SUBJECT: H.R.5311, the CARA 2.0 Act of 201
Dear Representatives Blackburn, Ryan, MacArthur and Kuster:
On behalf of the American Association of Neurological Surgeons (AANS) and Congress of Neurological
Surgeons (CNS), representing more than 4,000 practicing neurosurgeons in the United States, we
applaud the bipartisan efforts of the U.S. House of Representatives to address our country’s opioid crisis
and appreciate the ability to be involved in this process.
Limits on Opioid Prescribing
As neurosurgeons, we support legislation that reduces the risk of opioid abuse. Limiting the availability
of excess opioid medication in the postoperative period is one potential way to accomplish this, and we
generally concur with this approach.
There are, however, some postoperative scenarios, common in the practice of neurosurgery, where a 3-
day limit would be inappropriate and burdensome for patients. For example, complex spinal surgery
typically necessitates that patients appropriately utilize opioid medication to manage their postoperative
pain for 2-3 weeks (or even longer) after the surgery. Another example is polytrauma patients suffering
from several concurrent major injuries (e.g., multiple spine and limb fractures, head injury, etc.). These
operations are often performed by subspecialists in tertiary care medical centers that are located far from
the patients’ residences. In this situation, the patient would be forced to commute a long distance,
merely to get a prescription refill, thus subjecting these patients to an undue burden that likely would lead
to under-treatment of their pain, and expose them to unnecessary postoperative complications and poor
outcomes.
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