I 

115TH CONGRESS 

2D SESSION H. R. 5197 

To direct the Secretary of Health and Human Services to conduct a demonstration program to test alternative pain management protocols to 

limit the use of opioids in emergency departments. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 7, 2018 

Mr. PASCRELL (for himself, Mr. MCKINLEY, Ms. DEGETTE, and Mr. TIPTON) 

introduced the following bill; which was referred to the Committee on Energy and Commerce 

A BILL 

To direct the Secretary of Health and Human Services to 

conduct a demonstration program to test alternative pain 

management protocols to limit the use of opioids in emergency departments. 

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 ‘‘Alternatives to Opioids 

5 (ALTO) in the Emergency Department Act’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 


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1 (1) Opioids contributed to the deaths of more 

2 than 42,000 people in 2016, more than any year on 

3 official record. Forty percent of all opioid overdose 

4 deaths involve a prescription opioid. 

5 (2) The economic burden of prescription opioid 

6 misuse in the United States is estimated to be 

7 $78,500,000,000 per year. This includes costs stem8 ming from health care, including addiction treat9 ment, lost productivity, and criminal justice involve10 ment. 

11 (3) Over 200 million opioid prescriptions are 

12 written in the United States each year, and 

13 2,000,000 Americans have the symptoms of sub14 stance use disorder. 

15 (4) Approximately 21 to 29 percent of patients 

16 prescribed opioids for chronic pain misuse them. 

17 (5) Emergency departments in several States, 

18 including in New Jersey and Colorado, have devel19 oped innovative programs to more widely utilize non20 opioid pain treatments to reduce the use of opioids. 

21 SEC. 3. EMERGENCY DEPARTMENT ALTERNATIVES TO 

22 OPIOIDS DEMONSTRATION PROGRAM. 

23 (a) DEMONSTRATION PROGRAM GRANTS.—The Sec24 retary of Health and Human Services acting through the 

25 Assistant Secretary for Mental Health and Substance Use 


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1 (in this section referred to as the ‘‘Secretary’’) shall carry 

2 out a 3-year demonstration program under which the Sec3 retary shall award grants to eligible hospitals and emer4 gency departments, including freestanding emergency de5 partments, to develop, implement, enhance, or study alter6 native pain management protocols and treatments that 

7 promote the appropriate limited use of opioids in emer8 gency departments. 

9 (b) ELIGIBILITY.—To be eligible to receive a grant 

10 under subsection (a), a hospital or emergency department 

11 shall submit an application to the Secretary at such time, 

12 in such manner, and containing such information as the 

13 Secretary may require. 

14 (c) GEOGRAPHIC DIVERSITY.—In awarding grants 

15 under this section, the Secretary shall seek to ensure geo16 graphical diversity among grant recipients. 

17 (d) USE OF FUNDS.—In addition to the activities de18 scribed in subsection (a), grants under this section shall 

19 be used to— 

20 (1) target common painful conditions, which 

21 may include renal colic, sciatica, headaches, mus22 culoskeletal pain, and extremity fractures; 

23 (2) train providers and other hospital personnel 

24 on protocols and use of treatments that promote the 


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1 appropriate limited use of opioids in the emergency 

2 department; 

3 (3) collect data, including data required for the 

4 reporting requirement established under subsection 

5 (f); and 

6 (4) provide alternatives to opioids to patients 

7 with painful conditions, not including patients who 

8 present with pain related to cancer, end-of-life symp9 tom palliation, or complex multisystem trauma. 

10 (e) DUTIES OF THE SECRETARY.—The Secretary 

11 shall offer to each recipient of a grant under subsection 

12 (a) technical support through a process that provides 

13 for— 

14 (1) the provision of information by the Sec15 retary on alternative pain management protocols and 

16 treatments, which may include— 

17 (A) non-opioid medications; 

18 (B) protocols and treatments that do not 

19 involve a medication; 

20 (C) alternative pain management protocols 

21 and treatments that are appropriate to use for 

22 specific common painful conditions, such as 

23 renal colic, back pain, pain from fractures, and 

24 other common painful conditions that present 

25 to the emergency department; 


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1 (D) the alternative pain management pro2 tocol or treatments, if any, that are appropriate 

3 for certain patient populations, such as geri4 atric patients, pregnant patients, and pediatric 

5 patients; and 

6 (E) any other information the Secretary 

7 determines necessary; and 

8 (2) the provision of information by emergency 

9 departments and providers that have successfully 

10 implemented alternatives to opioids programs in the 

11 emergency department, promoting non-opioid proto12 cols and medications while appropriately limiting the 

13 use of opioids. 

14 (f) REPORT TO THE SECRETARY.—Each recipient of 

15 a grant under this section shall submit to the Secretary 

16 annual evaluations of the progress of the program funded 

17 through the grant. These evaluations shall include— 

18 (1) a description of and specific information 

19 about the alternative pain management protocols 

20 and treatments employed; 

21 (2) data on the alternative pain management 

22 protocols and treatments employed, including— 

23 (A) during a baseline period before the 

24 program began, as defined by the Secretary; 


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1 (B) at various stages of the program, as 

2 determined by the Secretary; 

3 (C) the conditions for which the alternative 

4 pain management protocols and treatments 

5 were employed; and 

6 (D) data on patients’ self-reported pain 

7 rating, using a pain scale model provided by the 

8 Secretary, before and after the alternative pain 

9 management protocol or treatment was pro10 vided; 

11 (3) data on the opioid prescriptions written, in12 cluding— 

13 (A) during a baseline period before the 

14 program began, as defined by the Secretary; 

15 (B) at various stages of the program, as 

16 determined by the Secretary; 

17 (C) the conditions for which the opioids 

18 were prescribed; and 

19 (D) data on patients’ self-reported pain 

20 rating, using a pain scale model provided by the 

21 Secretary, before and after the opioid prescrip22 tion was provided; 

23 (4) the demographic characteristics of patients 

24 who were treated with an alternative pain manageVerDate Sep 11 2014 03:56 Mar 14, 2018 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H5197.IH H5197

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1 ment protocol, including age, sex, race, ethnicity, 

2 and insurance status and type; 

3 (5) data on patients who were eventually pre4 scribed opioids after alternative pain management 

5 protocols and treatments were employed; 

6 (6) data on patients who were transitioned to 

7 inpatient care following treatment with an alter8 native pain management protocol and treatment; 

9 and 

10 (7) any other information the Secretary deems 

11 necessary. 

12 (g) REPORT TO CONGRESS.—Not later than 120 days 

13 after completion of the demonstration program under this 

14 section, the Secretary shall submit a report to the Con15 gress on the results of the demonstration program and in16 clude in the report— 

17 (1) the number of applications received and the 

18 number funded; 

19 (2) a summary of the evaluations described in 

20 subsection (f), including standardized data; and 

21 (3) recommendations for broader implementa22 tion of pain management protocols that limit the use 

23 of opioids in emergency departments or other areas 

24 of the health care delivery system. 


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1 (h) AUTHORIZATION OF APPROPRIATIONS.—To carry 

2 out this section, there is authorized to be appropriated 

3 $10,000,000 for each of fiscal years 2019 through 2021. 

Æ 


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