CARA, the Comprehensive Addiction and Recovery Act, is a momentous milestone.
The war on drugs has long been proven ineffective and inhumane, and now with the passage of CARA, Congress has clearly signaled that people with addictions must be treated instead of jailed.
It is progress that we've finally decided to treat addiction as a disease instead of a crime, but our slow progress toward this end comes at the expense of too many people.
Decades of neglect mean we are in the middle of a massive public-health crisis.
There isn't anywhere near enough help for the nine out of 10 Americans who need treatment for a substance-use disorder but don't get it.
As many as 25 million Americans are facing an addiction, 2 million alone to opiates. That costs the country $700 billion a year, says the National Institute on Drug Abuse, in health costs, crime and lost productivity.
More important is the toll in agony and death. Overdoses on heroin and prescription opiates now kill more Americans than car accidents.
It is a national disgrace -- and a holdover from the old days of people with addictions being labeled as weak or immoral -- that there aren't enough counselors and doctors and nurses and other resources to lift people with these life-threatening health conditions out of misery and give them the tools and support they need to lead a productive life.
CARA gives us a start. This new law includes prescriber education; allows nurse practitioners and physician assistants to prescribe buprenorphine; incentivizes Prescription Drug Monitoring Programs; and authorizes an array of grant programs.
Unfortunately, CARA calls for expanding resources in the fight against addiction to opiates but doesn't provide a single dime in funding.
The House says it will appropriate $581 million when it returns to Washington in September. While we're waiting, more than 6,000 Americans will die from opioid overdoses, and thousands more from alcohol-related deaths. We must finish the process, and give CARA teeth.
But no matter what amount Congress decides on for CARA, the money will come in the form of grants. That means some treatment facilities will get money and some people with addictions will get help, but others will not. And when the grant ends, the care ends.
We'd be appalled if a hospital couldn't treat us for a broken arm because it needed a grant to do so. Yet that's too often the case for people with an addiction.
There's a way, however, to start fixing this problem. That is for the states to step up to the responsibilities on which many of them, too, have underperformed.
Addiction treatment has not been a priority, despite the broad changes in attitudes about addiction over the last few decades.
So it's not fair that the federal government get all the blame for short-changing addiction treatment for so long.
That's why it's heartening that 46 members of the National Governors Association -- who gathered for their annual meeting last weekend -- recently signed the Compact to Fight Opioid Addiction.
The compact binds the governors to "redouble their efforts to fight the opioid epidemic with new steps to reduce inappropriate prescribing, change the nation's understanding of opioids and addiction and ensure a pathway to recovery for individuals suffering from addiction."
It was the first time in a decade that the governors had signed such a compact on an urgent national issue.
They're in a position to make a huge difference. Is it just rhetoric? Or will they put money behind their compact?
How can they do it? They can take advantage of an existing federal state partnership, the Medicaid program. Expanding capacity through state Medicaid programs provides a continuous, reliable source of funding for treatment that doesn't depend upon winning a grant.
Medicaid, the government health insurer for those unable to afford private insurance, is a federal state partnership with the federal government that picks up from 50 percent to 82 percent of the costs of care.
The federal Centers for Medicare and Medicaid Services is already encouraging expansion of addiction services at the state level. And some states, like California, are using this flexibility to design and fund the full continuum of inpatient and community treatments and supports necessary when someone is dealing with a deadly disease.
This is the direction the future of addiction treatment must take. Our thinking must change because we can no longer tolerate turning away people in desperate need simply because we don't have a bed, a medication or a counselor. Grants are not enough. Not in this day and age.
Congress has passed a bill -- now they must fund it. The Governors have committed to a compact -- now they must take action. Our good intentions can't be on paper only -- they need to translate to lifesaving treatment for the millions of Americans who cannot wait another day.