59–006 

114TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 114–536 

TO PROVIDE FOR THE ESTABLISHMENT OF AN INTER-AGENCY TASK 

FORCE TO REVIEW, MODIFY, AND UPDATE BEST PRACTICES FOR PAIN 

MANAGEMENT AND PRESCRIBING PAIN MEDICATION, AND FOR OTHER 

PURPOSES 

MAY 3, 2016.—Committed to the Committee of the Whole House on the State of the 

Union and ordered to be printed 

Mr. UPTON, from the Committee on Energy and Commerce, 

submitted the following 

R E P O R T 

[To accompany H.R. 4641] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Energy and Commerce, to whom was referred 

the bill (H.R. 4641) to provide for the establishment of an interagency task force to review, modify, and update best practices for 

pain management and prescribing pain medication, and for other 

purposes, having considered the same, report favorably thereon 

with an amendment and recommend that the bill as amended do 

pass. 

CONTENTS 

Page 

Purpose and Summary ............................................................................................ 3 

Background and Need for Legislation .................................................................... 3 

Hearings ................................................................................................................... 3 

Committee Consideration ........................................................................................ 3 

Committee Votes ...................................................................................................... 4 

Committee Oversight Findings ............................................................................... 4 

Statement of General Performance Goals and Objectives .................................... 4 

New Budget Authority, Entitlement Authority, and Tax Expenditures ............. 4 

Earmark, Limited Tax Benefits, and Limited Tariff Benefits ............................. 4 

Committee Cost Estimate ....................................................................................... 4 

Congressional Budget Office Estimate ................................................................... 4 

Federal Mandates Statement ................................................................................. 5 

Duplication of Federal Programs ............................................................................ 5 

Disclosure of Directed Rule Makings ..................................................................... 6 

Advisory Committee Statement .............................................................................. 6 

Applicability to Legislative Branch ........................................................................ 6 

Section-by-Section Analysis of the Legislation ...................................................... 6 

Changes in Existing Law Made by the Bill, as Reported ..................................... 6 


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The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. DEVELOPMENT OF BEST PRACTICES FOR THE USE OF PRESCRIPTION OPIOIDS. 

(a) DEFINITIONS.—In this section— 

(1) the term ‘‘Secretary’’ means the Secretary of Health and Human Services; 

and 

(2) the term ‘‘task force’’ means the Pain Management Best Practices InterAgency Task Force convened under subsection (b). 

(b) INTER-AGENCY TASK FORCE.—Not later than December 14, 2018, the Secretary, in cooperation with the Secretary of Veterans Affairs, the Secretary of Defense, and the Administrator of the Drug Enforcement Administration, shall convene a Pain Management Best Practices Inter-Agency Task Force to review, modify, 

and update, as appropriate, best practices for pain management (including chronic 

and acute pain) and prescribing pain medication. 

(c) MEMBERSHIP.—The task force shall be comprised of— 

(1) representatives of— 

(A) the Department of Health and Human Services; 

(B) the Department of Veterans Affairs; 

(C) the Food and Drug Administration; 

(D) the Department of Defense; 

(E) the Drug Enforcement Administration; 

(F) the Centers for Disease Control and Prevention; 

(G) the Health Resources and Services Administration; 

(H) the Indian Health Service; 

(I) the National Academy of Medicine; 

(J) the National Institutes of Health; 

(K) the Office of National Drug Control Policy; and 

(L) the Substance Abuse and Mental Health Services Administration; 

(2) State medical boards; 

(3) physicians, dentists, and nonphysician prescribers; 

(4) hospitals; 

(5) pharmacists and pharmacies; 

(6) experts in the fields of pain research and addiction research; 

(7) representatives of— 

(A) pain management professional organizations; 

(B) the mental health treatment community; 

(C) the addiction treatment and recovery community; 

(D) pain advocacy groups; and 

(E) groups with expertise on overdose reversal; 

(8) a person in recovery from addiction to medication for chronic pain; 

(9) a person with chronic pain; and 

(10) other stakeholders, as the Secretary determines appropriate. 

(d) DUTIES.—The task force shall— 

(1) not later than 180 days after the date on which the task force is convened 

under subsection (b), review, modify, and update, as appropriate, best practices 

for pain management (including chronic and acute pain) and prescribing pain 

medication, taking into consideration— 

(A) existing pain management research; 

(B) recommendations from relevant conferences and existing relevant evidence-based guidelines; 

(C) ongoing efforts at the State and local levels and by medical professional organizations to develop improved pain management strategies, including consideration of differences within and between classes of opioids, 

the availability of opioids with abuse deterrent technology, and pharmacological, nonpharmacological, and medical device alternatives to opioids to 

reduce opioid monotherapy in appropriate cases; 

(D) the management of high-risk populations, other than populations who 

suffer pain, who— 

(i) may use or be prescribed benzodiazepines, alcohol, and diverted 

opioids; or 

(ii) receive opioids in the course of medical care; and 

(E) the 2016 Guideline for Prescribing Opioids for Chronic Pain issued by 

the Centers for Disease Control and Prevention; 

(2) solicit and take into consideration public comment on the practices developed under paragraph (1), amending such best practices if appropriate; and 

(3) develop a strategy for disseminating information about the best practices 

developed under paragraphs (1) and (2) to prescribers, pharmacists, State medVerDate Sep 11 2014 02:00 May 04, 2016 Jkt 059006 PO 00000 Frm 00002 Fmt 6659 Sfmt 6621 E:\HR\OC\HR536.XXX HR536

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ical boards, educational institutions that educate prescribers and pharmacists, 

and other parties, as the Secretary determines appropriate. 

(e) LIMITATION.—The task force shall not have rulemaking authority. 

(f) REPORT.—Not later than 270 days after the date on which the task force is convened under subsection (b), the task force shall submit to Congress a report that 

includes— 

(1) the strategy for disseminating best practices for pain management (including chronic and acute pain) and prescribing pain medication, as developed 

under subsection (d); 

(2) the results of a feasibility study on linking the best practices described in 

paragraph (1) to receiving and renewing registrations under section 303(f) of the 

Controlled Substances Act (21 U.S.C. 823(f)); and 

(3) recommendations for effectively applying the best practices described in 

paragraph (1) to improve prescribing practices at medical facilities, including 

medical facilities of the Veterans Health Administration and Indian Health 

Service. 

PURPOSE AND SUMMARY

H.R. 4641 would establish an interagency task force to review, 

modify, and update best practices for acute and chronic pain management. 

BACKGROUND AND NEED FOR LEGISLATION

Health care professionals need accurate, evidence-based information to provide quality care to patients with acute and chronic pain 

while minimizing the potential for the development of substance 

use disorder and overdose when prescribing opioids. This bill will 

ensure that current treatment guidelines and best practices continue to be reviewed and, if appropriate, updated in a transparent 

manner by a wide-range of government agencies, experts in the 

field, and patient representatives. 

HEARINGS

On October 8, 2015, the Subcommittee on Health held a hearing 

entitled ‘‘Examining Legislative Proposals to Combat Our Nation’s 

Drug Abuse Crisis’’ and received testimony from: 

• Allen Anderson, President, American Orthopaedic Society 

for Sports Medicine; 

• Michael Botticelli, Director, Office of National Drug Control Policy; 

• Richard Frank, Assistant Secretary for Planning and Evaluation, Department of Health and Human Services; 

• Paul Halverson, Dean, Indiana University; 

• Richard M. Fairbanks School of Public Health; 

• Kenneth Katz, Lehigh Valley Health Network, Department 

of Emergency Medicine; 

• Chapman Sledge, Chief Medical Officer, Cumberland 

Heights; and, 

• Robert Corey Waller, Chair, Legislative Advocacy Committee, American Society of Addiction Medicine. 

COMMITTEE CONSIDERATION

On April 20, 2016, the Subcommittee on Health met in open 

markup session and forwarded H.R. 4641, as amended, to the full 

Committee by a voice vote. On April 26, 27, and 28, 2016, the full 

Committee met in open markup session and ordered H.R. 4641, as 

amended, favorably reported to the House by a voice vote. 


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COMMITTEE VOTES

Clause 3(b) of rule XIII of the Rules of the House of Representatives requires the Committee to list the record votes on the motion 

to report legislation and amendments thereto. There were no 

record votes taken in connection with ordering H.R. 4641 reported. 

COMMITTEE OVERSIGHT FINDINGS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee held a hearing and made findings that are reflected in this report. 

STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

The purpose of this act is to ensure health care providers have 

evidence-based guidelines and best practices for treating patients 

with acute and chronic pain. 

NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX

EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee finds that H.R. 4641 

would result in no new or increased budget authority, entitlement 

authority, or tax expenditures or revenues. 

EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

In compliance with clause 9(e), 9(f), and 9(g) of rule XXI of the 

Rules of the House of Representatives, the Committee finds that 

H.R. 4641 contains no earmarks, limited tax benefits, or limited 

tariff benefits. 

COMMITTEE COST ESTIMATE

The Committee adopts as its own the cost estimate prepared by 

the Director of the Congressional Budget Office pursuant to section 

402 of the Congressional Budget Act of 1974. 

CONGRESSIONAL BUDGET OFFICE ESTIMATE

Pursuant to clause 3(c)(3) of rule XIII of the Rules of the House 

of Representatives, the following is the cost estimate provided by 

the Congressional Budget Office pursuant to section 402 of the 

Congressional Budget Act of 1974: 

U.S. CONGRESS, CONGRESSIONAL BUDGET OFFICE, 

Washington, DC, May 3, 2016. 

Hon. FRED UPTON, Chairman, Committee on Energy and Commerce, 

U.S. House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 4641, a bill to provide for 

the establishment of an inter-agency task force to review, modify, 

and update best practices for pain management and prescribing 

pain medication, and for other purposes. 


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If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contact is Andrea Noda. 

Sincerely, 

KEITH HALL. 

Enclosure. 

H.R. 4641—A bill to provide for the establishment of an inter-agency task force to review, modify, and update best practices for 

pain management and prescribing pain medication, and for 

other purposes. 

H.R. 4641 would require the Secretary of the Department of 

Health and Human Services (HHS) to establish a task force to review and modify best practices for the treatment of pain. The Secretary of HHS would be required to coordinate with the Secretary 

of Veterans Affairs, the Secretary of Defense, and the Administrator of the Drug Enforcement Administration. Task force members would include representatives from relevant federal agencies, 

medical professionals, researchers, and individuals who have specific expertise in pain management and addiction to pain medication. The task force would issue a report to Congress on its findings, which would include a strategy for disseminating information 

to relevant medical professionals about best practices in pain management. 

CBO estimates that implementing H.R. 4641 would cost $2 million over the 2016–2021 period, assuming appropriation of the estimated amounts, mostly to cover administrative expenses associated 

with the task force. Estimated outlays are based on information 

from affected agencies and historical spending for similar types of 

initiatives. Enacting H.R. 4641 would not affect direct spending or 

revenues; therefore, pay-as-you-go procedures do not apply. 

CBO estimates that enacting H.R. 4641 would not increase net 

direct spending or on-budget deficits in any of the four consecutive 

10-year period beginning in 2027. 

The bill contains no intergovernmental or private-sector mandates as defined in the Unfunded Mandates Reform Act and would 

impose no costs on state, local, or tribal governments. 

The CBO staff contact for this estimate is Andrea Noda. The estimate was approved by Holly Harvey, Deputy Assistant Director for 

Budget Analysis. 

FEDERAL MANDATES STATEMENT

The Committee adopts as its own the estimate of Federal mandates prepared by the Director of the Congressional Budget Office 

pursuant to section 423 of the Unfunded Mandates Reform Act. 

DUPLICATION OF FEDERAL PROGRAMS

No provision of H.R. 4641 establishes or reauthorizes a program 

of the Federal Government known to be duplicative of another Federal program, a program that was included in any report from the 

Government Accountability Office to Congress pursuant to section 

21 of Public Law 111–139, or a program related to a program identified in the most recent Catalog of Federal Domestic Assistance. 


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DISCLOSURE OF DIRECTED RULE MAKINGS

The Committee estimates that enacting H.R. 4641 does not direct 

any specific rule making within the meaning of 5 U.S.C. 551. 

ADVISORY COMMITTEE STATEMENT

No advisory committees within the meaning of section 5(b) of the 

Federal Advisory Committee Act were created by this legislation. 

APPLICABILITY TO LEGISLATIVE BRANCH

The Committee finds that the legislation does not relate to the 

terms and conditions of employment or access to public services or 

accommodations within the meaning of section 102(b)(3) of the Congressional Accountability Act. 

SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Development of best practices for the use of prescription 

opioids 

The bill would require the Secretary of Health and Human Services to convene a Pain Management Best Practices Inter-Agency 

Task Force. The Task Force shall be comprised of representatives 

from several Federal agencies; state medical boards; health care 

practitioners; pharmacists; experts from both the pain and addiction recovery community; and other stakeholders. 

The Task Force shall be convened no later than December 14, 

2018, and, within 180 days, review, modify, and update best practices for acute and chronic pain management. The Task Force 

shall, among other things, consider existing pain management research and guidelines, including the 2016 Guideline for Prescribing 

Opioids for Chronic Pain issued by the Centers for Disease Control 

and Prevention, as well as ongoing State, local, and medical professional organization efforts to develop pain management strategies. 

Further, the Task Force shall develop a strategy for the dissemination of such best practices to health care professionals and report 

to Congress within 270 days. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

This legislation does not amend any existing Federal statute. 

Æ 


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