Union Calendar No. 229

106TH CONGRESS

1ST SESSION H. R. 2260

[Report No. 106–378, Parts I and II]

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.

OCTOBER 18, 1999

Reported from the Committee on Commerce with amendments, committed to the Committee of the Whole

House on the State of the Union, and ordered to beprinted
IB

Union Calendar No. 229

106TH CONGRESS

1ST SESSION H. R. 2260

[Report No. 106–378, Parts I and II]

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

OCTOBER 13, 1999

Reported from the Committee on the Judiciary

OCTOBER 18, 1999

Additional sponsors: Mr. DEMINT, Mrs. NORTHUP, Mr. BARTLETT of Mary-
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land, Mr. CALVERT, Mr. POMBO, Mr. HOSTETTLER, Mr. ARMEY, Mr.

ENGLISH, Mr. TAYLOR of Mississippi, Mr. HUNTER, Mr. PACKARD, Mr.

EHLERS, Mr. BARR of Georgia, Mr. GOODLING, Mr. WATTS of Oklahoma, Mr. THUNE, Mr. SOUDER, Mr. DEAL of Georgia, Mr. KILDEE, Mr.

BRADY of Texas, Mr. RADANOVICH, Mr. HILLEARY, Mr. GIBBONS, Mr.

MORAN of Kansas, Mr. COBLE, Mr. HASTINGS of Washington, Mr.

LATOURETTE, Mr. TALENT, Mr. TAUZIN, Mr. NORWOOD, Mr. JONES of

North Carolina, Mr. OXLEY, Mr. WOLF, Mr. MCINNIS, Mr. LIPINSKI,

Mr. PEASE, Mr. RYUN of Kansas, Mr. JENKINS, Mr. HILL of Montana,

Mr. COSTELLO, Mr. SUNUNU, Mr. CAMP, Mr. MASCARA, Mr. WICKER,

Mr. WATKINS, Mr. FORBES, Mr. HALL of Ohio, Mr. PETRI, Mr.

MCINTOSH, Mr. TAYLOR of North Carolina, Mr. CHAMBLISS, Mr. KLINK,

Mr. SIMPSON, Mr. DIAZ-BALART, Mr. TIAHRT, Mrs. KELLY, Mr.

FLETCHER, Mr. RILEY, Mr. GUTKNECHT, Mr. LATHAM, Mr. WHITFIELD,

Mr. CRANE, Mr. BACHUS, Mrs. CUBIN, Mr. BARRETT of Nebraska, Mr.

SWEENEY, Mr. SAM JOHNSON of Texas, Mr. UPTON, Mr. CANNON, Ms.

PRYCE of Ohio, Mr. HEFLEY, Mr. GARY MILLER of California, Mr.

VITTER, Mr. KINGSTON, Mr. COMBEST, Mr. SESSIONS, Mr. COOK, Mr.

CALLAHAN, Mr. DUNCAN, Mr. RYAN of Wisconsin, Mr. QUINN, Mr. BLILEY, Mr. GALLEGLY, Mr. MICA, Mr. BROWN of Ohio, Mr. GREEN of Wisconsin, Mr. BATEMAN, Mr. NEAL of Massachusetts, Mr. LAZIO, Mr.

SHADEGG, Mr. BILIRAKIS, Mr. ISAKSON, Mr. REYNOLDS, Mrs. FOWLER,

Mr. BERRY, Mr. WELLER, and Mr. FRANKS of New Jersey

OCTOBER 18, 1999

Reported from the Committee on Commerce with amendments, committed to

the Committee of the Whole House on the State of the Union, and ordered to be printed

[Omit the part struck through and insert the part printed in italic]

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.

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’’.
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1 TITLE I—USE OF CONTROLLED

2 SUBSTANCES CONSISTENT

3 WITH THE CONTROLLED SUB4 STANCES ACT

5 SEC. 101. REINFORCING EXISTING STANDARD FOR LEGITI6 MATE USE OF CONTROLLED SUBSTANCES.

7 Section 303 of the Controlled Substances Act (21

8 U.S.C. 823) is amended by adding at the end the fol9 lowing:

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

11 to implement this Act, alleviating pain or discomfort in

12 the usual course of professional practice is a legitimate

13 medical purpose for the dispensing, distributing, or admin14 istering of a controlled substance that is consistent with

15 public health and safety, even if the use of such a sub16 stance may increase the risk of death. Nothing in this sec17 tion authorizes intentionally dispensing, distributing, or

18 administering a controlled substance for the purpose of

19 causing death or assisting another person in causing

20 death.

21 ‘‘(2) Notwithstanding any other provision of this Act,

22 in determining whether a registration is consistent with

23 the public interest under this Act, the Attorney General

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

25 permitting assisted suicide or euthanasia.
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1 ‘‘(3) Paragraph (2) applies only to conduct occurring

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

3 SEC. 102. EDUCATION AND TRAINING PROGRAMS.

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

5 U.S.C. 872(a)) is amended—

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

7 (5);

8 (2) by striking the period at the end of para9 graph (6) and inserting ‘‘; and’’; and

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

11 ‘‘(7) educational and training programs for

12 local, State, and Federal personnel, incorporating

13 recommendations by the Secretary of Health and

14 Human Services, on the necessary and legitimate

15 use of controlled substances in pain management

16 and palliative care, and means by which investiga17 tion and enforcement actions by law enforcement

18 personnel may accommodate such use.’’.

19 TITLE II—PROMOTING

20 PALLIATIVE CARE

21 SEC. 201. ACTIVITIES OF AGENCY FOR HEALTH CARE POL22 ICY AND RESEARCH.

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

24 (42 U.S.C. 299 et seq.) is amended by adding at the end

25 the following section:
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1 ‘‘SEC. 906. PROGRAM FOR PALLIATIVE CARE RESEARCH

2 AND QUALITY.

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

4 out a program to accomplish the following:

5 ‘‘(1) Develop and advance scientific under6 standing of palliative care.

7 ‘‘(2) Collect and disseminate protocols and evi8 dence-based practices regarding palliative care, with

9 priority given to pain management for terminally ill

10 patients, and make such information available to

11 public and private health care programs and pro12 viders, health professions schools, and hospices, and

13 to the general public.

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

15 term ‘palliative care’ means the active total care of pa16 tients whose prognosis is limited due to progressive, far17 advanced disease. The purpose of such care is to alleviate

18 pain and other distressing symptoms and to enhance the

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

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

21 term ‘palliative care’ means the active, total care of patients

22 whose disease or medical condition is not responsive to cu23 rative treatment or whose prognosis is limited due to pro24 gressive, far-advanced disease. The purpose of such care is

25 to alleviate pain and other distressing symptoms and to en26 hance the quality of life, not to hasten or postpone death.’’.
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1 SEC. 202. ACTIVITIES OF HEALTH RESOURCES AND SERV2 ICES ADMINISTRATION.

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

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

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

6 is amended—

7 (1) by redesignating sections 754 through 757

8 as sections 755 through 758, respectively; and

9 (2) by inserting after section 753 the following

10 section:

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

12 PALLIATIVE CARE.

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

14 with the Administrator for Health Care Policy and Re15 search, may make awards of grants, cooperative agree16 ments, and contracts to health professions schools, hos17 pices, and other public and private entities for the develop18 ment and implementation of programs to provide edu19 cation and training to health care professionals in pallia20 tive care.

21 ‘‘(b) PRIORITIES.—In making awards under sub22 section (a), the Secretary shall give priority to awards for

23 the implementation of programs under such subsection.

24 ‘‘(c) CERTAIN TOPICS.—An award may be made

25 under subsection (a) only if the applicant for the award
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1 agrees that the program carried out with the award will

2 include information and education on—

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

4 of patients, especially terminally ill patients, includ5 ing the medically appropriate use of controlled sub6 stances;

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

8 including laws permitting health care professionals

9 to dispense or administer controlled substances as

10 needed to relieve pain even in cases where such ef11 forts may unintentionally increase the risk of death;

12 and

13 ‘‘(3) recent findings, developments, and im14 provements in the provision of palliative care.

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

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

17 professions schools, residency training programs and other

18 graduate programs in the health professions, entities that

19 provide continuing medical education, hospices, and such

20 other programs or sites as the Secretary determines to be

21 appropriate.

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

23 shall (directly or through grants or contracts) provide for

24 the evaluation of programs implemented under subsection
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1 (a) in order to determine the effect of such programs on

2 knowledge and practice regarding palliative care.

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

4 799(f) with respect to this section, the Secretary shall en5 sure that the membership of each peer review group in6 volved includes one or more individuals with expertise and

7 experience in palliative care.

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

9 term ‘palliative care’ means the active total care of pa10 tients whose prognosis is limited due to progressive, far11 advanced disease. The purpose of such care is to alleviate

12 pain and other distressing symptoms and to enhance the

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

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

15 term ‘palliative care’ means the active, total care of patients

16 whose disease or medical condition is not responsive to cu17 rative treatment or whose prognosis is limited due to pro18 gressive, far-advanced disease. The purpose of such care is

19 to alleviate pain and other distressing symptoms and to en20 hance the quality of life, not to hasten or postpone death.’’.

21 (b) AUTHORIZATION OF APPROPRIATIONS; ALLOCA22 TION.—

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

24 Health Service Act (as redesignated by subsection

25 (a)(1) of this section) is amended in subsection
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1 (b)(1)(C) by striking ‘‘sections 753, 754, and 755’’

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

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

4 the Public Health Service Act (as redesignated by

5 subsection (a)(1) of this section), the dollar amount

6 specified in subsection (b)(1)(C) of such section is

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

8 SEC. 203. EFFECTIVE DATE.

9 The amendments made by this title take effect Octo10 ber 1, 1999, or upon the date of the enactment of this

11 Act, whichever occurs later.