A 92-2 vote in the U.S. Senate will send a legislative package aimed at fighting opioid addiction and abuse to President Barack Obama, who has promised to sign it even though it doesn’t contain the $1.1 billion in extra funding he requested for treatment and prevention programs.

Disagreements over funding threatened to derail the Comprehensive Addiction and Recovery Act (CARA), which has been discussed for more than a year. When the House and Senate’s conference committee last met on July 6, attempts by Democrats to add $920 million in emergency funding to the bill were rejected and only Republicans signed off the conference report.

When the conference bill came up for a vote in the House, however, Democrats decided to support it, and Senate Democrats did the same.

“Today’s strong bipartisan vote is a victory for American families who are struggling with the disease of addiction,” said Sen. Rob Portman, R-Ohio. “This is a historic moment, the first time in decades that Congress has passed comprehensive addiction legislation, and the first time Congress has ever supported long-term addiction recovery. This is also the first time that we’ve treated addiction like the disease that it is, which will help put an end to the stigma that has surrounded addiction for too long.”

The two votes against it came from Republican Sens. Ben Sasse of Nebraska and Mike Lee of Utah.

Without providing new funding, the bill does authorize a number of new programs, some of which may need appropriations made through the normal budgeting process:

• Requires a task force to review practices on chronic and acute pain management within two years.
• Requires the Food and Drug Administration (FDA) consult with advisory committees before approving new opioids for pediatric patients, issue final guidance on generic drugs which claim abuse deterrence, and develop recommendations for opioid prescriber education.
• Allows National Institutes of Health to “intensify and coordinate” research on pain management and the development of non-addictive pain therapies.
• Implements regulations allowing nurse practitioners and physician assistants to receive a waiver to “dispense certain drugs for maintenance or detoxification treatment in an office-based setting to up to 30 patients in the first year and up to 100 patients after the first year and going forward.”

President Obama will sign the bill, though response to its passage indicated the fight over funding will continue.

“We continue to believe this bill falls far short,” said White House Press Secretary Josh Earnest. “That's why the Administration strongly supported Democratic efforts to add $920 million in funding for states to provide treatment for Americans struggling with opioid addiction. Every day that Republicans stand in the way of action to fund opioid treatment means more missed opportunities to save lives: 78 Americans die every day from opioid overdose. While the President will sign this bill once it reaches his desk because some action is better than none, he won’t stop fighting to secure the resources this public health crisis demands.”

That fight will likely play out in the ongoing discussions on HHS’s budget for the next fiscal year.

Before the July 13 vote on CARA, Senate Democrats sent a letter to Senate Majority Leader Mitch McConnell, R-Ky., to argue the money for opioid programs shouldn’t come from cutting other programs within the agency.

“Unfortunately, despite the fact that the House Labor-HHS-Education Appropriations bill contains a $457 million increase in funding for heroin and opioid prevention and treatment, it also makes unacceptable cuts to important accounts elsewhere,” the Democrats wrote. “The same Americans who suffer from opioid use disorders may also need access to birth control; they may also need mammograms to detect early onset breast cancer; and they may also need health insurance through the private insurance marketplaces created by the Affordable Care Act. Unfortunately, House Republican appropriators zeroed out funding for accounts or eliminated provisions dedicated to these purposes.”

For now, groups who had been advocating for Congress to address the growing problem of opioid abuse applauded CARA’s passage. The Senior Care Pharmacy Coalition said the bill balances the needs to treat and prevent addiction while “protecting the ability of long-term care (LTC) pharmacies to meet and manage the medication needs of LTC residents.” The National Safety Council said the bill will save thousands of lives, while echoing Democrats’ calls for additional funding.