I 

115TH CONGRESS 

2D SESSION H. R. 5531 

To provide for a comprehensive, multifaceted approach to preventing and 

treating opioid addiction. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 17, 2018 

Mr. BUCHANAN (for himself and Mrs. MURPHY of Florida) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, the Budget, Veterans’ Affairs, Oversight and Government Reform, and 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 provide for a comprehensive, multifaceted approach to 

preventing and treating opioid addiction. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Opioid Emergency Response Act’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Alternatives to opioids prescribing. 


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Sec. 3. Opioids and STOP Pain Initiative. 

Sec. 4. Veteran over-medication prevention. 

Sec. 5. Amendment relating to the account for the State response to the opioid 

abuse crisis. 

Sec. 6. Mental health access improvement. 

Sec. 7. Synthetics Trafficking and Overdose Prevention. 

Sec. 8. Stop the Importation and Trafficking of Synthetic Analogues. 

1 SEC. 2. ALTERNATIVES TO OPIOIDS PRESCRIBING. 

2 (a) ESTABLISHMENT.—Beginning not later than one 

3 year after the date of the enactment of this Act, the Sec4 retary of Health and Human Services (in this Act referred 

5 to as the ‘‘Secretary’’) shall carry out a 5-year demonstra6 tion project under which payment shall be made under the 

7 hospital outpatient prospective payment system under part 

8 B of title XVIII of the Social Security Act (42 U.S.C. 

9 1395j et seq.) to participating hospitals for items and 

10 services furnished as alternatives to opioid medications to 

11 individuals enrolled under such part to treat conditions 

12 designated under subsection (c)(1) for purposes of evalu13 ating the benefits of using, instead of opioid medications, 

14 such alternatives to treat in emergency departments such 

15 symptoms and conditions. 

16 (b) EMERGENCY DEPARTMENTS.— 

17 (1) SELECTION.—The Secretary shall select 

18 from hospitals with emergency departments volun19 tarily submitting applications under paragraph (4), 

20 not fewer than 30 hospitals with emergency depart21 ments, and not more than 50 hospitals with emerVerDate Sep 11 2014 03:13 Apr 20, 2018 Jkt 079200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H5531.IH H5531

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1 gency departments, for participation in the dem2 onstration project. 

3 (2) DIVERSITY.—In selecting hospitals with 

4 emergency departments, the Secretary shall ensure 

5 such hospitals and emergency departments are di6 verse in geography and size. 

7 (3) VOLUNTARY PARTICIPATION.—Participation 

8 in the demonstration project under this section shall 

9 be on a voluntary basis. 

10 (4) APPLICATIONS.— 

11 (A) IN GENERAL.—To participate in the 

12 demonstration project, a hospital with an emer13 gency department shall submit to the Secretary 

14 an application at such time, in such manner, 

15 and containing such information (in addition to 

16 the written commitment described in subpara17 graph (B)) as specified by the Secretary. The 

18 Secretary shall take such measures as is nec19 essary to make available such application form 

20 to potential participants no later than 180 days 

21 after the date of the enactment of this Act. 

22 (B) INFORMATION REQUIRED.—Each ap23 plication submitted by a hospital under sub24 paragraph (A) shall include a binding written 

25 commitment to participate in the demonstration 


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1 project for the duration of the project signed by 

2 the Chief Executive Officer of the hospital, the 

3 physician medical director of the emergency de4 partment of the hospital, the nursing director of 

5 the emergency department of the hospital, and 

6 the pharmacy director of the emergency depart7 ment of the hospital. 

8 (c) ELEMENTS OF DEMONSTRATION PROJECT.— 

9 Under the demonstration project, the following shall 

10 apply: 

11 (1) The Secretary shall designate no fewer than 

12 five conditions or sets of symptoms that will be mon13 itored during the demonstration project. 

14 (2) The performance during each year of the 

15 demonstration project, with respect to such condi16 tions designated under paragraph (1), of all emer17 gency departments of hospitals participating in the 

18 demonstration project will be measured against the 

19 performance of such emergency departments during 

20 a base year, which shall represent the most recent 

21 set of full year data available before the first date 

22 of the demonstration project. 

23 (3) The Secretary shall provide hospitals par24 ticipating in the demonstration project with a de25 scription of clearly defined treatments that are conVerDate Sep 11 2014 03:13 Apr 20, 2018 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H5531.IH H5531

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1 sidered alternatives to opioids to be applied for pur2 poses of subsection (a). 

3 (d) INCENTIVE PAYMENT.—Under the demonstration 

4 project, the Secretary shall create a payment structure 

5 under which hospitals participating in the demonstration 

6 project that increase the use of alternatives to opioids and 

7 decrease the use of opioids may receive a shared savings 

8 bonus in addition to what would otherwise be made for 

9 items and services furnished under subsection (a). The 

10 amount of such shared savings shall be based on the dif11 ference between readmission rates for individuals treated 

12 with an alternative to opioids at the emergency depart13 ment of the participating hospital and the average rate 

14 of readmissions for individuals treated with opioids and 

15 discharged from a representative group of emergency de16 partments of hospitals not participating in the demonstra17 tion project in the same region as the participating hos18 pital over a period of five years. 

19 (e) CLARIFICATION.—Nothing under this section 

20 shall prevent a health care provider from prescribing an 

21 opioid if an opioid is a medically necessary treatment. 

22 (f) REPORTS TO CONGRESS.— 

23 (1) INITIAL REPORT.—Not later than 180 days 

24 after the date of the enactment of this Act, the SecVerDate Sep 11 2014 03:13 Apr 20, 2018 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H5531.IH H5531

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1 retary shall submit to Congress a report that in2 cludes— 

3 (A) the application form described in sub4 section (b)(4)(A) that is to be made available to 

5 potential participants; and 

6 (B) a progress report with respect to des7 ignating the conditions under subsection (c)(1) 

8 and establishing the description of clearly de9 fined treatments described in subsection (c)(3). 

10 (2) PERIODIC DEMONSTRATION REPORTS.—Be11 ginning after the first year of the demonstration 

12 project and annually thereafter for each year of the 

13 demonstration project and not later than one year 

14 after the completion of the demonstration, the Sec15 retary shall submit to Congress a report that in16 cludes the following data for each hospital partici17 pating under the demonstration project: 

18 (A) With respect to each condition or set 

19 of symptom designated under subsection (c)(1), 

20 the number of individuals treated. 

21 (B) With respect to each such condition, 

22 the number of individuals treated only with an 

23 alternative to opioids. 

24 (C) With respect to each such condition, 

25 the number of individuals treated first with an 


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1 alternative to opioids, followed by an opioid in 

2 the same visit. 

3 (D) With respect to each such condition, 

4 the number of individuals treated only with an 

5 opioid. 

6 (E) With respect to each individual de7 scribed in subparagraph (A) treated for such a 

8 condition or set of symptoms, whether or not 

9 the individual involved returned to the emer10 gency department of the hospital or an emer11 gency department of a different hospital for the 

12 same condition or symptoms. 

13 (F) The difference in cost between treating 

14 an individual with an alternative to opioid 

15 versus an opioid. 

16 (G) Any additional information the Sec17 retary determines necessary. 

18 SEC. 3. OPIOIDS AND STOP PAIN INITIATIVE. 

19 (a) ESTABLISHMENT.—There is established an 

20 Opioids and STOP Pain Initiative, to be administered by 

21 the Director of the National Institutes of Health, in co22 ordination with other agencies, as appropriate, which shall 

23 include efforts to support research on the following: 

24 (1) Section 108 of the Comprehensive Addiction 

25 and Recovery Act of 2016 (42 U.S.C. 284q–1), 


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1 known as the STOP Pain Act, which directs the Na2 tional Institutes of Health to intensify and coordi3 nate fundamental, translational, and clinical re4 search with respect to— 

5 (A) the understanding of pain; 

6 (B) the discovery and development of 

7 therapies for chronic pain; and 

8 (C) the development of alternatives to 

9 opioids for effective pain treatments. 

10 (2) Developing improved options and evidence 

11 for medication-assisted treatment. 

12 (3) Developing improved options and evidence 

13 for opioid overdose reversal treatments. 

14 (4) The Federal Pain Research Strategy, in15 cluding research that focuses on— 

16 (A) novel drugs, non-addictive, and non17 pharmacological treatments for pain; 

18 (B) screening tools and outcome measure 

19 for assessments across the continuum of pain; 

20 (C) national registries, datasets, and re21 search networks; 

22 (D) effective models of care delivery for 

23 pain management; and 

24 (E) precision medicine methodology to pre25 vent and treat pain. 


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1 (5) The components of the Department of 

2 Health and Human Services five-point strategy to 

3 address the opioid crisis that states: ‘‘Providing sup4 port for cutting edge research on pain and addic5 tion’’. 

6 (6) The pain therapy screening program estab7 lished under subsection (c). 

8 (7) Other elements that the Secretary of Health 

9 and Human Services may designate, in consultation 

10 with the Director of the National Institutes of 

11 Health. 

12 (b) FUNDING FOR THE OPIOIDS AND STOP PAIN

13 INITIATIVE.— 

14 (1) IN GENERAL.—There is authorized to be 

15 appropriated, and there is appropriated, 

16 $500,000,000, to be used during the 5-fiscal-year 

17 period beginning in the fiscal year in which such 

18 funds are appropriated, to the National Institutes of 

19 Health Innovation Account to be used to administer 

20 the Opioids and STOP Pain Initiative established 

21 under subsection (a). 

22 (2) EMERGENCY SPENDING.— 

23 (A) IN GENERAL.—Amounts appropriated 

24 under paragraph (1) are designated as an emer25 gency requirement pursuant to section 4(g) of 


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1 the Statutory Pay-As-You-Go Act of 2010 (2 

2 U.S.C. 933(g)). 

3 (B) DESIGNATION IN THE SENATE.—In 

4 the Senate, amounts appropriated under sub5 section (a) are designated as an emergency re6 quirement pursuant to section 403(a) of S. 

7 Con. Res. 13 (111th Congress), the concurrent 

8 resolution on the budget for fiscal year 2010. 

9 (c) PAIN THERAPY SCREENING PROGRAM.— 

10 (1) IN GENERAL.—The Secretary of Health and 

11 Human Services (referred to in this section as the 

12 ‘‘Secretary’’) shall carry out through the National 

13 Institutes of Health a program to be known as the 

14 ‘‘Pain Therapy Screening Program’’ that focuses on 

15 the development of pain therapeutics. 

16 (2) GRANTS.—The Secretary shall award 

17 grants under the program under paragraph (1) to 

18 eligible public and private nonprofit entities to sup19 port the development of new pre-clinical models for 

20 pain disorders, and the application of these models 

21 in drug, device, or other therapy screening. 

22 (3) MODEL.—The program under this section 

23 shall be modeled after the Epilepsy Therapy Screen24 ing Program carried out by the National Institute of 

25 Neurological Disorders and Stroke. 


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1 (4) FEES.—The Secretary of Health and 

2 Human Services may assess reasonable fees on pri3 vate pharmaceutical or medical device industry enti4 ties that utilize the program under this section to 

5 screen proprietary molecular compounds and devices. 

6 Such fees shall be paid to the Foundation for the 

7 National Institutes of Health and transferred to the 

8 NIH Innovation Account to be used for the Opioids 

9 and STOP Pain Initiative established under sub10 section (a). 

11 (5) FUNDING.—The Director of the National 

12 Institutes of Health shall determine the amount, and 

13 allocate, funds from the amount appropriated under 

14 subsection (b), to carry out this section. 

15 (d) FUNDING PROVISIONS.— 

16 (1) SUPPLEMENT NOT SUPPLANT.—Amounts 

17 appropriated in this section (including the amend18 ments made by this section) shall be used to supple19 ment, not supplant, current funding for pain and 

20 opioid research at the National Institutes of Health. 

21 (2) ACCEPTANCE OF DONATIONS.—Notwith22 standing section 1342 of title 31, United States 

23 Code, the Secretary of Health and Human Services 

24 may accept donations (including from the pharma25 ceutical and medical device industries) to be used to 


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1 assist in carrying out programs and activities under 

2 this section (and the amendments made by this sec3 tion). Such donations shall be paid to the Founda4 tion for the National Institutes of Health and trans5 ferred to the NIH Innovation Account to be used for 

6 the Opioids and STOP Pain Initiative established 

7 under subsection (a). 

8 (3) INCLUSION OF CONTRIBUTION AMOUNTS IN

9 BASIC RESEARCH FOR PURPOSES OF RESEARCH

10 CREDIT.— 

11 (A) IN GENERAL.—Paragraph (6) of sec12 tion 41(e) of the Internal Revenue Code of 

13 1986 is amended by adding at the end the fol14 lowing new subparagraph: 

15 ‘‘(E) OPIOIDS AND STOP PAIN INITIA16 TIVE.—The National Institutes of Health, if the 

17 payment is made in support of the Opioids and 

18 STOP Pain Initiative, as established by the 

19 Opioids and STOP Pain Initiative Act.’’. 

20 (B) EFFECTIVE DATE.—The amendments 

21 made by this subsection shall apply to taxable 

22 years beginning after the date of the enactment 

23 of this Act. 

24 (e) AUTHORITY.—Notwithstanding any other provi25 sion of the law, the Director of the National Institutes 


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1 of Health may use funds available under subsection (b) 

2 to enter into transactions (other than contracts, coopera3 tive agreements, or grants) to carry out research identified 

4 pursuant to the Opioids and STOP Pain Initiative estab5 lished under subsection (a). 

6 (f) REPORTS.— 

7 (1) ANNUAL REPORTS.—Not later than October 

8 1 of each of fiscal years 2019 through 2026, the Di9 rector of the National Institutes of Health shall sub10 mit to the Committee on Health, Education, Labor, 

11 and Pensions and the Committee on Appropriations 

12 of the Senate and the Committee on Energy and 

13 Commerce and the Committee on Appropriations of 

14 the House of Representatives, a report that in15 cludes— 

16 (A) the amount obligated or expended in 

17 the fiscal year prior to the fiscal year in which 

18 the report is being submitted for each program 

19 or activity described in this section (or an 

20 amendment made by this section); 

21 (B) a description of all such programs or 

22 activities carried out using funds provided 

23 under this section (or amendments); and 

24 (C) a description of how such programs or 

25 activities are advancing public health, including 


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1 the impact on treating pain and addressing 

2 opioid misuse in the United States. 

3 (2) ADDITIONAL REPORTS.—At the request of 

4 the Committee on Health, Education, Labor, and 

5 Pensions or the Committee on Appropriations of the 

6 Senate, or the Committee on Energy and Commerce 

7 or the Committee on Appropriations of the House of 

8 Representatives, the Director of the National Insti9 tutes of Health shall provide to the relevant com10 mittee an update in the form of testimony and addi11 tional reports concerning the allocation of funding 

12 under this section (or the amendments made by this 

13 section) or the description of the programs and ac14 tivities carried out with such funding. 

15 SEC. 4. VETERAN OVER-MEDICATION PREVENTION. 

16 (a) REVIEW REQUIRED.— 

17 (1) IN GENERAL.—Not later than 90 days after 

18 the date of the enactment of this Act, the Secretary 

19 of Veterans Affairs shall seek to enter into an agree20 ment with the National Academies of Sciences, En21 gineering, and Medicine under which the National 

22 Academies shall conduct a review of the deaths of all 

23 covered veterans who died by suicide during the five24 year period ending on the date of the enactment of 

25 this Act, regardless of whether information relating 


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1 to such deaths has been reported by the Centers for 

2 Disease Control and Prevention. 

3 (2) ELEMENTS.—The review required by para4 graph (1) shall include the following: 

5 (A) The total number of covered veterans 

6 who died by suicide during the five-year period 

7 ending on the date of the enactment of this Act. 

8 (B) The total number of covered veterans 

9 who died by a violent death during such five10 year period. 

11 (C) The total number of covered veterans 

12 who died by an accidental death during such 

13 five-year period. 

14 (D) A description of each covered veteran 

15 described in subparagraphs (A) through (C), in16 cluding age, gender, race, and ethnicity. 

17 (E) A comprehensive list of prescribed 

18 medications and legal or illegal substances as 

19 annotated on toxicology reports of covered vet20 erans described in subparagraphs (A) through 

21 (C), specifically listing any medications that 

22 carried a black box warning, were prescribed for 

23 off-label use, were psychotropic, or carried 

24 warnings that included suicidal ideation. 


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1 (F) A summary of medical diagnoses by 

2 physicians of the Department of Veterans Af3 fairs or physicians providing services to covered 

4 veterans through programs of the Department 

5 that led to the prescribing of medications re6 ferred to in subparagraph (E) in cases of post7 traumatic stress disorder, traumatic brain in8 jury, military sexual trauma, and other anxiety 

9 and depressive disorders. 

10 (G) The number of instances in which a 

11 covered veteran described in subparagraph (A), 

12 (B), or (C) was concurrently on multiple medi13 cations prescribed by physicians of the Depart14 ment or physicians providing services to vet15 erans through programs of the Department to 

16 treat post-traumatic stress disorder, traumatic 

17 brain injury, military sexual trauma, other anx18 iety and depressive disorders, or instances of 

19 comorbidity. 

20 (H) The number of covered veterans de21 scribed in subparagraphs (A) through (C) who 

22 were not taking any medication prescribed by a 

23 physician of the Department or a physician pro24 viding services to veterans through a program 

25 of the Department. 


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1 (I) With respect to the treatment of post2 traumatic stress disorder, traumatic brain in3 jury, military sexual trauma, or other anxiety 

4 and depressive disorders, the percentage of cov5 ered veterans described in subparagraphs (A) 

6 through (C) who received a non-medication 

7 first-line treatment compared to the percentage 

8 of such veterans who received medication only. 

9 (J) With respect to the treatment of cov10 ered veterans described in subparagraphs (A) 

11 through (C) for post-traumatic stress disorder, 

12 traumatic brain injury, military sexual trauma, 

13 or other anxiety and depressive disorders, the 

14 number of instances in which a non-medication 

15 first-line treatment (such as cognitive behav16 ioral therapy) was attempted and determined to 

17 be ineffective for such a veteran, which subse18 quently led to the prescribing of a medication 

19 referred to in subparagraph (E). 

20 (K) A description and example of how the 

21 Department determines and continually updates 

22 the clinical practice guidelines governing the 

23 prescribing of medications. 

24 (L) An analysis of the use by the Depart25 ment, including protocols or practices at medVerDate Sep 11 2014 03:13 Apr 20, 2018 Jkt 079200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H5531.IH H5531

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1 ical facilities of the Department, of systemati2 cally measuring pain scores during clinical en3 counters under the Pain as the 5th Vital Sign 

4 Toolkit of the Department and an evaluation of 

5 the relationship between the use of such meas6 urements and the number of veterans concur7 rently on multiple medications prescribed by 

8 physicians of the Department. 

9 (M) A description of the efforts of the De10 partment to maintain appropriate staffing levels 

11 for mental health professionals, such as mental 

12 health counselors, marriage and family thera13 pists, and other appropriate counselors, includ14 ing— 

15 (i) a description of any impediments 

16 to carry out the education, training, and 

17 hiring of mental health counselors and 

18 marriage and family therapists under sec19 tion 7302(a) of title 38, United States 

20 Code, and strategies for addressing those 

21 impediments; 

22 (ii) a description of the objectives, 

23 goals, and timing of the Department with 

24 respect to increasing the representation of 

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1 havioral health workforce of the Depart2 ment, including— 

3 (I) a review of eligibility criteria 

4 for such counselors and therapists and 

5 a comparison of such criteria to that 

6 of other behavioral health professions 

7 in the Department; and 

8 (II) an assessment of the partici9 pation of such counselors and thera10 pists in the mental health profes11 sionals trainee program of the De12 partment and any impediments to 

13 such participation; 

14 (iii) an assessment of the development 

15 by the Department of hiring guidelines for 

16 mental health counselors, marriage and 

17 family therapists, and other appropriate 

18 counselors; 

19 (iv) a description of how the Depart20 ment— 

21 (I) identifies gaps in the supply 

22 of mental health professionals; and 

23 (II) determines successful staff24 ing ratios for mental health profes25 sionals of the Department; 


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1 (v) a description of actions taken by 

2 the Secretary, in consultation with the Di3 rector of the Office of Personnel Manage4 ment, to create an occupational series for 

5 mental health counselors and marriage and 

6 family therapists of the Department and a 

7 timeline for the creation of such an occu8 pational series; and 

9 (vi) a description of actions taken by 

10 the Secretary to ensure that the national, 

11 regional, and local professional standards 

12 boards for mental health counselors and 

13 marriage and family therapists are com14 prised of only mental health counselors and 

15 marriage and family therapists and that 

16 the liaison from the Department to such 

17 boards is a mental health counselor or 

18 marriage and family therapist. 

19 (N) The percentage of covered veterans de20 scribed in subparagraphs (A) through (C) with 

21 combat experience or trauma related to combat 

22 experience (including military sexual trauma, 

23 traumatic brain injury, and post-traumatic 

24 stress). 


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1 (O) An identification of the medical facili2 ties of the Department with markedly high pre3 scription rates and suicide rates for veterans re4 ceiving treatment at those facilities. 

5 (P) An analysis, by State, of programs of 

6 the Department that collaborate with State 

7 Medicaid agencies and the Centers for Medicare 

8 and Medicaid Services, including the following: 

9 (i) An analysis of the sharing of pre10 scription and behavioral health data for 

11 veterans. 

12 (ii) An analysis of whether Depart13 ment staff check with State prescription 

14 drug monitoring programs before pre15 scribing medications to veterans. 

16 (iii) A description of the procedures of 

17 the Department for coordinating with pre18 scribers outside of the Department to en19 sure that veterans are not overprescribed. 

20 (iv) A description of actions that the 

21 Department takes when a veteran is deter22 mined to be overprescribed. 

23 (Q) An analysis of the collaboration of 

24 medical centers of the Department with medical 


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1 examiners’ offices or local jurisdictions to deter2 mine veteran mortality and cause of death. 

3 (R) An identification and determination of 

4 a best practice model to collect and share vet5 eran death certificate data between the Depart6 ment of Veterans Affairs, the Department of 

7 Defense, States, and tribal entities. 

8 (S) A description of how data relating to 

9 death certificates of veterans is collected, deter10 mined, and reported by the Department of Vet11 erans Affairs. 

12 (T) An assessment of any patterns appar13 ent to the National Academies of Sciences, En14 gineering, and Medicine based on the review 

15 conducted under paragraph (1). 

16 (U) Such recommendations for further ac17 tion that would improve the safety and well18 being of veterans as the National Academies of 

19 Sciences, Engineering, and Medicine determine 

20 appropriate. 

21 (3) COMPILATION OF DATA.— 

22 (A) FORM OF COMPILATION.—The Sec23 retary of Veterans Affairs shall ensure that 

24 data compiled under paragraph (2) is compiled 

25 in a manner that allows it to be analyzed across 


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1 all data fields for purposes of informing and 

2 updating clinical practice guidelines of the De3 partment of Veterans Affairs. 

4 (B) COMPILATION OF DATA REGARDING

5 COVERED VETERANS.—In compiling data under 

6 paragraph (2) regarding covered veterans de7 scribed in subparagraphs (A) through (C) of 

8 such paragraph, data regarding veterans de9 scribed in each such subparagraph shall be 

10 compiled separately and disaggregated by year. 

11 (4) COMPLETION OF REVIEW AND REPORT.— 

12 The agreement entered into under paragraph (1) 

13 shall require that the National Academies of 

14 Sciences, Engineering, and Medicine complete the 

15 review under such paragraph and submit to the Sec16 retary of Veterans Affairs a report containing the 

17 results of the review not later than 180 days after 

18 entering into the agreement. 

19 (b) REPORT.—Not later than 30 days after the com20 pletion by the National Academies of Sciences, Engineer21 ing, and Medicine of the review required under subsection 

22 (a), the Secretary of Veterans Affairs shall— 

23 (1) submit to the Committee on Veterans’ Af24 fairs of the Senate and the Committee on Veterans’ 


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1 Affairs of the House of Representatives a report on 

2 the results of the review; and 

3 (2) make such report publicly available. 

4 (c) DEFINITIONS.—In this section: 

5 (1) The term ‘‘black box warning’’ means a 

6 warning displayed on the label of a prescription drug 

7 that is designed to call attention to the serious or 

8 life-threatening risk of the prescription drug. 

9 (2) The term ‘‘covered veteran’’ means a vet10 eran who received hospital care or medical services 

11 furnished by the Department of Veterans Affairs 

12 during the five-year period preceding the death of 

13 the veteran. 

14 (3) The term ‘‘first-line treatment’’ means a po15 tential intervention that has been evaluated and as16 signed a high score within clinical practice guide17 lines. 

18 (4) The term ‘‘State’’ means each of the States, 

19 territories, and possessions of the United States, the 

20 District of Columbia, and the Commonwealth of 

21 Puerto Rico. 


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1 SEC. 5. AMENDMENT RELATING TO THE ACCOUNT FOR THE 

2 STATE RESPONSE TO THE OPIOID ABUSE CRI3 SIS. 

4 Section 1003 of the 21st Century Cures Act (Public 

5 Law 114–255; 42 U.S.C. 290ee–3 note) is amended in 

6 subsection (b)(3), by adding at the end the following new 

7 subparagraph: 

8 ‘‘(C) APPROPRIATIONS AFTER FISCAL

9 YEAR 2018.—There is authorized to be appro10 priated, and there is appropriated, out of any 

11 monies in the Treasury not otherwise appro12 priated, to the Account For the State Response 

13 to the Opioid Abuse Crisis $500,000,000 for 

14 each of fiscal years 2019 through 2023.’’. 

15 SEC. 6. MENTAL HEALTH ACCESS IMPROVEMENT. 

16 (a) COVERAGE OF SERVICES.— 

17 (1) IN GENERAL.—Section 1861(s)(2) of the 

18 Social Security Act (42 U.S.C. 1395x(s)(2)) is 

19 amended— 

20 (A) in subparagraph (FF), by striking 

21 ‘‘and’’ after the semicolon at the end; 

22 (B) in subparagraph (GG), by inserting 

23 ‘‘and’’ after the semicolon at the end; and 

24 (C) by adding at the end the following new 

25 subparagraph: 


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1 ‘‘(HH) marriage and family therapist services 

2 (as defined in subsection (jjj)(1)) and mental health 

3 counselor services (as defined in subsection 

4 (jjj)(3));’’. 

5 (2) DEFINITIONS.—Section 1861 of the Social 

6 Security Act (42 U.S.C. 1395x) is amended by add7 ing at the end the following new subsection: 

8 ‘‘Marriage and Family Therapist Services; Marriage and 

9 Family Therapist; Mental Health Counselor Serv10 ices; Mental Health Counselor 

11 ‘‘(jjj)(1) The term ‘marriage and family therapist 

12 services’ means services performed by a marriage and 

13 family therapist (as defined in paragraph (2)) for the diag14 nosis and treatment of mental illnesses, which the mar15 riage and family therapist is legally authorized to perform 

16 under State law (or the State regulatory mechanism pro17 vided by State law) of the State in which such services 

18 are performed, as would otherwise be covered if furnished 

19 by a physician or as an incident to a physician’s profes20 sional service, but only if no facility or other provider 

21 charges or is paid any amounts with respect to the fur22 nishing of such services. 

23 ‘‘(2) The term ‘marriage and family therapist’ means 

24 an individual who— 


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1 ‘‘(A) possesses a master’s or doctoral degree 

2 which qualifies for licensure or certification as a 

3 marriage and family therapist pursuant to State 

4 law; 

5 ‘‘(B) after obtaining such degree has performed 

6 at least 2 years of clinical supervised experience in 

7 marriage and family therapy; and 

8 ‘‘(C) in the case of an individual performing 

9 services in a State that provides for licensure or cer10 tification of marriage and family therapists, is li11 censed or certified as a marriage and family thera12 pist in such State. 

13 ‘‘(3) The term ‘mental health counselor services’ 

14 means services performed by a mental health counselor (as 

15 defined in paragraph (4)) for the diagnosis and treatment 

16 of mental illnesses which the mental health counselor is 

17 legally authorized to perform under State law (or the 

18 State regulatory mechanism provided by the State law) of 

19 the State in which such services are performed, as would 

20 otherwise be covered if furnished by a physician or as inci21 dent to a physician’s professional service, but only if no 

22 facility or other provider charges or is paid any amounts 

23 with respect to the furnishing of such services. 

24 ‘‘(4) The term ‘mental health counselor’ means an 

25 individual who— 


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1 ‘‘(A) possesses a master’s or doctor’s degree in 

2 mental health counseling or a related field; 

3 ‘‘(B) after obtaining such a degree has per4 formed at least 2 years of supervised mental health 

5 counselor practice; and 

6 ‘‘(C) in the case of an individual performing 

7 services in a State that provides for licensure or cer8 tification of mental health counselors or professional 

9 counselors, is licensed or certified as a mental health 

10 counselor or professional counselor in such State.’’. 

11 (3) PROVISION FOR PAYMENT UNDER PART

12 B.—Section 1832(a)(2)(B) of the Social Security 

13 Act (42 U.S.C. 1395k(a)(2)(B)) is amended by add14 ing at the end the following new clause: 

15 ‘‘(v) marriage and family therapist 

16 services (as defined in section 1861(jjj)(1)) 

17 and mental health counselor services (as 

18 defined in section 1861(jjj)(3));’’. 

19 (4) AMOUNT OF PAYMENT.—Section 1833(a)(1) 

20 of the Social Security Act (42 U.S.C. 1395l(a)(1)) 

21 is amended— 

22 (A) by striking ‘‘and (BB)’’ and inserting 

23 ‘‘(BB)’’; and 

24 (B) by inserting before the semicolon at 

25 the end the following: ‘‘, and (CC) with respect 


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1 to marriage and family therapist services and 

2 mental health counselor services under section 

3 1861(s)(2)(HH), the amounts paid shall be 80 

4 percent of the lesser of the actual charge for 

5 the services or 75 percent of the amount deter6 mined for payment of a psychologist under sub7 paragraph (L)’’. 

8 (5) EXCLUSION OF MARRIAGE AND FAMILY

9 THERAPIST SERVICES AND MENTAL HEALTH COUN10 SELOR SERVICES FROM SKILLED NURSING FACILITY

11 PROSPECTIVE PAYMENT SYSTEM.—Section 

12 1888(e)(2)(A)(ii) of the Social Security Act (42 

13 U.S.C. 1395yy(e)(2)(A)(ii)) is amended by inserting 

14 ‘‘marriage and family therapist services (as defined 

15 in section 1861(jjj)(1)), mental health counselor 

16 services (as defined in section 1861(jjj)(3)),’’ after 

17 ‘‘qualified psychologist services,’’. 

18 (6) INCLUSION OF MARRIAGE AND FAMILY

19 THERAPISTS AND MENTAL HEALTH COUNSELORS AS

20 PRACTITIONERS FOR ASSIGNMENT OF CLAIMS.—Sec21 tion 1842(b)(18)(C) of the Social Security Act (42 

22 U.S.C. 1395u(b)(18)(C)) is amended by adding at 

23 the end the following new clauses: 

24 ‘‘(vii) A marriage and family therapist (as de25 fined in section 1861(jjj)(2)). 


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1 ‘‘(viii) A mental health counselor (as defined in 

2 section 1861(jjj)(4)).’’. 

3 (b) COVERAGE OF CERTAIN MENTAL HEALTH SERV4 ICES PROVIDED IN CERTAIN SETTINGS.— 

5 (1) RURAL HEALTH CLINICS AND FEDERALLY

6 QUALIFIED HEALTH CENTERS.—Section 

7 1861(aa)(1)(B) of the Social Security Act (42 

8 U.S.C. 1395x(aa)(1)(B)) is amended by striking ‘‘or 

9 by a clinical social worker (as defined in subsection 

10 (hh)(1))’’ and inserting ‘‘, by a clinical social worker 

11 (as defined in subsection (hh)(1)), by a marriage 

12 and family therapist (as defined in subsection 

13 (jjj)(2)), or by a mental health counselor (as defined 

14 in subsection (jjj)(4))’’. 

15 (2) HOSPICE PROGRAMS.—Section 

16 1861(dd)(2)(B)(i)(III) of the Social Security Act (42 

17 U.S.C. 1395x(dd)(2)(B)(i)(III)) is amended by in18 serting ‘‘, marriage and family therapist, or mental 

19 health counselor’’ after ‘‘social worker’’. 

20 (c) AUTHORIZATION OF MARRIAGE AND FAMILY

21 THERAPISTS AND MENTAL HEALTH COUNSELORS TO

22 DEVELOP DISCHARGE PLANS FOR POST-HOSPITAL SERV23 ICES.—Section 1861(ee)(2)(G) of the Social Security Act 

24 (42 U.S.C. 1395x(ee)(2)(G)) is amended by inserting ‘‘, 

25 including a marriage and family therapist and a mental 


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1 health counselor who meets qualification standards estab2 lished by the Secretary’’ before the period at the end. 

3 (d) EFFECTIVE DATE.—The amendments made by 

4 this section shall apply with respect to services furnished 

5 on or after January 1, 2019. 

6 SEC. 7. SYNTHETICS TRAFFICKING AND OVERDOSE PRE7 VENTION. 

8 (a) FORMAL ENTRY REQUIREMENTS—POSTAL

9 SERVICE AS CONSIGNEE.—Subparagraph (B) of section 

10 484(a)(2) of the Tariff Act of 1930 (19 U.S.C. 

11 1484(a)(2)(B)) is amended to read as follows: 

12 ‘‘(B)(i) When an entry of merchandise is made 

13 under this section, the required documentation or in14 formation shall be filed or electronically trans15 mitted— 

16 ‘‘(I) by the owner or purchaser of the mer17 chandise; or 

18 ‘‘(II) when appropriately designated by the 

19 owner, purchaser, or consignee of the merchan20 dise, by a person holding a valid license under 

21 section 641. 

22 ‘‘(ii) The Postmaster General shall be deemed 

23 the consignee for merchandise, as defined by section 

24 498(c), imported through the mail, and the Post25 master General shall, at the Postmaster General’s 


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1 sole expense, designate a person holding a valid li2 cense under section 641 to file the required docu3 mentation or information or ensure that the owner 

4 or purchaser of the merchandise or a person holding 

5 a valid license under section 641 that is designated 

6 by the owner or purchaser files the required docu7 mentation or information. 

8 ‘‘(iii) When a consignee declares on entry that 

9 he or she is the owner or purchaser of merchandise, 

10 U.S. Customs and Border Protection may, without 

11 liability, accept the declaration. 

12 ‘‘(iv) For the purposes of this Act, the importer 

13 of record must be one of the parties who is eligible 

14 to file the documentation or information required by 

15 this section.’’. 

16 (b) INFORMAL ENTRIES.—Section 498 of the Tariff 

17 Act of 1930 (19 U.S.C. 1498) is amended by adding at 

18 the end the following: 

19 ‘‘(c) APPLICATION TO POSTAL SHIPMENTS.— 

20 ‘‘(1) DEFINITIONS.—In this subsection: 

21 ‘‘(A) DOCUMENT.—The term ‘document’ 

22 means a piece of written, drawn, printed, or 

23 digital information, excluding objects of mer24 chandise, that— 


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1 ‘‘(i) is conveyed in an envelope that is 

2 less than or equal to 165 millimeters in 

3 width, 245 millimeters in length, and 5 

4 millimeters in depth; and 

5 ‘‘(ii) weighs 100 grams or less when 

6 conveyed. 

7 ‘‘(B) MERCHANDISE.—The term ‘merchan8 dise’ has the same meaning as that term is de9 fined in section 401 but does not include a doc10 ument. 

11 ‘‘(2) REQUIREMENT.—Notwithstanding any 

12 other provision of law, for merchandise meeting the 

13 requirements of subsection (a), the Postmaster Gen14 eral shall comply with the entry requirements of sec15 tion 484. 

16 ‘‘(3) REGULATIONS.—Any regulation issued 

17 pursuant to this subsection shall apply identical 

18 entry procedures for merchandise imported through 

19 the mail as are applied for merchandise imported via 

20 a private carrier.’’. 

21 (c) DE MINIMIS SHIPMENTS.—Section 321 of the 

22 Tariff Act of 1930 (19 U.S.C. 1321) is amended by add23 ing at the end the following: 

24 ‘‘(c)(1) For imported articles that qualify for the ad25 ministrative exemption under subsection (a)(2) and that 


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1 arrive at international mail facilities in the United States, 

2 the Postmaster General shall be deemed the consignee for 

3 such articles that are considered merchandise, as the term 

4 is defined in section 498(c). 

5 ‘‘(2) In addition to the parties that are authorized 

6 to comply with the entry requirements of sections 498 and 

7 484, the Postmaster General, as a consignee, may, using 

8 reasonable care, enter such merchandise that qualifies for 

9 the administrative exemption under subsection (a)(2).’’. 

10 (d) CUSTOMS FEES.— 

11 (1) IN GENERAL.—Paragraph (6) of section 

12 13031(a) of the Consolidated Omnibus Budget Rec13 onciliation Act of 1985 (19 U.S.C. 58c(a)(6)) is 

14 amended to read as follows: 

15 ‘‘(6)(A) For the arrival of shipments of mer16 chandise (as the term is defined in section 498(c) of 

17 the Trade Act of 1930) or any other item that is 

18 valued at $2,000 or less (or such higher amount as 

19 the Secretary of the Treasury may set by regulation 

20 pursuant to section 498 of the Tariff Act of 1930 

21 (19 U.S.C. 1498) and subject to adjustment under 

22 subsection (l)) arriving at an international mail facil23 ity: 


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1 ‘‘(i) $1 per individual airway bill or bill of 

2 lading (subject to adjustment under subsection 

3 (l)); or 

4 ‘‘(ii) if such merchandise is formally en5 tered, the fee provided for in paragraph (9), if 

6 applicable. 

7 ‘‘(B) Notwithstanding section 451 of the Tariff 

8 Act of 1930 (19 U.S.C. 1451), the payment required 

9 by subparagraph (A) shall be the only payment re10 quired for reimbursement of U.S. Customs and Bor11 der Protection in connection with the processing of 

12 an individual airway bill or bill of lading in accord13 ance with such subparagraph and for providing serv14 ices at international mail facilities, except that U.S. 

15 Customs and Border Protection may require such 

16 facilities to cover expenses of the agency for ade17 quate office space, equipment, furnishings, supplies, 

18 and security. 

19 ‘‘(C) The payment required by subparagraphs 

20 (A) and (B) shall be paid on a quarterly basis by the 

21 Postmaster General in accordance with regulations 

22 prescribed by the Secretary of the Treasury. The 

23 payments shall be allocated as follows: 

24 ‘‘(i) 50 percent of the amount of payments 

25 received in this paragraph shall, in accordance 


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1 with section 524 of the Tariff Act of 1930 (19 

2 U.S.C. 1524), be deposited in the Customs 

3 User Fee Account and shall be used to directly 

4 reimburse each appropriation for the amount 

5 paid out of that appropriation for the costs in6 curred in providing services to international 

7 mail facilities. Amounts deposited in accordance 

8 with the preceding sentence shall be available 

9 until expended for the provision of customs 

10 services to international mail facilities. 

11 ‘‘(ii) Notwithstanding section 524 of the 

12 Tariff Act of 1930 (19 U.S.C. 1524), 50 per13 cent of the amount of payments received under 

14 this paragraph shall be paid to the Secretary of 

15 the Treasury, which is in lieu of the payment 

16 of fees under paragraph (10).’’. 

17 (2) TECHNICAL AMENDMENTS.—Paragraph 

18 (10) of section 13031(a) of the Consolidated Omni19 bus Budget Reconciliation Act of 1985 (19 U.S.C. 

20 58c(a)(10)) is amended— 

21 (A) by striking ‘‘or’’ in subparagraph (B); 

22 (B) by striking the period at the end of 

23 subparagraph (C)(iii) and inserting a comma 

24 and ‘‘or’’; 


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1 (C) by inserting after subparagraph 

2 (C)(iii) the following: 

3 ‘‘(D) an international mail facility.’’; and 

4 (D) in the undesignated material at the 

5 end by striking the period and inserting ‘‘or re6 ferred to in subparagraph (D) see paragraph 

7 (6).’’. 

8 (e) MANDATORY ADVANCED ELECTRONIC INFORMA9 TION FOR POSTAL SHIPMENTS.—Subparagraph (K) of 

10 section 343(a)(3) of the Trade Act of 2002 (Public Law 

11 107–210; 19 U.S.C. 2071 note) is amended to read as 

12 follows: 

13 ‘‘(K) The Secretary shall require the Post14 master General to transmit or to ensure the 

15 transmission of the information required in 

16 paragraphs (1) and (2) to U.S. Customs and 

17 Border Protection for all shipments by the 

18 United States Postal Service which includes 

19 shipments that the United States Postal Service 

20 receives from foreign postal operators (ship21 ments from foreign postal operators may be 

22 transported by private carriers). All regulations 

23 issued pursuant to this provision are required 

24 to impose the same information requirements 


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1 on the United States Postal Service and private 

2 carriers.’’. 

3 (f) MANIFEST PENALTIES APPLIED TO THE UNITED

4 STATES POSTAL SERVICE.— 

5 (1) PENALTIES FOR VIOLATIONS OF THE AR6 RIVAL, REPORTING, ENTRY, AND CLEARANCE RE7 QUIREMENTS.—Section 436 of the Tariff Act of 

8 1930 (19 U.S.C. 1436) is amended by adding at the 

9 end the following new subsection: 

10 ‘‘(e) CIVIL PENALTIES ARISING FROM VIOLATIONS

11 FOR POSTAL SHIPMENTS.—With respect to civil penalties 

12 provided for in subsections (b) and (d), the Postmaster 

13 General shall be liable for the penalty if the violation was 

14 caused by a foreign postal operator or the United States 

15 Postal Service.’’. 

16 (2) PENALTIES FOR FALSITY OR LACK OF

17 MANIFEST.—Section 584 of the Tariff Act of 1930 

18 (19 U.S.C. 1584) is amended by adding at the end 

19 the following new subsection: 

20 ‘‘(c) PERSON DIRECTLY OR INDIRECTLY RESPON21 SIBLE SHALL INCLUDE THE POSTMASTER GENERAL.— 

22 For purposes of subsection (a), the Postmaster General 

23 may be the person directly or indirectly responsible for a 

24 discrepancy if the discrepancy is the result of— 


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1 ‘‘(1) an omission by a foreign postal operator or 

2 the United States Postal Service; or 

3 ‘‘(2) false information regarding the shipment 

4 that was provided to the carrier by a foreign postal 

5 operator or the United States Postal Service.’’. 

6 (g) LIMITATION ON INTERNATIONAL POSTAL AR7 RANGEMENTS.— 

8 (1) EXISTING AGREEMENTS.— 

9 (A) IN GENERAL.—In the event that any 

10 provision in this section is found to be in viola11 tion of obligations of the United States under 

12 the Universal Postal Union, the Secretary of 

13 State shall negotiate to amend the relevant pro14 visions of the agreement so that the United 

15 States is no longer in violation of the agree16 ment. 

17 (B) CONSTRUCTION.—Nothing in this sub18 section may be construed to require or permit 

19 any delay in the implementation of this section. 

20 (2) FUTURE AGREEMENTS.—The Secretary of 

21 State may not conclude any international postal ar22 rangement pursuant to the authority set out in sec23 tion 407 of title 39, United States Code, that is in24 consistent with this section or any amendment made 

25 by this section. 


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1 (h) APPLICATION OF OTHER CUSTOMS LAWS.— 

2 (1) IN GENERAL.—U.S. Customs and Border 

3 Protection shall ensure that all merchandise, as that 

4 term is defined in subsection (c) of section 498 of 

5 the Tariff Act of 1930 (19 U.S.C. 1498), imported 

6 to the United States through the mail shall be sub7 ject to the same import procedures, legal restric8 tions, and certifications as merchandise imported by 

9 private carriers. 

10 (2) REGULATIONS.—The Secretary of the 

11 Treasury shall issue regulations pursuant to this 

12 section to ensure that merchandise imported through 

13 the mail is in accordance with Federal law. 

14 (i) COST RECOUPMENT.—The Postmaster General 

15 shall ensure that all costs associated with complying with 

16 this section, as well as all penalties assessed against the 

17 Postmaster General, are charged directly to foreign ship18 pers, foreign postal operators, or United States ultimate 

19 consignees. 

20 (j) EFFECTIVE DATE; REGULATIONS.— 

21 (1) EFFECTIVE DATE.—This section shall be22 come effective upon the date of the enactment of 

23 this Act. 

24 (2) REGULATIONS.—Not later than 1 year after 

25 the date of the enactment of this Act, the Secretary 


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1 shall prescribe all regulations required under this 

2 section. 

3 SEC. 8. STOP THE IMPORTATION AND TRAFFICKING OF 

4 SYNTHETIC ANALOGUES. 

5 (a) ESTABLISHMENT OF SCHEDULE A.—Section 202 

6 of the Controlled Substances Act (21 U.S.C. 812) is 

7 amended— 

8 (1) in subsection (a), by striking ‘‘five schedules 

9 of controlled substances, to be known as schedules I, 

10 II, III, IV, and V’’ and inserting ‘‘six schedules of 

11 controlled substances, to be known as schedules I, 

12 II, III, IV, V, and A’’; 

13 (2) in subsection (b), by adding at the end the 

14 following: 

15 ‘‘(6) SCHEDULE A.— 

16 ‘‘(A) IN GENERAL.—The drug or substance— 

17 ‘‘(i) has— 

18 ‘‘(I) a chemical structure that is sub19 stantially similar to the chemical structure 

20 of a controlled substance in schedule I, II, 

21 III, IV, or V; and 

22 ‘‘(II) an actual or predicted stimulant, 

23 depressant, or hallucinogenic effect on the 

24 central nervous system that is substantially 

25 similar to or greater than the stimulant, 


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1 depressant, or hallucinogenic effect on the 

2 central nervous system of a controlled sub3 stance in schedule I, II, III, IV, or V; and 

4 ‘‘(ii) is not— 

5 ‘‘(I) listed or otherwise included in 

6 any other schedule in this section or by 

7 regulation of the Attorney General; and 

8 ‘‘(II) with respect to a particular per9 son, subject to an exemption that is in ef10 fect for investigational use, for that person, 

11 under section 505 of the Federal Food, 

12 Drug, and Cosmetic Act (21 U.S.C. 355) 

13 to the extent conduct with respect to such 

14 substance is pursuant to such exemption. 

15 ‘‘(B) PREDICTED STIMULANT, DEPRESSANT, OR

16 HALLUCINOGENIC EFFECT.—For purpose of this 

17 paragraph, a predicted stimulant, depressant, or hal18 lucinogenic effect on the central nervous system may 

19 be based on— 

20 ‘‘(i) the chemical structure, structure activ21 ity relationships, binding receptor assays, or 

22 other relevant scientific information about the 

23 substance; 

24 ‘‘(ii)(I) the current or relative potential for 

25 abuse of the substance; and 


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1 ‘‘(II) the clandestine importation, manu2 facture, or distribution, or diversion from legiti3 mate channels, of the substance; or 

4 ‘‘(iii) the capacity of the substance to 

5 cause a state of dependence, including physical 

6 or psychological dependence that is similar to or 

7 greater than that of a controlled substance in 

8 schedule I, II, III, IV, or V.’’; and 

9 (3) in subsection (c)— 

10 (A) in the matter preceding schedule I, by 

11 striking ‘‘IV, and V’’ and inserting ‘‘IV, V, and 

12 A’’; and 

13 (B) by adding at the end the following: 

14 ‘‘SCHEDULE A

15 ‘‘(a) Unless specifically excepted or unless listed in 

16 another schedule, any of the following substances, as 

17 scheduled in accordance with section 201(k)(5): 

18 ‘‘(1) 4-fluoroisobutyryl fentanyl. 

19 ‘‘(2) Valeryl fentanyl. 

20 ‘‘(3) 4-methoxybutyryl fentanyl. 

21 ‘‘(4) 4-methylphenethyl acetyl fentanyl. 

22 ‘‘(5) 3-furanyl fentanyl. 

23 ‘‘(6) Ortho-fluorofentanyl. 

24 ‘‘(7) Tetrahydrofuranyl fentanyl. 

25 ‘‘(8) Ocfentanil. 

26 ‘‘(9) 4-fluorobutyryl fentanyl. 


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1 ‘‘(10) Methoxyacetyl fentanyl. 

2 ‘‘(11) Meta-fluorofentanyl. 

3 ‘‘(12) Isobutyryl fentanyl. 

4 ‘‘(13) Acryl fentanyl.’’. 

5 (b) TEMPORARY AND PERMANENT SCHEDULING OF

6 SCHEDULE A SUBSTANCES.—Section 201 of the Con7 trolled Substances Act (21 U.S.C. 811) is amended by 

8 adding at the end the following: 

9 ‘‘(k) TEMPORARY AND PERMANENT SCHEDULING OF

10 SCHEDULE A SUBSTANCES.— 

11 ‘‘(1) The Attorney General may issue a tem12 porary order adding a drug or substance to schedule 

13 A if the Attorney General finds that— 

14 ‘‘(A) the drug or other substance satisfies 

15 the criteria for being considered a schedule A 

16 substance; and 

17 ‘‘(B) adding such drug or substance to 

18 schedule A will assist in preventing abuse or 

19 misuse of the drug or other substance. 

20 ‘‘(2) A temporary scheduling order issued under 

21 paragraph (1) shall not take effect until 30 days 

22 after the date of the publication by the Attorney 

23 General of a notice in the Federal Register of the in24 tention to issue such order and the grounds upon 

25 which such order is to be issued. The temporary 


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1 scheduling order shall expire not later than 5 years 

2 after the date it becomes effective, except that the 

3 Attorney General may, during the pendency of pro4 ceedings under paragraph (5), extend the temporary 

5 scheduling order for up to 180 days. 

6 ‘‘(3) A temporary scheduling order issued under 

7 paragraph (1) shall be vacated upon the issuance of 

8 a permanent order issued under paragraph (5) with 

9 regard to the same substance, or upon the subse10 quent issuance of any scheduling order under this 

11 section. 

12 ‘‘(4) A temporary scheduling order issued under 

13 paragraph (1) shall not be subject to judicial review. 

14 ‘‘(5) The Attorney General may, by rule, issue 

15 a permanent order adding a drug or other substance 

16 to schedule A if such drug or substance satisfies the 

17 criteria for being considered a schedule A substance. 

18 Such rulemaking may be commenced simultaneously 

19 with the issuance of the temporary scheduling order 

20 issued under paragraph (1) with regard to the same 

21 substance. 

22 ‘‘(6) Before initiating proceedings under para23 graph (1) or (5), the Attorney General shall trans24 mit notice of an order proposed to be issued to the 

25 Secretary of Health and Human Services. In issuing 


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1 an order under paragraph (1) or (5), the Attorney 

2 General shall take into consideration any comments 

3 submitted by the Secretary of Health and Human 

4 Services in response to a notice transmitted pursu5 ant to this paragraph. 

6 ‘‘(7) On the date of the publication of a notice 

7 in the Federal Register pursuant to paragraph (2), 

8 the Attorney General shall transmit the same notice 

9 to Congress. The temporary scheduling order shall 

10 take effect according to paragraph (2), except that 

11 the temporary scheduling order may be disapproved 

12 by Act of Congress within 180 days from the date 

13 of publication of the notice in the Federal Reg14 ister.’’. 

15 (c) PENALTIES.— 

16 (1) CONTROLLED SUBSTANCES ACT.—The Con17 trolled Substances Act (21 U.S.C. 801 et seq.) is 

18 amended— 

19 (A) in section 401(b)(1) (21 U.S.C. 

20 841(b)(1)), by adding at the end the following: 

21 ‘‘(F)(i) In the case of any controlled substance in 

22 schedule A, such person shall be sentenced to a term of 

23 imprisonment of not more than 10 years and if death or 

24 serious bodily injury results from the use of such sub25 stance shall be sentenced to a term of imprisonment of 


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1 not more than 15 years, a fine not to exceed the greater 

2 of that authorized in accordance with the provisions of 

3 title 18, United States Code, or $500,000 if the defendant 

4 is an individual or $2,500,000 if the defendant is other 

5 than an individual, or both. 

6 ‘‘(ii) If any person commits such a violation after a 

7 prior conviction for a felony drug offense has become final, 

8 such person shall be sentenced to a term of imprisonment 

9 of not more than 20 years and if death or serious bodily 

10 injury results from the use of such substance shall be sen11 tenced to a term of imprisonment of not more than 30 

12 years, a fine not to exceed the greater of twice that author13 ized in accordance with the provisions of title 18, United 

14 States Code, or $1,000,000 if the defendant is an indi15 vidual or $5,000,000 if the defendant is other than an in16 dividual, or both. 

17 ‘‘(iii) Any sentence imposing a term of imprisonment 

18 under this subparagraph shall, in the absence of such a 

19 prior conviction, impose a term of supervised release of 

20 not less than 2 years in addition to such term of imprison21 ment and shall, if there was such a prior conviction, im22 pose a term of supervised release of not less than 4 years 

23 in addition to such term of imprisonment.’’; 

24 (B) in section 403(a) (21 U.S.C. 

25 843(a))— 


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1 (i) in paragraph (8), by striking ‘‘or’’ 

2 at the end; 

3 (ii) in paragraph (9), by striking the 

4 period at the end and inserting ‘‘; or’’; and 

5 (iii) by inserting after paragraph (9) 

6 the following: 

7 ‘‘(10) to export a substance in violation of the 

8 controlled substance laws of the country to which 

9 the substance is exported.’’; and 

10 (C) in section 404 (21 U.S.C. 844), by in11 serting after subsection (a) the following: 

12 ‘‘(b) A person shall not be subject to a criminal or 

13 civil penalty under this title or under any other Federal 

14 law solely for possession of a schedule A controlled sub15 stance.’’. 

16 (2) CONTROLLED SUBSTANCES IMPORT AND

17 EXPORT ACT.—Section 1010(b) of the Controlled 

18 Substances Import and Export Act (21 U.S.C. 

19 960(b)) is amended by adding at the end the fol20 lowing: 

21 ‘‘(8) In the case of a violation under subsection (a) 

22 involving a controlled substance in schedule A, the person 

23 committing such violation shall be sentenced to a term of 

24 imprisonment of not more than 20 years and if death or 

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1 stance shall be sentenced to a term of imprisonment of 

2 not more than life, a fine not to exceed the greater of that 

3 authorized in accordance with the provisions of title 18, 

4 United States Code, or $1,000,000 if the defendant is an 

5 individual or $5,000,000 if the defendant is other than 

6 an individual, or both. If any person commits such a viola7 tion after a prior conviction for a felony drug offense has 

8 become final, such person shall be sentenced to a term 

9 of imprisonment of not more than 30 years and if death 

10 or serious bodily injury results from the use of such sub11 stance shall be sentenced to not more than life imprison12 ment, a fine not to exceed the greater of twice that author13 ized in accordance with the provisions of title 18, United 

14 States Code, or $2,000,000 if the defendant is an indi15 vidual or $10,000,000 if the defendant is other than an 

16 individual, or both. Notwithstanding section 3583 of title 

17 18, United States Code, any sentence imposing a term of 

18 imprisonment under this paragraph shall, in the absence 

19 of such a prior conviction, impose a term of supervised 

20 release of not less than 3 years in addition to such term 

21 of imprisonment and shall, if there was such a prior con22 viction, impose a term of supervised release of not less 

23 than 6 years in addition to such term of imprisonment. 

24 Notwithstanding the prior sentence, and notwithstanding 

25 any other provision of law, the court shall not place on 


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1 probation or suspend the sentence of any person sentenced 

2 under the provisions of this paragraph which provide for 

3 a mandatory term of imprisonment if death or serious 

4 bodily injury results.’’. 

5 (d) FALSE LABELING OF SCHEDULE A CONTROLLED

6 SUBSTANCES.— 

7 (1) IN GENERAL.—Section 305 of the Con8 trolled Substances Act (21 U.S.C. 825) is amended 

9 by adding at the end the following: 

10 ‘‘(f) FALSE LABELING OF SCHEDULE A CON11 TROLLED SUBSTANCES.— 

12 ‘‘(1) It shall be unlawful to import, export, 

13 manufacture, distribute, dispense, or possess with 

14 intent to manufacture, distribute, or dispense, a 

15 schedule A substance or product containing a sched16 ule A substance, unless the substance or product 

17 bears a label clearly identifying a schedule A sub18 stance or product containing a schedule A substance 

19 by the nomenclature used by the International 

20 Union of Pure and Applied Chemistry (IUPAC). 

21 ‘‘(2)(A) A product described in subparagraph 

22 (B) is exempt from the International Union of Pure 

23 and Applied Chemistry nomenclature requirement of 

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1 ner required under the Federal Food, Drug, and 

2 Cosmetic Act. 

3 ‘‘(B) A product is described in this subpara4 graph if the product— 

5 ‘‘(i) is the subject of an approved applica6 tion as described in section 505(b) or (j) of the 

7 Federal Food, Drug, and Cosmetic Act; or 

8 ‘‘(ii) is exempt from the provisions of sec9 tion 505 of such Act relating to new drugs be10 cause— 

11 ‘‘(I) it is intended solely for investiga12 tional use as described in section 505(i) of 

13 such Act; and 

14 ‘‘(II) such product is being used ex15 clusively for purposes of a clinical trial 

16 that is the subject of an effective investiga17 tional new drug application.’’. 

18 (2) PENALTIES.—Section 402 of the Controlled 

19 Substances Act (21 U.S.C. 842) is amended— 

20 (A) in subsection (a)(16), by inserting ‘‘or 

21 subsection (f)’’ after ‘‘subsection (e)’’; and 

22 (B) in subsection (c)(1)(D), by inserting 

23 ‘‘or a schedule A substance’’ after ‘‘anabolic 

24 steroid’’. 


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1 (e) REGISTRATION REQUIREMENTS FOR HANDLERS

2 OF SCHEDULE A SUBSTANCES.— 

3 (1) CONTROLLED SUBSTANCES ACT.—Section 

4 303 of the Controlled Substances Act (21 U.S.C. 

5 823) is amended by adding at the end the following: 

6 ‘‘(k)(1) The Attorney General shall register an appli7 cant to manufacture schedule A substances if— 

8 ‘‘(A) the applicant demonstrates that the sched9 ule A substances will be used for research, analyt10 ical, or industrial purposes approved by the Attorney 

11 General; and 

12 ‘‘(B) the Attorney General determines that such 

13 registration is consistent with the public interest and 

14 with the United States obligations under inter15 national treaties, conventions, or protocols in effect 

16 on the date of enactment of this subsection. 

17 ‘‘(2) In determining the public interest under para18 graph (1)(B), the Attorney General shall consider— 

19 ‘‘(A) maintenance of effective controls against 

20 diversion of particular controlled substances and any 

21 controlled substance in schedule A compounded 

22 therefrom into other than legitimate medical, sci23 entific, research, or industrial channels, by limiting 

24 the importation and bulk manufacture of such con25 trolled substances to a number of establishments 


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1 which can produce an adequate and uninterrupted 

2 supply of these substances under adequately com3 petitive conditions for legitimate medical, scientific, 

4 research, and industrial purposes; 

5 ‘‘(B) compliance with applicable State and local 

6 law; 

7 ‘‘(C) promotion of technical advances in the art 

8 of manufacturing substances described in subpara9 graph (A) and the development of new substances; 

10 ‘‘(D) prior conviction record of applicant under 

11 Federal and State laws relating to the manufacture, 

12 distribution, or dispensing of substances described in 

13 paragraph (A); 

14 ‘‘(E) past experience in the manufacture of con15 trolled substances, and the existence in the establish16 ment of effective control against diversion; and 

17 ‘‘(F) such other factors as may be relevant to 

18 and consistent with the public health and safety. 

19 ‘‘(3) If an applicant is registered to manufacture con20 trolled substances in schedule I or II under subsection (a), 

21 the applicant shall not be required to apply for a separate 

22 registration under this subsection. 

23 ‘‘(l)(1) The Attorney General shall register an appli24 cant to distribute schedule A substances— 


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1 ‘‘(A) if the applicant demonstrates that the 

2 schedule A substances will be used for research, ana3 lytical, or industrial purposes approved by the Attor4 ney General; and 

5 ‘‘(B) unless the Attorney General determines 

6 that the issuance of such registration is inconsistent 

7 with the public interest. 

8 ‘‘(2) In determining the public interest under para9 graph (1)(B), the Attorney General shall consider— 

10 ‘‘(A) maintenance of effective control against 

11 diversion of particular controlled substances into 

12 other than legitimate medical, scientific, and indus13 trial channels; 

14 ‘‘(B) compliance with applicable State and local 

15 law; 

16 ‘‘(C) prior conviction record of applicant under 

17 Federal or State laws relating to the manufacture, 

18 distribution, or dispensing of substances described in 

19 subparagraph (A); 

20 ‘‘(D) past experience in the distribution of con21 trolled substances; and 

22 ‘‘(E) such other factors as may be relevant to 

23 and consistent with the public health and safety. 

24 ‘‘(3) If an applicant is registered to distribute a con25 trolled substance in schedule I or II under subsection (b), 


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1 the applicant shall not be required to apply for a separate 

2 registration under this subsection. 

3 ‘‘(m)(1) Not later than 90 days after the date on 

4 which a substance is placed in schedule A, any practitioner 

5 who was engaged in research on the substance before the 

6 placement of the substance in schedule A and any manu7 facturer or distributor who was handling the substance be8 fore the placement of the substance in schedule A shall 

9 register with the Attorney General. 

10 ‘‘(2)(A) Not later than 60 days after the date on 

11 which the Attorney General receives an application for 

12 registration to conduct research on a schedule A sub13 stance, the Attorney General shall— 

14 ‘‘(i) grant, or initiate proceedings under section 

15 304(c) to deny, the application; or 

16 ‘‘(ii) request supplemental information from the 

17 applicant. 

18 ‘‘(B) Not later than 30 days after the date on which 

19 the Attorney General receives supplemental information 

20 requested under subparagraph (A)(ii) in connection with 

21 an application described in subparagraph (A), the Attor22 ney General shall grant or deny the application. 

23 ‘‘(n)(1) The Attorney General shall register a sci24 entific investigator or a qualified research institution to 

25 conduct research with controlled substances in schedule A 


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1 in accordance with this subsection. In evaluating applica2 tions for such registration, the Attorney General shall 

3 apply the criteria set forth in subsection (f) of this section 

4 that apply to practitioners seeking a registration to con5 duct research with a schedule I controlled substance, ex6 cept that the applicant shall not be required to submit a 

7 research protocol. 

8 ‘‘(2) If the applicant is not currently registered under 

9 subsection (f) to conduct research with a schedule I con10 trolled substance, the Attorney General shall refer the ap11 plication to the Secretary, who shall determine whether 

12 the applicant will be engaged in bona fide research and 

13 is qualified to conduct such research. 

14 ‘‘(3) If the applicant is currently registered under 

15 subsection (f) to conduct research with a schedule I con16 trolled substance, the applicant will be considered qualified 

17 to conduct research with controlled substances in schedule 

18 A and the Attorney General shall modify the applicant’s 

19 registration to include schedule A controlled substances in 

20 accordance with this paragraph. The applicant shall notify 

21 the Attorney General of his intent to conduct research 

22 with a controlled substance in schedule A. Upon receiving 

23 such notification, the Attorney General shall modify the 

24 practitioner’s existing registration to authorize research 

25 with schedule A controlled substances, unless the Attorney 


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1 General determines that the registration modification 

2 would be inconsistent with the public interest based on the 

3 criteria of subsection (f). 

4 ‘‘(4) Registrations issued under this subsection to a 

5 qualified research institution will apply to all agents and 

6 employees of that institution acting within the scope of 

7 their professional practice. 

8 ‘‘(5) At least thirty days prior to conducting any re9 search with a controlled substance in schedule A, the reg10 istrant shall provide the Attorney General with written no11 tification of the following: 

12 ‘‘(A) The name of and drug code for each sub13 stance. 

14 ‘‘(B) The name of each individual with access 

15 to each substance. 

16 ‘‘(C) The amount of each substance. 

17 ‘‘(D) Other similar information the Attorney 

18 General may require. 

19 ‘‘(6) The quantity of a schedule A controlled sub20 stance possessed by a person registered under this sub21 section shall be appropriate for the research being con22 ducted, subject to the additional limitations set forth in 

23 this paragraph. To reduce the risk of diversion, the Attor24 ney General may establish limitations on the quantity of 

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1 tured or possessed for purposes of research under this sub2 section and shall publish such limitations on the website 

3 of the Drug Enforcement Administration. A person reg4 istered under this subsection may, based on legitimate re5 search needs, apply to the Attorney General to manufac6 ture or possess an amount greater than that so specified 

7 by the Attorney General. The Attorney General shall 

8 specify the manner in which such applications shall be 

9 submitted. The Attorney General shall act on an applica10 tion filed under this subparagraph within 30 days of re11 ceipt of such application. If the Attorney General fails to 

12 act within 30 days, the registrant shall be allowed to man13 ufacture and possess up to the amount requested. The At14 torney General shall have the authority to reverse the in15 crease for cause. 

16 ‘‘(7) The Attorney General shall by regulation specify 

17 the manner in which applications for registration under 

18 this subsection shall be submitted. 

19 ‘‘(8) Registrants authorized under this subsection 

20 may manufacture and possess schedule A controlled sub21 stances up to the approved amounts only for use in their 

22 own research setting or institution. Manufacturing for use 

23 in any other setting or institution shall require a manufac24 turer’s registration under section 303(a).’’. 


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1 (2) CONTROLLED SUBSTANCES IMPORT AND

2 EXPORT ACT.—Section 1008 of the Controlled Sub3 stances Import and Export Act (21 U.S.C. 958) is 

4 amended by adding at the end the following: 

5 ‘‘(j)(1) The Attorney General shall register an appli6 cant to import or export a schedule A substance if— 

7 ‘‘(A) the applicant demonstrates that the sched8 ule A substances will be used for research, analyt9 ical, or industrial purposes approved by the Attorney 

10 General; and 

11 ‘‘(B) the Attorney General determines that such 

12 registration is consistent with the public interest and 

13 with the United States obligations under inter14 national treaties, conventions, or protocols in effect 

15 on the date of enactment of this subsection. 

16 ‘‘(2) In determining the public interest under para17 graph (1)(B), the Attorney General shall consider the fac18 tors described in subparagraphs (A) through (F) of sec19 tion 303(k)(2). 

20 ‘‘(3) If an applicant is registered to import or export 

21 a controlled substance in schedule I or II under subsection 

22 (a), the applicant shall not be required to apply for a sepa23 rate registration under this subsection.’’. 

24 (f) ADDITIONAL CONFORMING AMENDMENTS.— 


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1 (1) CONTROLLED SUBSTANCES ACT.—The Con2 trolled Substances Act (21 U.S.C. 801 et seq.) is 

3 amended— 

4 (A) in section 303(c) (21 U.S.C. 823(c))— 

5 (i) by striking ‘‘subsections (a) and 

6 (b)’’ and inserting ‘‘subsection (a), (b), (k), 

7 or (l)’’; and 

8 (ii) by striking ‘‘schedule I or II’’ and 

9 inserting ‘‘schedule I, II, or A’’; 

10 (B) in section 306 (21 U.S.C. 826)— 

11 (i) in subsection (a), in the first sen12 tence, by striking ‘‘schedules I and II’’ and 

13 inserting ‘‘schedules I, II, and A’’; 

14 (ii) in subsection (b), in the second 

15 sentence, by striking ‘‘schedule I or II’’ 

16 and inserting ‘‘schedule I, II, or A’’; 

17 (iii) in subsection (c), in the first sen18 tence, by striking ‘‘schedules I and II’’ and 

19 inserting ‘‘schedules I, II, and A’’; 

20 (iv) in subsection (d), in the first sen21 tence, by striking ‘‘schedule I or II’’ and 

22 inserting ‘‘schedule I, II, or A’’; 

23 (v) in subsection (e), in the first sen24 tence, by striking ‘‘schedule I or II’’ and 

25 inserting ‘‘schedule I, II, or A’’; and 


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1 (vi) in subsection (f), in the first sen2 tence, by striking ‘‘schedules I and II’’ and 

3 inserting ‘‘schedules I, II, and A’’; 

4 (C) in section 308(a) (21 U.S.C. 828(a)), 

5 by striking ‘‘schedule I or II’’ and inserting 

6 ‘‘schedule I, II, or A’’; 

7 (D) in section 402(b) (21 U.S.C. 842(b)), 

8 in the matter preceding paragraph (1), by strik9 ing ‘‘schedule I or II’’ and inserting ‘‘schedule 

10 I, II, or A’’; 

11 (E) in section 403(a)(1) (21 U.S.C. 

12 843(a)(1)), by striking ‘‘schedule I or II’’ and 

13 inserting ‘‘schedule I, II, or A’’; and 

14 (F) in section 511(f) (21 U.S.C. 881(f)), 

15 by striking ‘‘schedule I or II’’ each place it ap16 pears and inserting ‘‘schedule I, II, or A’’. 

17 (2) CONTROLLED SUBSTANCES IMPORT EXPORT

18 ACT.—The Controlled Substances Import and Ex19 port Act (21 U.S.C. 951 et seq.) is amended— 

20 (A) in section 1002(a) (21 U.S.C. 

21 952(a))— 

22 (i) in the matter preceding paragraph 

23 (1), by striking ‘‘schedule I or II’’ and in24 serting ‘‘schedule I, II, or A’’; and 


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1 (ii) in paragraph (2), by striking 

2 ‘‘schedule I or II’’ and inserting ‘‘schedule 

3 I, II, or A’’; 

4 (B) in section 1003 (21 U.S.C. 953)— 

5 (i) in subsection (c), in the matter 

6 preceding paragraph (1), by striking 

7 ‘‘schedule I or II’’ and inserting ‘‘schedule 

8 I, II, or A’’; and 

9 (ii) in subsection (d), by striking 

10 ‘‘schedule I or II’’ and inserting ‘‘schedule 

11 I, II, or A’’; 

12 (C) in section 1004(1) (21 U.S.C. 954(1)), 

13 by striking ‘‘schedule I’’ and inserting ‘‘sched14 ule I or A’’; 

15 (D) in section 1005 (21 U.S.C. 955), by 

16 striking ‘‘schedule I or II’’ and inserting 

17 ‘‘schedule I, II, or A’’; and 

18 (E) in section 1009(a) (21 U.S.C. 959(a)), 

19 by striking ‘‘schedule I or II’’ and inserting 

20 ‘‘schedule I, II, or A’’. 

21 (g) CONTROLLED SUBSTANCE ANALOGUES.—Section 

22 102 of the Controlled Substances Act (21 U.S.C. 802) is 

23 amended— 

24 (1) in paragraph (6), by striking ‘‘or V’’ and in25 serting ‘‘V, or A’’; 


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1 (2) in paragraph (14)— 

2 (A) by striking ‘‘schedule I(c) and’’ and in3 serting ‘‘schedule I(c), schedule A, and’’; and 

4 (B) by striking ‘‘schedule I(c),’’ and insert5 ing ‘‘schedule I(c) and schedule A,’’; and 

6 (3) in paragraph (32)(A), by striking ‘‘(32)(A)’’ 

7 and all that follows through clause (iii) and inserting 

8 the following: 

9 ‘‘(32)(A) Except as provided in subparagraph (C), 

10 the term ‘controlled substance analogue’ means a sub11 stance whose chemical structure is substantially similar to 

12 the chemical structure of a controlled substance in sched13 ule I or II— 

14 ‘‘(i) which has a stimulant, depressant, or hal15 lucinogenic effect on the central nervous system that 

16 is substantially similar to or greater than the stimu17 lant, depressant, or hallucinogenic effect on the cen18 tral nervous system of a controlled substance in 

19 schedule I or II; or 

20 ‘‘(ii) with respect to a particular person, which 

21 such person represents or intends to have a stimu22 lant, depressant, or hallucinogenic effect on the cen23 tral nervous system that is substantially similar to 

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1 cinogenic effect on the central nervous system of a 

2 controlled substance in schedule I or II.’’. 

3 (h) AMENDMENT TO THE SENTENCING GUIDE4 LINES.—Section 2D1.1 of the Federal Sentencing Guide5 lines is amended, in Application Note 6 (Analogues and 

6 Controlled Substances Not Referenced in this Guideline) 

7 of the Commentary, by striking ‘‘In determining the most 

8 closely related controlled substance, the court shall, to the 

9 extent practicable, consider the following:’’ and inserting 

10 the following: ‘‘In determining the most closely related 

11 controlled substance and the applicable guideline or drug 

12 equivalence, the court shall— 

13 ‘‘(A) if Attorney General has provided 

14 guidance on the appropriate sentencing equiva15 lency or ratio to a controlled substance that is 

16 referenced in the guidelines through publication 

17 in the Federal Register (whether such guidance 

18 is included in or separate from any notice of 

19 proposed temporary or permanent scheduling of 

20 such substance under section 201 of the Con21 trolled Substances Act (21 U.S.C. 811)), apply 

22 any such sentencing equivalency or ratio; and 

23 ‘‘(B) in the absence of guidance with re24 spect to a substance or group of substances as 

25 described in paragraph (A), use equivalencies 


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1 for the following structural classes of sub2 stances as if they were included on the Drug 

3 Equivalency Tables: 

‘‘Drug Class Marihuana Equivalency of 1 gm 

of subject substance 

Synthetic Opioids ............................ 1 gm = 10 kg 

Synthetic Cannabinoids .................. 1 gm = 167 gm 

Synthetic Cathinones ...................... 1 gm = 380 gm 

Tryptamine ..................................... 1 gm = 80 gm 

Phenethylamines ............................. 1 gm = 2.5 kg 

Piperazines ..................................... 1 gm = 2 kg 

Benzofurans .................................... 1 gm = 500 gm 

Arylcyclohexylamines 

(PCP-like substances) ................. 1 gm = 1 kg 

Methylphenidate analogs ................ 1 gm = 100 gm 

Benzodiazepines .............................. 1 ‘unit’ (as defined in Note (F) to the 

Drug Quantity Table in 2D1.1) = 

0.0625 gm 

4 In the case of a substance for which paragraphs (A) 

5 and (B) above are not applicable, the court shall de6 termine an equivalency or ratio by considering the 

7 following factors, to the extent practicable:’’. 

8 (i) RULES OF CONSTRUCTION.—Nothing in this sec9 tion, or the amendments made by this section, may be con10 strued to limit— 

11 (1) the prosecution of offenses involving con12 trolled substance analogues under the Controlled 

13 Substances Act (21 U.S.C. 801 et seq.); or 

14 (2) the authority of the Attorney General to 

15 temporarily or permanently schedule, reschedule, or 

16 decontrol controlled substances under provisions of 

17 section 201 of the Controlled Substances Act (21 


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1 U.S.C. 811) that are in effect on the day before the 

2 date of enactment of this Act. 

3 (j) STUDY BY COMPTROLLER GENERAL.—Not later 

4 than 2 years after the date of enactment of this Act, the 

5 Comptroller General of the United States shall complete 

6 a study and submit a report to the Committees on the 

7 Judiciary of the House of Representatives and of the Sen8 ate regarding the costs associated with the amendments 

9 made by subsection (c), including— 

10 (1) the annual amounts expended by Federal 

11 agencies in carrying out the amendments; 

12 (2) the costs associated with arrests, trials, con13 victions, imprisonment, or imposition of other sanc14 tions in accordance with the amendments; and 

15 (3) the impact (including the fiscal impact) of 

16 the amendments on existing correctional facilities 

17 and the likelihood that those amendments will create 

18 a need for additional capacity for housing prisoners. 

Æ 


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