IIB

106TH CONGRESS

1ST SESSION H. R. 2260

IN THE SENATE OF THE UNITED STATES

OCTOBER 28, 1999

Received

NOVEMBER 19, 1999

Read twice and referred to the Committee on the Judiciary

AN ACT

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,
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1 SECTION 1. SHORT TITLE.

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

3 Act of 1999’’.

4 TITLE I—USE OF CONTROLLED

5 SUBSTANCES CONSISTENT

6 WITH THE CONTROLLED SUB7 STANCES ACT

8 SEC. 101. REINFORCING EXISTING STANDARD FOR LEGITI9 MATE USE OF CONTROLLED SUBSTANCES.

10 Section 303 of the Controlled Substances Act (21

11 U.S.C. 823) is amended by adding at the end the fol12 lowing:

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

14 to implement this Act, alleviating pain or discomfort in

15 the usual course of professional practice is a legitimate

16 medical purpose for the dispensing, distributing, or admin17 istering of a controlled substance that is consistent with

18 public health and safety, even if the use of such a sub19 stance may increase the risk of death. Nothing in this sec20 tion authorizes intentionally dispensing, distributing, or

21 administering a controlled substance for the purpose of

22 causing death or assisting another person in causing

23 death.

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

25 in determining whether a registration is consistent with

26 the public interest under this Act, the Attorney General
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1 shall give no force and effect to State law authorizing or

2 permitting assisted suicide or euthanasia.

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

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

5 SEC. 102. EDUCATION AND TRAINING PROGRAMS.

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

7 U.S.C. 872(a)) is amended—

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

9 (5);

10 (2) by striking the period at the end of para11 graph (6) and inserting ‘‘; and’’; and

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

13 ‘‘(7) educational and training programs for

14 local, State, and Federal personnel, incorporating

15 recommendations by the Secretary of Health and

16 Human Services, on the necessary and legitimate

17 use of controlled substances in pain management

18 and palliative care, and means by which investiga19 tion and enforcement actions by law enforcement

20 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 disease or medical condition is not responsive

24 to curative treatment or whose prognosis is limited due

25 to progressive, far-advanced disease. The purpose of such
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1 care is to alleviate pain and other distressing symptoms

2 and to enhance the quality of life, not to hasten or post3 pone death.’’.

4 SEC. 202. ACTIVITIES OF HEALTH RESOURCES AND SERV5 ICES ADMINISTRATION.

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

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

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

9 is amended—

10 (1) by redesignating sections 754 through 757

11 as sections 755 through 758, respectively; and

12 (2) by inserting after section 753 the following

13 section:

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

15 PALLIATIVE CARE.

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

17 with the Administrator for Health Care Policy and Re18 search, may make awards of grants, cooperative agree19 ments, and contracts to health professions schools, hos20 pices, and other public and private entities for the develop21 ment and implementation of programs to provide edu22 cation and training to health care professionals in pallia23 tive care.
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1 ‘‘(b) PRIORITIES.—In making awards under sub2 section (a), the Secretary shall give priority to awards for

3 the implementation of programs under such subsection.

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

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

6 agrees that the program carried out with the award will

7 include information and education on—

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

9 of patients, especially terminally ill patients, includ10 ing the medically appropriate use of controlled sub11 stances;

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

13 including laws permitting health care professionals

14 to dispense or administer controlled substances as

15 needed to relieve pain even in cases where such ef16 forts may unintentionally increase the risk of death;

17 and

18 ‘‘(3) recent findings, developments, and im19 provements in the provision of palliative care.

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

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

22 professions schools, residency training programs and other

23 graduate programs in the health professions, entities that

24 provide continuing medical education, hospices, and such
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1 other programs or sites as the Secretary determines to be

2 appropriate.

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

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

5 the evaluation of programs implemented under subsection

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

7 knowledge and practice regarding palliative care.

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

9 799(f) with respect to this section, the Secretary shall en10 sure that the membership of each peer review group in11 volved includes one or more individuals with expertise and

12 experience in palliative care.

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

14 term ‘palliative care’ means the active, total care of pa15 tients whose disease or medical condition is not responsive

16 to curative treatment or whose prognosis is limited due

17 to progressive, far-advanced disease. The purpose of such

18 care is to alleviate pain and other distressing symptoms

19 and to enhance the quality of life, not to hasten or post20 pone 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 ‘‘sections 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.

Passed the House of Representatives October 27,

1999.

Attest: JEFF TRANDAHL,

Clerk.