onset of the pandemic, community organizations and treatment providers rapidly shifted to remote services and have thus increased access to timely and necessary care. CARA 3.0 would preserve these essential options for patients, enabling providers to prescribe and manage care remotely and be reimbursed for telehealth services. We urge policymakers to ensure that there are no barriers to making telehealth permanent.

CARA 3.0 would also ease limits on the number of patients a medical provider can treat using life-saving medications like buprenorphine. Recent research has found that this change would result in expanded access for patients and less stigma about seeking treatment, improving outcomes for patients and our communities. The change would especially benefit the underserved rural areas that have been particularly hard-hit by the opioid epidemic. A 2019 review of treatment availability published in the Journal of Rural Health found that more than half of all rural counties in the U.S. still lacked a single buprenorphine prescriber. CARA 3.0 would help address this challenge by reducing barriers to entry for providers and allowing rural physicians to serve more patients who need life-saving treatment.

Finally, CARA 3.0 makes policy changes that can help address the root causes of this devastating health crisis. The bill sets a three-day limit on initial opioid prescriptions for acute pain, as recommended by the CDC, and mandates physician education on addiction, treatment, and pain management. It also provides funding for public education on the dangers of opioid misuse, heroin, and lethal fentanyl, and funds research into non-opioid pain management alternatives.

It’s clearer than ever that we need targeted interventions to address our country’s devastating and deadly substance use epidemic. At Better Life Partners, we’re committed to doing our part by working closely with our members and partners in the community to further our mission of helping people achieve healthier lives. With regulatory action at the federal level, we can do even more to serve the people who need our care the most. We urge our lawmakers to support CARA 3.0, helping us more adequately tackle the opioid epidemic and advance treatment options into the 21st century. Once passed, we’d like to see our state legislature follow suit and pass legislation that aligns with the federal standards.

David de Gijsel, MD, MSc, MPH is the medical director at Better Life Partners, assistant professor of medicine, Geisel School of Medicine and staff physician, Section of Infectious Disease, with Dartmouth-Hitchcock Medical Center.

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