115TH CONGRESS 

2D SESSION H. R. 5812 

AN ACT 

To amend the Public Health Service Act to authorize the 

Director of the Centers for Disease Control and Prevention to carry out certain activities to prevent controlled 

substances overdoses, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Creating Opportunities 

3 that Necessitate New and Enhanced Connections That 

4 Improve Opioid Navigation Strategies Act of 2018’’ or the 

5 ‘‘CONNECTIONS Act’’. 

6 SEC. 2. PREVENTING OVERDOSES OF CONTROLLED SUB7 STANCES. 

8 Part P of title III of the Public Health Service Act 

9 (42 U.S.C. 280g et seq.) is amended by adding at the end 

10 the following new section: 

11 ‘‘SEC. 399V–7. PREVENTING OVERDOSES OF CONTROLLED 

12 SUBSTANCES. 

13 ‘‘(a) EVIDENCE-BASED PREVENTION GRANTS.— 

14 ‘‘(1) IN GENERAL.—The Director of the Cen15 ters for Disease Control and Prevention may— 

16 ‘‘(A) to the extent practicable, carry out 

17 any evidence-based prevention activity described 

18 in paragraph (2); 

19 ‘‘(B) provide training and technical assist20 ance to States, localities, and Indian tribes for 

21 purposes of carrying out any such activity; and 

22 ‘‘(C) award grants to States, localities, and 

23 Indian tribes for purposes of carrying out any 

24 such activity. 

25 ‘‘(2) EVIDENCE-BASED PREVENTION ACTIVI26 TIES.—An evidence-based prevention activity de-
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1 scribed in this paragraph is any of the following ac2 tivities: 

3 ‘‘(A) With respect to a State, improving 

4 the efficiency and use of the State prescription 

5 drug monitoring program by— 

6 ‘‘(i) encouraging all authorized users 

7 (as specified by the State) to register with 

8 and use the program and making the pro9 gram easier to use; 

10 ‘‘(ii) enabling such users to access any 

11 updates to information collected by the 

12 program in as close to real-time as pos13 sible; 

14 ‘‘(iii) providing for a mechanism for 

15 the program to automatically flag any po16 tential misuse or abuse of controlled sub17 stances and any detection of inappropriate 

18 prescribing practices relating to such sub19 stances; 

20 ‘‘(iv) enhancing interoperability be21 tween the program and any electronic 

22 health records system, including by inte23 grating the use of electronic health records 

24 into the program for purposes of improving 

25 clinical decisionmaking; 
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1 ‘‘(v) continually updating program ca2 pabilities to respond to technological inno3 vation for purposes of appropriately ad4 dressing a controlled substance overdose 

5 epidemic as such epidemic may occur and 

6 evolve; 

7 ‘‘(vi) facilitating data sharing between 

8 the program and the prescription drug 

9 monitoring programs of neighboring 

10 States; and 

11 ‘‘(vii) meeting the purpose of the pro12 gram established under section 399O, as 

13 described in section 399O(a). 

14 ‘‘(B) Achieving community or health sys15 tem interventions through activities such as— 

16 ‘‘(i) establishing or improving con17 trolled substances prescribing interventions 

18 for insurers and health systems; 

19 ‘‘(ii) enhancing the use of evidence20 based controlled substances prescribing 

21 guidelines across sectors and health care 

22 settings; and 

23 ‘‘(iii) implementing strategies to align 

24 the prescription of controlled substances 

25 with the guidelines described in clause (ii). 
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1 ‘‘(C) Evaluating interventions to better un2 derstand what works to prevent overdoses, in3 cluding those involving prescription and illicit 

4 controlled substances. 

5 ‘‘(D) Implementing projects to advance an 

6 innovative prevention approach with respect to 

7 new and emerging public health crises and op8 portunities to address such crises, such as en9 hancing public education and awareness on the 

10 risks associated with opioids. 

11 ‘‘(b) ENHANCED SURVEILLANCE OF CONTROLLED

12 SUBSTANCE OVERDOSE GRANTS.— 

13 ‘‘(1) IN GENERAL.—The Director of the Cen14 ters for Disease Control and Prevention may— 

15 ‘‘(A) to the extent practicable, carry out 

16 any controlled substance overdose surveillance 

17 activity described in paragraph (2); 

18 ‘‘(B) provide training and technical assist19 ance to States for purposes of carrying out any 

20 such activity; 

21 ‘‘(C) award grants to States for purposes 

22 of carrying out any such activity; and 

23 ‘‘(D) coordinate with the Assistant Sec24 retary for Mental Health and Substance Use to 

25 collect data pursuant to section 505(d)(1)(A) 
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1 (relating to the number of individuals admitted 

2 to the emergency rooms of hospitals as a result 

3 of the abuse of alcohol or other drugs). 

4 ‘‘(2) CONTROLLED SUBSTANCE OVERDOSE SUR5 VEILLANCE ACTIVITIES.—A controlled substance 

6 overdose surveillance activity described in this para7 graph is any of the following activities: 

8 ‘‘(A) Enhancing the timeliness of reporting 

9 data to the public, including data on fatal and 

10 nonfatal overdoses of controlled substances. 

11 ‘‘(B) Enhancing comprehensiveness of data 

12 on controlled substances overdoses by collecting 

13 information on such overdoses from appropriate 

14 sources such as toxicology reports, autopsy re15 ports, death scene investigations, and other risk 

16 factors. 

17 ‘‘(C) Using data to help identify risk fac18 tors associated with controlled substances 

19 overdoses. 

20 ‘‘(D) With respect to a State, supporting 

21 entities involved in providing information to in22 form efforts within the State, such as by coro23 ners and medical examiners, to improve accu24 rate testing and reporting of causes and con-
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1 tributing factors to controlled substances 

2 overdoses. 

3 ‘‘(E) Working to enable information shar4 ing regarding controlled substances overdoses 

5 among data sources. 

6 ‘‘(c) DEFINITIONS.—In this section: 

7 ‘‘(1) CONTROLLED SUBSTANCE.—The term 

8 ‘controlled substance’ has the meaning given that 

9 term in section 102 of the Controlled Substances 

10 Act. 

11 ‘‘(2) INDIAN TRIBE.—The term ‘Indian tribe’ 

12 has the meaning given that term in section 4 of the 

13 Indian Self-Determination and Education Assistance 

14 Act. 

15 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For 

16 purposes of carrying out this section and section 399O, 

17 there is authorized to be appropriated $486,000,000 for 

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

19 SEC. 3. PRESCRIPTION DRUG MONITORING PROGRAM. 

20 Section 399O of the Public Health Service Act (42 

21 U.S.C. 280g–3) is amended to read as follows: 

22 ‘‘SEC. 399O. PRESCRIPTION DRUG MONITORING PROGRAM. 

23 ‘‘(a) PROGRAM.— 

24 ‘‘(1) IN GENERAL.—Each fiscal year, the Sec25 retary, in consultation with the Director of National 
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1 Drug Control Policy, acting through the Director of 

2 the Centers for Disease Control and Prevention, the 

3 Assistant Secretary for Mental Health and Sub4 stance Use, and the National Coordinator for Health 

5 Information Technology, shall support States for the 

6 purpose of improving the efficiency and use of 

7 PDMPs, including— 

8 ‘‘(A) establishment and implementation of 

9 a PDMP; 

10 ‘‘(B) maintenance of a PDMP; 

11 ‘‘(C) improvements to a PDMP by— 

12 ‘‘(i) enhancing functional components 

13 to work toward— 

14 ‘‘(I) universal use of PDMPs 

15 among providers and their delegates, 

16 to the extent that State laws allow, 

17 within a State; 

18 ‘‘(II) more timely inclusion of 

19 data within a PDMP; 

20 ‘‘(III) active management of the 

21 PDMP, in part by sending proactive 

22 or unsolicited reports to providers to 

23 inform prescribing; and 

24 ‘‘(IV) ensuring the highest level 

25 of ease in use and access of PDMPs 
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1 by providers and their delegates, to 

2 the extent that State laws allow; 

3 ‘‘(ii) improving the intrastate inter4 operability of PDMPs by— 

5 ‘‘(I) making PDMPs more ac6 tionable by integrating PDMPs within 

7 electronic health records and health 

8 information technology infrastructure; 

9 and 

10 ‘‘(II) linking PDMP data to 

11 other data systems within the State, 

12 including— 

13 ‘‘(aa) the data of pharmacy 

14 benefit managers, medical exam15 iners and coroners, and the 

16 State’s Medicaid program; 

17 ‘‘(bb) worker’s compensation 

18 data; and 

19 ‘‘(cc) prescribing data of 

20 providers of the Department of 

21 Veterans Affairs and the Indian 

22 Health Service within the State; 

23 ‘‘(iii) improving the interstate inter24 operability of PDMPs through— 
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1 ‘‘(I) sharing of dispensing data in 

2 near-real time across State lines; and 

3 ‘‘(II) integration of automated 

4 queries for multistate PDMP data 

5 and analytics into clinical workflow to 

6 improve the use of such data and ana7 lytics by practitioners and dispensers; 

8 or 

9 ‘‘(iv) improving the ability to include 

10 treatment availability resources and refer11 ral capabilities within the PDMP. 

12 ‘‘(2) STATE LEGISLATION.—As a condition on 

13 the receipt of support under this section, the Sec14 retary shall require a State to demonstrate that the 

15 State has enacted legislation or regulations— 

16 ‘‘(A) to provide for the implementation of 

17 the PDMP; and 

18 ‘‘(B) to permit the imposition of appro19 priate penalties for the unauthorized use and 

20 disclosure of information maintained by the 

21 PDMP. 

22 ‘‘(b) PDMP STRATEGIES.—The Secretary shall en23 courage a State, in establishing, improving, or maintaining 

24 a PDMP, to implement strategies that improve— 
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1 ‘‘(1) the reporting of dispensing in the State of 

2 a controlled substance to an ultimate user so the re3 porting occurs not later than 24 hours after the dis4 pensing event; 

5 ‘‘(2) the consultation of the PDMP by each pre6 scribing practitioner, or their designee, in the State 

7 before initiating treatment with a controlled sub8 stance, or any substance as required by the State to 

9 be reported to the PDMP, and over the course of 

10 ongoing treatment for each prescribing event; 

11 ‘‘(3) the consultation of the PDMP before dis12 pensing a controlled substance, or any substance as 

13 required by the State to be reported to the PDMP; 

14 ‘‘(4) the proactive notification to a practitioner 

15 when patterns indicative of controlled substance mis16 use by a patient, including opioid misuse, are de17 tected; 

18 ‘‘(5) the availability of data in the PDMP to 

19 other States, as allowable under State law; and 

20 ‘‘(6) the availability of nonidentifiable informa21 tion to the Centers for Disease Control and Preven22 tion for surveillance, epidemiology, statistical re23 search, or educational purposes. 

24 ‘‘(c) DRUG MISUSE AND ABUSE.—In consultation 

25 with practitioners, dispensers, and other relevant and in-
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1 terested stakeholders, a State receiving support under this 

2 section— 

3 ‘‘(1) shall establish a program to notify practi4 tioners and dispensers of information that will help 

5 to identify and prevent the unlawful diversion or 

6 misuse of controlled substances; and 

7 ‘‘(2) may, to the extent permitted under State 

8 law, notify the appropriate authorities responsible 

9 for carrying out drug diversion investigations if the 

10 State determines that information in the PDMP 

11 maintained by the State indicates an unlawful diver12 sion or abuse of a controlled substance. 

13 ‘‘(d) EVALUATION AND REPORTING.—As a condition 

14 on receipt of support under this section, the State shall 

15 report on interoperability with PDMPs of other States and 

16 Federal agencies, where appropriate, intrastate interoper17 ability with health information technology systems such as 

18 electronic health records, health information exchanges, 

19 and e-prescribing, where appropriate, and whether or not 

20 the State provides automatic, up-to-date, or daily informa21 tion about a patient when a practitioner (or the designee 

22 of a practitioner, where permitted) requests information 

23 about such patient. 

24 ‘‘(e) EVALUATION AND REPORTING.—A State receiv25 ing support under this section shall provide the Secretary 
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1 with aggregate nonidentifiable information, as permitted 

2 by State law, to enable the Secretary— 

3 ‘‘(1) to evaluate the success of the State’s pro4 gram in achieving the purpose described in sub5 section (a); or 

6 ‘‘(2) to prepare and submit to the Congress the 

7 report required by subsection (i)(2). 

8 ‘‘(f) EDUCATION AND ACCESS TO THE MONITORING

9 SYSTEM.—A State receiving support under this section 

10 shall take steps to— 

11 ‘‘(1) facilitate prescribers and dispensers, and 

12 their delegates, as permitted by State law, to use the 

13 PDMP, to the extent practicable; and 

14 ‘‘(2) educate prescribers and dispensers, and 

15 their delegates on the benefits of the use of PDMPs. 

16 ‘‘(g) ELECTRONIC FORMAT.—The Secretary may 

17 issue guidelines specifying a uniform electronic format for 

18 the reporting, sharing, and disclosure of information pur19 suant to PDMPs. 

20 ‘‘(h) RULES OF CONSTRUCTION.— 

21 ‘‘(1) FUNCTIONS OTHERWISE AUTHORIZED BY

22 LAW.—Nothing in this section shall be construed to 

23 restrict the ability of any authority, including any 

24 local, State, or Federal law enforcement, narcotics 
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1 control, licensure, disciplinary, or program authority, 

2 to perform functions otherwise authorized by law. 

3 ‘‘(2) ADDITIONAL PRIVACY PROTECTIONS.— 

4 Nothing in this section shall be construed as pre5 empting any State from imposing any additional pri6 vacy protections. 

7 ‘‘(3) FEDERAL PRIVACY REQUIREMENTS.— 

8 Nothing in this section shall be construed to super9 sede any Federal privacy or confidentiality require10 ment, including the regulations promulgated under 

11 section 264(c) of the Health Insurance Portability 

12 and Accountability Act of 1996 (Public Law 104– 

13 191; 110 Stat. 2033) and section 543 of this Act. 

14 ‘‘(4) NO FEDERAL PRIVATE CAUSE OF AC15 TION.—Nothing in this section shall be construed to 

16 create a Federal private cause of action. 

17 ‘‘(i) PROGRESS REPORT.—Not later than 3 years 

18 after the date of enactment of the CONNECTIONS Act, 

19 the Secretary shall— 

20 ‘‘(1) complete a study that— 

21 ‘‘(A) determines the progress of States in 

22 establishing and implementing PDMPs con23 sistent with this section; 

24 ‘‘(B) provides an analysis of the extent to 

25 which the operation of PDMPs has— 
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1 ‘‘(i) reduced inappropriate use, abuse, 

2 diversion of, and overdose with, controlled 

3 substances; 

4 ‘‘(ii) established or strengthened ini5 tiatives to ensure linkages to substance use 

6 disorder treatment services; or 

7 ‘‘(iii) affected patient access to appro8 priate care in States operating PDMPs; 

9 ‘‘(C) determine the progress of States in 

10 achieving interstate interoperability and intra11 state interoperability of PDMPs, including an 

12 assessment of technical, legal, and financial 

13 barriers to such progress and recommendations 

14 for addressing these barriers; 

15 ‘‘(D) determines the progress of States in 

16 implementing near real-time electronic PDMPs; 

17 ‘‘(E) provides an analysis of the privacy 

18 protections in place for the information re19 ported to the PDMP in each State receiving 

20 support under this section and any rec21 ommendations of the Secretary for additional 

22 Federal or State requirements for protection of 

23 this information; 

24 ‘‘(F) determines the progress of States in 

25 implementing technological alternatives to cen-
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1 tralized data storage, such as peer-to-peer file 

2 sharing or data pointer systems, in PDMPs and 

3 the potential for such alternatives to enhance 

4 the privacy and security of individually identifi5 able data; and 

6 ‘‘(G) evaluates the penalties that States 

7 have enacted for the unauthorized use and dis8 closure of information maintained in PDMPs, 

9 and the criteria used by the Secretary to deter10 mine whether such penalties qualify as appro11 priate for purposes of subsection (a)(2); and 

12 ‘‘(2) submit a report to the Congress on the re13 sults of the study. 

14 ‘‘(j) ADVISORY COUNCIL.— 

15 ‘‘(1) ESTABLISHMENT.—A State may establish 

16 an advisory council to assist in the establishment, 

17 improvement, or maintenance of a PDMP consistent 

18 with this section. 

19 ‘‘(2) LIMITATION.—A State may not use Fed20 eral funds for the operations of an advisory council 

21 to assist in the establishment, improvement, or 

22 maintenance of a PDMP. 

23 ‘‘(3) SENSE OF CONGRESS.—It is the sense of 

24 the Congress that, in establishing an advisory coun25 cil to assist in the establishment, improvement, or 
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1 maintenance of a PDMP, a State should consult 

2 with appropriate professional boards and other inter3 ested parties. 

4 ‘‘(k) DEFINITIONS.—For purposes of this section: 

5 ‘‘(1) The term ‘controlled substance’ means a 

6 controlled substance (as defined in section 102 of 

7 the Controlled Substances Act) in schedule II, III, 

8 or IV of section 202 of such Act. 

9 ‘‘(2) The term ‘dispense’ means to deliver a 

10 controlled substance to an ultimate user by, or pur11 suant to the lawful order of, a practitioner, irrespec12 tive of whether the dispenser uses the internet or 

13 other means to effect such delivery. 

14 ‘‘(3) The term ‘dispenser’ means a physician, 

15 pharmacist, or other person that dispenses a con16 trolled substance to an ultimate user. 

17 ‘‘(4) The term ‘interstate interoperability’ with 

18 respect to a PDMP means the ability of the PDMP 

19 to electronically share reported information with an20 other State if the information concerns either the 

21 dispensing of a controlled substance to an ultimate 

22 user who resides in such other State, or the dis23 pensing of a controlled substance prescribed by a 

24 practitioner whose principal place of business is lo25 cated in such other State. 
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1 ‘‘(5) The term ‘intrastate interoperability’ with 

2 respect to a PDMP means the integration of PDMP 

3 data within electronic health records and health in4 formation technology infrastructure or linking of a 

5 PDMP to other data systems within the State, in6 cluding the State’s Medicaid program, workers’ com7 pensation programs, and medical examiners or coro8 ners. 

9 ‘‘(6) The term ‘nonidentifiable information’ 

10 means information that does not identify a practi11 tioner, dispenser, or an ultimate user and with re12 spect to which there is no reasonable basis to believe 

13 that the information can be used to identify a practi14 tioner, dispenser, or an ultimate user. 

15 ‘‘(7) The term ‘PDMP’ means a prescription 

16 drug monitoring program that is State-controlled. 

17 ‘‘(8) The term ‘practitioner’ means a physician, 

18 dentist, veterinarian, scientific investigator, phar19 macy, hospital, or other person licensed, registered, 

20 or otherwise permitted, by the United States or the 

21 jurisdiction in which the individual practices or does 

22 research, to distribute, dispense, conduct research 

23 with respect to, administer, or use in teaching or 

24 chemical analysis, a controlled substance in the 

25 course of professional practice or research. 
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1 ‘‘(9) The term ‘State’ means each of the 50 

2 States, the District of Columbia, and any common3 wealth or territory of the United States. 

4 ‘‘(10) The term ‘ultimate user’ means a person 

5 who has obtained from a dispenser, and who pos6 sesses, a controlled substance for the person’s own 

7 use, for the use of a member of the person’s house8 hold, or for the use of an animal owned by the per9 son or by a member of the person’s household. 

10 ‘‘(11) The term ‘clinical workflow’ means the 

11 integration of automated queries for prescription 

12 drug monitoring programs data and analytics into 

13 health information technologies such as electronic 

14 health record systems, health information exchanges, 

15 and/or pharmacy dispensing software systems, thus 

16 streamlining provider access through automated que17 ries.’’. 

Passed the House of Representatives June 12, 2018. 

Attest: 

Clerk. 
115TH CONGRESS 

2D SESSION H. R. 5812 

AN ACT 

To amend the Public Health Service Act to authorfor other purposes. to prevent controlled substances overdoses, and trol and Prevention to carry out certain activities ize the Director of the Centers for Disease Con-