I

106TH CONGRESS

1ST SESSION H. R. 2260

To amend the Controlled Substances Act to promote pain management and

palliative care without permitting assisted suicide and euthanasia, and

for other purposes.

IN THE HOUSE OF REPRESENTATIVES

JUNE 17, 1999

Mr. HYDE (for himself, Mr. STUPAK, Mr. ADERHOLT, Mr. BAKER, Mr.

BALLENGER, Mr. BARCIA, Mr. BARTON of Texas, Mr. BLUNT, Mr. BRYANT, Mr. BURR of North Carolina, Mr. BURTON of Indiana, Mr. CANADY

of Florida, Mr. CHABOT, Mr. COBURN, Mr. COLLINS, Mr. CUNNINGHAM,

Mr. DICKEY, Mr. DOOLITTLE, Mr. DOYLE, Mrs. EMERSON, Mr. EVERETT, Mr. FOSSELLA, Mr. GRAHAM, Mr. GOODE, Mr. GOODLATTE, Mr.

HALL of Texas, Mr. HAYES, Mr. HERGER, Mr. HOEKSTRA, Mr. HUTCHINSON, Mr. ISTOOK, Mr. JOHN, Mr. KING, Mr. KNOLLENBERG, Mr. LAFALCE, Mr. LAHOOD, Mr. LARGENT, Mr. LEWIS of Kentucky, Mr.

LUCAS of Kentucky, Mr. LUCAS of Oklahoma, Mr. MCINTYRE, Mr. MILLER of Florida, Mrs. MYRICK, Mr. NUSSLE, Mr. NETHERCUTT, Mr. PETERSON of Pennsylvania, Mr. PETERSON of Minnesota, Mr. PHELPS, Mr.

PICKERING, Mr. PITTS, Mr. PORTMAN, Mr. RAHALL, Mr. ROGAN, Mr.

ROGERS, Mr. SALMON, Mr. SCHAFFER, Mr. SENSENBRENNER, Mr.

SHIMKUS, Mr. SHOWS, Mr. SKELTON, Mr. SMITH of Texas, Mr. SMITH

of New Jersey, Mr. SPENCE, Mr. STEARNS, Mr. TANCREDO, Mr. TERRY,

Mr. WALSH, Mr. WAMP, and Mr. WELDON of Florida) introduced the following bill; which was referred to the Committee on Commerce, and in

addition to the Committee on the Judiciary, for a period to be subsequently determined by the Speaker, in each case for consideration of such

provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend the Controlled Substances Act to promote pain

management and palliative care without permitting assisted suicide and euthanasia, and for other purposes.
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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Pain Relief Promotion

5 Act of 1999’’.

6 TITLE I—USE OF CONTROLLED SUB7 STANCES CONSISTENT WITH THE

8 CONTROLLED SUBSTANCES ACT

9 SEC. 101. REINFORCING EXISTING STANDARD FOR LEGITI10 MATE USE OF CONTROLLED SUBSTANCES.

11 Section 303 of the Controlled Substances Act (21

12 U.S.C. 823) is amended by adding at the end the fol13 lowing:

14 ‘‘(i)(1) For purposes of this Act and any regulations

15 to implement this Act, alleviating pain or discomfort in

16 the usual course of professional practice is a legitimate

17 medical purpose for the dispensing, distributing, or admin18 istering of a controlled substance that is consistent with

19 public health and safety, even if the use of such a sub20 stance may increase the risk of death. Nothing in this sec21 tion authorizes intentionally dispensing, distributing, or

22 administering a controlled substance for the purpose of

23 causing death or assisting another person in causing

24 death.
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1 ‘‘(2) Notwithstanding any other provision of this Act,

2 in determining whether a registration is consistent with

3 the public interest under this Act, the Attorney General

4 shall give no force and effect to State law authorizing or

5 permitting assisted suicide or euthanasia.

6 ‘‘(3) Paragraph (2) applies only to conduct occurring

7 after the date of enactment of this subsection.’’.

8 SEC. 102. EDUCATION AND TRAINING PROGRAMS.

9 Section 502(a) of the Controlled Substances Act (21

10 U.S.C. 872(a)) is amended—

11 (1) by striking ‘‘and’’ at the end of paragraph

12 (5);

13 (2) by striking the period at the end of para14 graph (6) and inserting ‘‘; and’’; and

15 (3) by adding at the end the following:

16 ‘‘(7) educational and training programs for

17 local, State, and Federal personnel, incorporating

18 recommendations by the Secretary of Health and

19 Human Services, on the necessary and legitimate

20 use of controlled substances in pain management

21 and palliative care, and means by which investiga22 tion and enforcement actions by law enforcement

23 personnel may accommodate such use.’’.
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1 TITLE II—PROMOTING

2 PALLIATIVE CARE

3 SEC. 201. ACTIVITIES OF AGENCY FOR HEALTH CARE POL4 ICY AND RESEARCH.

5 Part A of title IX of the Public Health Service Act

6 (42 U.S.C. 299 et seq.) is amended by adding at the end

7 the following section:

8 ‘‘SEC. 906. PROGRAM FOR PALLIATIVE CARE RESEARCH

9 AND QUALITY.

10 ‘‘(a) IN GENERAL.—The Administrator shall carry

11 out a program to accomplish the following:

12 ‘‘(1) Develop and advance scientific under13 standing of palliative care.

14 ‘‘(2) Collect and disseminate protocols and evi15 dence-based practices regarding palliative care, with

16 priority given to pain management for terminally ill

17 patients, and make such information available to

18 public and private health care programs and pro19 viders, health professions schools, and hospices, and

20 to the general public.

21 ‘‘(b) DEFINITION.—For purposes of this section, the

22 term ‘palliative care’ means the active total care of pa23 tients whose prognosis is limited due to progressive, far24 advanced disease. The purpose of such care is to alleviate
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1 pain and other distressing symptoms and to enhance the

2 quality of life, not to hasten or postpone death.’’.

3 SEC. 202. ACTIVITIES OF HEALTH RESOURCES AND SERV4 ICES ADMINISTRATION.

5 (a) IN GENERAL.—Part D of title VII of the Public

6 Health Service Act (42 U.S.C. 294 et seq.), as amended

7 by section 103 of Public Law 105–392 (112 Stat. 3541),

8 is amended—

9 (1) by redesignating sections 754 through 757

10 as sections 755 through 758, respectively; and

11 (2) by inserting after section 753 the following

12 section:

13 ‘‘SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN

14 PALLIATIVE CARE.

15 ‘‘(a) IN GENERAL.—The Secretary, in consultation

16 with the Administrator for Health Care Policy and Re17 search, may make awards of grants, cooperative agree18 ments, and contracts to health professions schools, hos19 pices, and other public and private entities for the develop20 ment and implementation of programs to provide edu21 cation and training to health care professionals in pallia22 tive care.

23 ‘‘(b) PRIORITIES.—In making awards under sub24 section (a), the Secretary shall give priority to awards for

25 the implementation of programs under such subsection.
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1 ‘‘(c) CERTAIN TOPICS.—An award may be made

2 under subsection (a) only if the applicant for the award

3 agrees that the program carried out with the award will

4 include information and education on—

5 ‘‘(1) means for alleviating pain and discomfort

6 of patients, especially terminally ill patients, includ7 ing the medically appropriate use of controlled sub8 stances;

9 ‘‘(2) applicable laws on controlled substances,

10 including laws permitting health care professionals

11 to dispense or administer controlled substances as

12 needed to relieve pain even in cases where such ef13 forts may unintentionally increase the risk of death;

14 and

15 ‘‘(3) recent findings, developments, and im16 provements in the provision of palliative care.

17 ‘‘(d) PROGRAM SITES.—Education and training

18 under subsection (a) may be provided at or through health

19 professions schools, residency training programs and other

20 graduate programs in the health professions, entities that

21 provide continuing medical education, hospices, and such

22 other programs or sites as the Secretary determines to be

23 appropriate.

24 ‘‘(e) EVALUATION OF PROGRAMS.—The Secretary

25 shall (directly or through grants or contracts) provide for
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1 the evaluation of programs implemented under subsection

2 (a) in order to determine the effect of such programs on

3 knowledge and practice regarding palliative care.

4 ‘‘(f) PEER REVIEW GROUPS.—In carrying out section

5 799(f) with respect to this section, the Secretary shall en6 sure that the membership of each peer review group in7 volved includes one or more individuals with expertise and

8 experience in palliative care.

9 ‘‘(g) DEFINITION.—For purposes of this section, the

10 term ‘palliative care’ means the active total care of pa11 tients whose prognosis is limited due to progressive, far12 advanced disease. The purpose of such care is to alleviate

13 pain and other distressing symptoms and to enhance the

14 quality of life, not to hasten or postpone death.’’.

15 (b) AUTHORIZATION OF APPROPRIATIONS; ALLOCA16 TION.—

17 (1) IN GENERAL.—Section 758 of the Public

18 Health Service Act (as redesignated by subsection

19 (a)(1) of this section) is amended in subsection

20 (b)(1)(C) by striking ‘‘sections 753, 754, and 755’’

21 and inserting ‘‘section 753, 754, 755, and 756’’.

22 (2) AMOUNT.—With respect to section 758 of

23 the Public Health Service Act (as redesignated by

24 subsection (a)(1) of this section), the dollar amount
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1 specified in subsection (b)(1)(C) of such section is

2 deemed to be increased by $5,000,000.

3 SEC. 203. EFFECTIVE DATE.

4 The amendments made by this title take effect Octo5 ber 1, 1999, or upon the date of the enactment of this

6 Act, whichever occurs later.

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