I 

113TH CONGRESS 

2D SESSION H. R. 4169 

To prevent deaths occurring from drug overdoses. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 6, 2014 

Ms. EDWARDS (for herself, Ms. BASS, Mr. CARSON of Indiana, Mr. CUMMINGS, Mr. ELLISON, Mr. KEATING, Ms. LEE of California, Mr. LYNCH, 

Mr. MICHAUD, Mr. RANGEL, Mr. RYAN of Ohio, Ms. SCHWARTZ, Mr. 

SERRANO, Ms. SHEA-PORTER, Mr. TIERNEY, Mr. TONKO, Ms. WILSON

of Florida, Mr. FOSTER, and Mr. BEN RAY LUJA ́N of New Mexico) introduced the following bill; which was referred to the Committee on Energy 

and Commerce 

A BILL 

To prevent deaths occurring from drug overdoses. 

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 ‘‘Stop Overdose Stat 

5 Act’’ or the ‘‘S.O.S. Act’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds the following: 

8 (1) According to the Centers for Disease Con9 trol and Prevention (CDC), each day in the United 


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1 States more than 100 people die from a drug over2 dose. Among people 25 to 64 years old, drug over3 dose caused more deaths than motor vehicle acci4 dents. 

5 (2) The CDC reports that more than 38,000 

6 people in the United States died from a drug over7 dose in 2010 alone. Seventy-eight percent of these 

8 deaths were due to unintentional drug overdoses, 

9 and many could have been prevented. 

10 (3) Deaths resulting from unintentional drug 

11 overdoses increased more than 400 percent between 

12 1980 and 1999, and more than doubled between 

13 1999 and 2010. 

14 (4) Ninety-one percent of all unintentional poi15 soning deaths are due to drugs. Since 1999, in the 

16 United States the population of Non-Hispanic 

17 Whites and the population of American Indians and 

18 Alaska Natives have seen the highest rates of unin19 tentional drug poisoning deaths. 

20 (5) Opioid medications such as oxycodone and 

21 hydrocodone are involved in 55 percent of all unin22 tentional drug poisoning deaths. 

23 (6) Between 1999 and 2010, opioid medication 

24 overdose fatalities increased by more than 400 per25 cent among women and 265 percent among men. 


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1 (7) Military veterans are at elevated risk of ex2 periencing a drug overdose. Vietnam, Iraq, and Af3 ghanistan veterans with combat injuries, posttrau4 matic stress disorder (PTSD), and other co-occur5 ring mental health diagnoses are at elevated risk of 

6 fatal drug overdose from opioid medications. 

7 (8) Rural and suburban regions are dispropor8 tionately affected by opioid medication overdoses. 

9 Urban centers also continue to struggle with over10 dose, which is the leading cause of death among 

11 homeless adults. 

12 (9) In the year 2009 alone, estimated lost pro13 ductivity and direct medical costs from opioid medi14 cation poisonings exceeded $20,000,000,000. 

15 (10) Both fatal and nonfatal overdoses place a 

16 heavy burden on public health and public safety re17 sources, yet there is no coordinated cross-Federal 

18 agency response to prevent overdose fatalities. 

19 (11) Naloxone is a medication that rapidly re20 verses overdose from heroin and opioid medications. 

21 (12) In 2012, the Food and Drug Administra22 tion (FDA) held a public workshop in collaboration 

23 with the National Institute on Drug Abuse (NIDA) 

24 and the CDC, and with participation from the Sub25 stance Abuse and Mental Health Services AdminisVerDate Mar 15 2010 00:29 Mar 11, 2014 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4169.IH H4169

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1 tration (SAMHSA) and the Office of National Drug 

2 Control Policy (ONDCP), to discuss making 

3 naloxone more widely available outside of conven4 tional medical settings to reduce the incidence of 

5 opioid overdose fatalities. 

6 (13) Lawmakers in California, Colorado, Con7 necticut, Illinois, Kentucky, Massachusetts, Mary8 land, New Jersey, New Mexico, New York, North 

9 Carolina, Oregon, Rhode Island, Vermont, Virginia, 

10 Washington, and the District of Columbia have re11 moved legal impediments to increasing naloxone pre12 scription and its use by bystanders who are in a po13 sition to respond to an overdose. 

14 (14) Health practitioners are often not fully 

15 aware of overdose symptoms and prevention meth16 ods, impacting their ability to adequately inform pa17 tients and caregivers on how to recognize symptoms, 

18 respond effectively by seeking emergency assistance, 

19 and provide naloxone and other first aid in order to 

20 save a life. 

21 (15) The American Medical Association (AMA), 

22 the Nation’s largest physician organization, supports 

23 further implementation of community-based pro24 grams that offer naloxone and other opioid overdose 

25 prevention services. 


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1 (16) Community-based overdose prevention pro2 grams have successfully prevented deaths from 

3 opioid overdoses by making rescue trainings and 

4 naloxone available to first responders, parents, and 

5 other bystanders who may encounter an overdose. 

6 Over 50,000 potential bystanders have been trained 

7 by overdose prevention programs in the United 

8 States. A CDC report credits overdose prevention 

9 programs with saving more than 10,000 lives since 

10 1996. 

11 (17) At least 188 local overdose prevention pro12 grams are operating in the United States, including 

13 in major cities such as Baltimore, Chicago, Los An14 geles, New York City, Boston, San Francisco, and 

15 Philadelphia, and statewide in New Mexico, Massa16 chusetts, and New York. Between 2006 and 2009, 

17 overdose prevention programs facilitated by the Mas18 sachusetts Department of Public Health trained 

19 nearly 3,000 people who reported more than 300 

20 rescues. Since 2004, a program administered by the 

21 Baltimore City Health Department has trained more 

22 than 3,000 people who reported more than 220 res23 cues. Project Lazarus, an overdose prevention pro24 gram in Wilkes County, North Carolina, reduced 

25 overdose deaths 69 percent between 2009 and 2011. 


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1 (18) The ONDCP supports equipping first re2 sponders to help reverse overdoses. Police officers on 

3 patrol in Quincy, Massachusetts, have conducted 

4 170 overdose rescues with naloxone since 2010. The 

5 police department has reported a 95-percent success 

6 rate with overdose rescue attempts by police officers. 

7 In Suffolk County, New York, police officers have 

8 saved more than 50 lives with naloxone. 

9 (19) Research shows that the cost per year of 

10 life gained by making naloxone available to reverse 

11 overdoses is within the range of what Americans 

12 usually pay for health treatments. 

13 (20) Overdose prevention programs are needed 

14 in correctional facilities, addiction treatment pro15 grams, and other places where people are at higher 

16 risk of overdosing after a period of abstinence. 

17 (21) People affected by drug overdose gather 

18 each year in communities nationwide on August 31st 

19 for Overdose Awareness Day to mourn and pay trib20 ute to loved ones and raise awareness about overdose 

21 risk and prevention. 

22 SEC. 3. OVERDOSE PREVENTION GRANT PROGRAM. 

23 (a) PROGRAM AUTHORIZED.—The Secretary, acting 

24 through the Director of the CDC, shall award grants or 

25 cooperative agreements to eligible entities to enable the eliVerDate Mar 15 2010 00:29 Mar 11, 2014 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4169.IH H4169

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1 gible entities to reduce deaths occurring from overdoses 

2 of drugs. 

3 (b) APPLICATION.— 

4 (1) IN GENERAL.—An eligible entity desiring a 

5 grant or cooperative agreement under this section 

6 shall submit to the Secretary an application at such 

7 time, in such manner, and containing such informa8 tion as the Secretary may require. 

9 (2) CONTENTS.—An application under para10 graph (1) shall include— 

11 (A) a description of the activities to be 

12 funded through the grant or cooperative agree13 ment; and 

14 (B) a demonstration that the eligible entity 

15 has the capacity to carry out such activities. 

16 (c) PRIORITY.—In awarding grants and cooperative 

17 agreements under subsection (a), the Secretary shall give 

18 priority to eligible entities that— 

19 (1) are a public health agency or community20 based organization; and 

21 (2) have expertise in preventing deaths occur22 ring from overdoses of drugs in populations at high 

23 risk of such deaths. 

24 (d) ELIGIBLE ACTIVITIES.— 


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1 (1) REQUIRED ACTIVITY.—As a condition on 

2 receipt of a grant or cooperative agreement under 

3 this section, an eligible entity shall agree to use the 

4 grant or cooperative agreement to purchase and dis5 tribute the drug naloxone. 

6 (2) ADDITIONAL ACTIVITIES.—In addition to 

7 the activity described in paragraph (1), an eligible 

8 entity shall use a grant or cooperative agreement 

9 under this section to carry out one or more of the 

10 following activities: 

11 (A) Educating prescribers and pharmacists 

12 about overdose prevention and naloxone pre13 scription. 

14 (B) Training first responders, other indi15 viduals in a position to respond to an overdose, 

16 and law enforcement and corrections officials on 

17 the effective response to individuals who have 

18 overdosed on drugs. Training pursuant to this 

19 subparagraph may include any activity that is 

20 educational, instructional, or consultative in na21 ture, and may include volunteer trainings, 

22 awareness building exercises, outreach to indi23 viduals who are at-risk of a drug overdose, and 

24 distribution of educational materials. 


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1 (C) Implementing and enhancing programs 

2 to provide overdose prevention, recognition, 

3 treatment, and response to individuals in need 

4 of such services. 

5 (D) Expanding activities described in para6 graph (1). 

7 (E) Expanding activities described in sub8 paragraph (A) or (B). 

9 (e) COORDINATING CENTER.— 

10 (1) ESTABLISHMENT.—The Secretary shall es11 tablish and provide for the operation of a coordi12 nating center responsible for— 

13 (A) collecting, compiling, and dissemi14 nating data on the programs and activities 

15 under this section; 

16 (B) evaluating such data and, based on 

17 such evaluation, developing best practices for 

18 preventing deaths occurring from drug 

19 overdoses; and 

20 (C) making such best practices specific to 

21 the type of community involved. 

22 (2) REPORTS TO CENTER.—As a condition on 

23 receipt of a grant or cooperative agreement under 

24 this section, an eligible entity shall agree to prepare 

25 and submit, not later than 90 days after the end of 


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1 the grant or cooperative agreement period, a report 

2 to such coordinating center and the Secretary de3 scribing the results of the activities supported 

4 through the grant or cooperative agreement. 

5 (f) MATCHING FUNDS.— 

6 (1) IN GENERAL.—As a condition on receipt of 

7 a grant or cooperative agreement under this section, 

8 an eligible entity shall agree that, with respect to the 

9 costs to be incurred by the eligible entity in carrying 

10 out the activities for which the grant or cooperative 

11 agreement is awarded, the eligible entity will make 

12 available non-Federal contributions in an amount 

13 equal to not less than 50 percent of the Federal 

14 funds provided through the grant or cooperative 

15 agreement. 

16 (2) SATISFYING MATCHING REQUIREMENT.— 

17 The non-Federal contributions required under para18 graph (1) may be— 

19 (A) in cash or in-kind, including services, 

20 fairly evaluated; and 

21 (B) from— 

22 (i) any private source; or 

23 (ii) a State, tribal, or local agency. 

24 (3) WAIVER.—The Secretary may waive or re25 duce the non-Federal contribution required by paraVerDate Mar 15 2010 00:29 Mar 11, 2014 Jkt 039200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4169.IH H4169

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1 graph (1) if the eligible entity involved demonstrates 

2 that the eligible entity cannot meet the contribution 

3 requirement due to financial hardship. 

4 (g) DURATION.—The period of a grant or cooperative 

5 agreement under this section shall be 4 years. 

6 (h) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated $10,000,000 to carry 

8 out this section for each of the fiscal years 2014 through 

9 2018. 

10 SEC. 4. SURVEILLANCE CAPACITY BUILDING. 

11 (a) PROGRAM AUTHORIZED.—The Secretary, acting 

12 through the Director of the CDC, shall award grants or 

13 cooperative agreements to State, local, or tribal govern14 ments, or the National Poison Data System working in 

15 conjunction with State, local, or tribal governments, to im16 prove fatal and nonfatal drug overdose surveillance and 

17 reporting capabilities, including the following: 

18 (1) Providing training to improve identification 

19 of drug overdose as the cause of death by coroners 

20 and medical examiners. 

21 (2) Establishing, in cooperation with the Na22 tional Poison Data System, coroners, and medical 

23 examiners, a comprehensive national program for 

24 surveillance of, and reporting to an electronic data25 base on, drug overdose deaths in the United States. 


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1 (3) Establishing, in cooperation with the Na2 tional Poison Data System, a comprehensive na3 tional program for surveillance of, and reporting to 

4 an electronic database on, fatal and nonfatal drug 

5 overdose occurrences, including epidemiological and 

6 toxicologic analysis and trends. 

7 (b) APPLICATION.— 

8 (1) IN GENERAL.—A State, local, or tribal gov9 ernment or the National Poison Data System desir10 ing a grant or cooperative agreement under this sec11 tion shall submit to the Secretary an application at 

12 such time, in such manner, and containing such in13 formation as the Secretary may require. 

14 (2) CONTENTS.—The application described in 

15 paragraph (1) shall include— 

16 (A) a description of the activities to be 

17 funded through the grant or cooperative agree18 ment; and 

19 (B) a demonstration that the State, local, 

20 or tribal government or the National Poison 

21 Data System has the capacity to carry out such 

22 activities. 

23 (c) REPORT.—As a condition on receipt of a grant 

24 or cooperative agreement under this section, a State, local, 

25 or tribal government or the National Poison Data System 


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1 shall agree to prepare and submit, not later than 90 days 

2 after the end of the grant or cooperative agreement period, 

3 a report to the Secretary describing the results of the ac4 tivities supported through the grant or cooperative agree5 ment. 

6 (d) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated to carry out this section 

8 $5,000,000 for each of the fiscal years 2014 through 

9 2018. 

10 SEC. 5. REDUCING OVERDOSE DEATHS. 

11 Part J of title III of the Public Health Service Act 

12 (42 U.S.C. 280b et seq.) is amended by inserting after 

13 section 393D (42 U.S.C. 280b–1f) the following: 

14 ‘‘SEC. 393F. REDUCING OVERDOSE DEATHS. 

15 ‘‘(a) PREVENTION OF DRUG OVERDOSE.—Not later 

16 than 180 days after the date of the enactment of this sec17 tion, the Secretary, in consultation with a task force com18 prised of stakeholders, shall develop a plan to reduce the 

19 number of deaths occurring from overdoses of drugs and 

20 shall submit the plan to Congress. The plan shall in21 clude— 

22 ‘‘(1) a plan for implementation of a public 

23 health campaign to educate prescribers and the pub24 lic about overdose prevention and naloxone prescrip25 tion; 


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1 ‘‘(2) recommendations for improving and ex2 panding overdose prevention programming; and 

3 ‘‘(3) recommendations for such legislative or 

4 administrative action as the Secretary considers ap5 propriate. 

6 ‘‘(b) TASK FORCE REPRESENTATION.— 

7 ‘‘(1) REQUIRED MEMBERS.—The task force re8 ferred to in subsection (a) shall include at least one 

9 representative of each of the following: 

10 ‘‘(A) Individuals directly impacted by drug 

11 overdose. 

12 ‘‘(B) Direct service providers who engage 

13 individuals at risk of a drug overdose. 

14 ‘‘(C) Drug overdose prevention advocates. 

15 ‘‘(D) The NIDA. 

16 ‘‘(E) The Center for Substance Abuse 

17 Treatment. 

18 ‘‘(F) The CDC. 

19 ‘‘(G) The Health Resources and Services 

20 Administration. 

21 ‘‘(H) The Food and Drug Administration. 

22 ‘‘(I) The Office of National Drug Control 

23 Policy. 

24 ‘‘(J) The American Medical Association. 


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1 ‘‘(K) The American Association of Poison 

2 Control Centers. 

3 ‘‘(L) The Bureau of Prisons. 

4 ‘‘(M) The Centers for Medicare & Medicaid 

5 Services. 

6 ‘‘(N) The Department of Justice. 

7 ‘‘(2) ADDITIONAL MEMBERS.—In addition to 

8 the representatives required by paragraph (1), the 

9 task force referred to in subsection (a) may include 

10 other representatives of individuals or entities with 

11 expertise relating to drug overdoses.’’. 

12 SEC. 6. OVERDOSE PREVENTION RESEARCH. 

13 (a) OVERDOSE RESEARCH.—The Director of the 

14 NIDA shall prioritize and conduct or support research on 

15 drug overdose and overdose prevention. The primary aims 

16 of this research shall include— 

17 (1) examination of circumstances that con18 tribute to drug overdose and identification of drugs 

19 associated with fatal overdose; 

20 (2) evaluation of existing overdose prevention 

21 methods; 

22 (3) pilot programs or research trials on new 

23 overdose prevention strategies or programs that have 

24 not been studied in the United States; 


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1 (4) scientific research concerning the effective2 ness of overdose prevention programs, including how 

3 to effectively implement and sustain such programs; 

4 and 

5 (5) comparative effectiveness research on over6 dose prevention programs. 

7 (b) FORMULATIONS OF NALOXONE.—The Director of 

8 the NIDA shall support research on the development of 

9 formulations of naloxone and dosage delivery devices spe10 cifically intended to be used by lay persons or first re11 sponders for the prehospital treatment of unintentional 

12 drug overdose. 

13 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated to carry out this section 

15 $5,000,000 for each of the fiscal years 2014 through 

16 2018. 

17 SEC. 7. OFFSET OF COSTS AND PERSONNEL. 

18 Notwithstanding any other provision of law, the Sec19 retary shall— 

20 (1) eliminate such initiatives, positions, and 

21 programs as the Secretary deems necessary to en22 sure any and all costs incurred to carry out the pro23 visions of this Act, and the amendments made by 

24 this Act, are entirely offset; 


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1 (2) ensure no net increase in personnel are 

2 added to carry out the provisions of this Act, with 

3 any new full- or part-time employees or equivalents 

4 offset by eliminating an equivalent number of exist5 ing staff; 

6 (3) not later than 60 days after the date of the 

7 enactment of this Act, report to the Congress on the 

8 actions taken to ensure compliance with paragraphs 

9 (1) and (2), including the specific initiatives, posi10 tions, and programs that have been eliminated to en11 sure that the costs of carrying out this Act will be 

12 offset; and 

13 (4) not implement any other provision of this 

14 Act (other than paragraphs (1), (2), and (3)) or any 

15 amendment made by this Act until the Secretary has 

16 certified that the actions specified in paragraphs (1), 

17 (2), and (3) have been completed. 

18 SEC. 8. DEFINITIONS. 

19 In this Act: 

20 (1) CDC.—The term ‘‘CDC’’ means the Cen21 ters for Disease Control and Prevention. 

22 (2) DRUG.—The term ‘‘drug’’— 

23 (A) means a drug (as that term is defined 

24 in section 201 of the Federal Food, Drug, and 

25 Cosmetic Act (21 U.S.C. 321)); and 


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1 (B) includes any controlled substance (as 

2 that term is defined in section 102 of the Con3 trolled Substances Act (21 U.S.C. 802)). 

4 (3) ELIGIBLE ENTITY.—The term ‘‘eligible enti5 ty’’ means an entity that is a State, local, or tribal 

6 government, a correctional institution, a law enforce7 ment agency, a community agency, a professional or8 ganization in the field of poison control and surveil9 lance, or a private nonprofit organization. 

10 (4) NATIONAL POISON DATA SYSTEM.—The 

11 term ‘‘National Poison Data System’’ means the 

12 system operated by the American Association of Poi13 son Control Centers, in partnership with the CDC, 

14 for real-time local, State, and national electronic re15 porting, and the corresponding database network. 

16 (5) NIDA.—The term ‘‘NIDA’’ means the Na17 tional Institute on Drug Abuse. 

18 (6) ONDCP.—The term ‘‘ONDCP’’ means the 

19 Office of National Drug Control Policy. 

20 (7) SECRETARY.—The term ‘‘Secretary’’ means 

21 the Secretary of Health and Human Services. 

22 (8) STATE.—The term ‘‘State’’ means any of 

23 the several States, the District of Columbia, Puerto 

24 Rico, the Northern Mariana Islands, the United 

25 States Virgin Islands, Guam, American Samoa, and 


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1 any other territory or possession of the United 

2 States. 

Æ 


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