II 

113TH CONGRESS 

2D SESSION S. 2755 

To prevent deaths occurring from drug overdoses. 

IN THE SENATE OF THE UNITED STATES 

JULY 31, 2014 

Mr. REED (for himself, Mr. DURBIN, Mr. WHITEHOUSE, Mr. MARKEY, and 

Mr. LEAHY) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To prevent deaths occurring from drug overdoses. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Overdose Prevention 

5 Act’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds the following: 

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

10 more than 100 people die from a drug overdose. 


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1 Among people 25 to 64 years old, drug overdose 

2 causes more deaths than motor vehicle accidents. 

3 (2) The Centers for Disease Control and Pre4 vention reports that more than 41,000 people in the 

5 United States died from a drug overdose in 2011 

6 alone. Nearly 80 percent of those deaths were due 

7 to unintentional drug overdoses, and many could 

8 have been prevented. 

9 (3) Deaths resulting from unintentional drug 

10 overdoses increased more than 300 percent between 

11 1980 and 1998, and nearly tripled between 1999 

12 and 2011. 

13 (4) Ninety-one percent of all unintentional poi14 soning deaths are due to drugs. Since 1999, in the 

15 United States the population of non-Hispanic 

16 Whites and the population of Indians (as defined in 

17 section 4 of the Indian Self-Determination and Edu18 cation Assistance Act (25 U.S.C. 450b)) have seen 

19 the highest rates of unintentional drug poisoning 

20 deaths. 

21 (5) Opioid medications such as oxycodone and 

22 hydrocodone are involved in 55 percent of all unin23 tentional drug poisoning deaths. 


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1 (6) Between 1999 and 2010, opioid medication 

2 overdose fatalities increased by more than 400 per3 cent among women and 265 percent among men. 

4 (7) Military veterans are at elevated risk of ex5 periencing a drug overdose. Veterans who served in 

6 Vietnam, Iraq, or Afghanistan and who have combat 

7 injuries, posttraumatic stress disorder, and other co8 occurring mental health diagnoses are at elevated 

9 risk of fatal drug overdose from opioid medications. 

10 (8) Rural and suburban regions are dispropor11 tionately affected by opioid medication overdoses. 

12 Urban centers also continue to struggle with over13 dose, which is the leading cause of death among 

14 homeless adults. 

15 (9) In the year 2009 alone, estimated lost pro16 ductivity and direct medical costs from opioid medi17 cation poisonings exceeded $20,000,000,000. 

18 (10) Both fatal and nonfatal overdoses place a 

19 heavy burden on public health and public safety re20 sources, yet there is no coordinated cross-Federal 

21 agency response to prevent overdose fatalities. 

22 (11) Naloxone is a medication that rapidly re23 verses overdose from heroin and opioid medications. 

24 (12) In 2012, the Food and Drug Administra25 tion held a public workshop in collaboration with the 


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1 National Institute on Drug Abuse and the Centers 

2 for Disease Control and Prevention, and with par3 ticipation from the Substance Abuse and Mental 

4 Health Services Administration and the Office of 

5 National Drug Control Policy, to discuss making 

6 naloxone more widely available outside of conven7 tional medical settings to reduce the incidence of 

8 opioid overdose fatalities. 

9 (13) Lawmakers in California, Colorado, Con10 necticut, Georgia, Illinois, Kentucky, Maine, Mary11 land, Massachusetts, Minnesota, New Jersey, New 

12 Mexico, New York, North Carolina, Ohio, Oklahoma, 

13 Oregon, Rhode Island, Tennessee, Utah, Vermont, 

14 Virginia, Washington, Wisconsin, and the District of 

15 Columbia have removed legal impediments to in16 creasing naloxone prescription and its use by by17 standers who are in a position to respond to an over18 dose. 

19 (14) The American Medical Association, the 

20 Nation’s largest physician organization, supports 

21 further implementation of community-based pro22 grams that offer naloxone and other opioid overdose 

23 prevention services. 

24 (15) Community-based overdose prevention pro25 grams have successfully prevented deaths from 


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1 opioid overdoses by making rescue training and 

2 naloxone available to first responders, parents, and 

3 other bystanders who may encounter an overdose. A 

4 study funded by the Centers for Disease Control and 

5 Prevention of community-based overdose prevention 

6 programs provided by the Massachusetts Depart7 ment of Public Health found that communities with 

8 access to overdose prevention programs experienced 

9 lower mortality rates from opioid overdoses than 

10 communities that did not have access to overdose 

11 prevention programs during the study period. 

12 (16) Over 50,000 potential bystanders have 

13 been trained by overdose prevention programs in the 

14 United States. A Centers for Disease Control and 

15 Prevention report credits overdose prevention pro16 grams with saving more than 10,000 lives since 

17 1996. 

18 (17) At least 188 local overdose prevention pro19 grams are operating in the United States, including 

20 in major cities such as Baltimore, Chicago, Los An21 geles, New York City, Boston, San Francisco, and 

22 Philadelphia, and statewide in New Mexico, Massa23 chusetts, and New York. Between 2006 and 2009, 

24 overdose prevention programs facilitated by the Mas25 sachusetts Department of Public Health trained 


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1 more than 4,800 people who reported more than 500 

2 rescues. Since 2004, a program administered by the 

3 Baltimore City Health Department has trained more 

4 than 3,000 people who reported more than 220 res5 cues. Project Lazarus, an overdose prevention pro6 gram in Wilkes County, North Carolina, reduced 

7 overdose deaths 69 percent between 2009 and 2011. 

8 (18) In Illinois, the Department of Human 

9 Services, Division of Alcoholism and Substance 

10 Abuse has enrolled over 20 drug overdose prevention 

11 programs with over 100 designated sites across Illi12 nois targeting multiple service populations. These 

13 enrollees include police departments, county health 

14 departments, medical facilities, licensed substance 

15 abuse treatment programs, and community organiza16 tions. Statewide, over 2,000 police officers and more 

17 than 600 others have been trained thus far. The 

18 DuPage County Illinois Health Department has 

19 trained over 1,200 police officers and has reported 

20 12 overdose reversals. 

21 (19) The Office of National Drug Control Pol22 icy supports equipping first responders to help re23 verse overdoses. Police officers on patrol in Quincy, 

24 Massachusetts, have conducted 170 overdose rescues 

25 with naloxone since 2010. The police department has 


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1 reported a 95-percent success rate with overdose res2 cue attempts by police officers. In Suffolk County, 

3 New York, police officers have saved more than 50 

4 lives with naloxone. 

5 (20) Research shows that the cost per year of 

6 life gained by making naloxone available to reverse 

7 overdoses is within the range of what people in the 

8 United States usually pay for health treatments. 

9 (21) Overdose prevention programs are needed 

10 in correctional facilities, addiction treatment pro11 grams, and other places where people are at higher 

12 risk of overdosing after a period of abstinence. 

13 (22) People affected by drug overdose gather on 

14 August 31 of each year in communities nationwide 

15 for Overdose Awareness Day, to mourn and pay 

16 tribute to loved ones and raise awareness about 

17 overdose risk and prevention. 

18 SEC. 3. OVERDOSE PREVENTION PROGRAMS. 

19 Title III of the Public Health Service Act (42 U.S.C. 

20 241 et seq.) is amended by adding at the end the fol21 lowing: 


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1 ‘‘PART W—OVERDOSE PREVENTION PROGRAMS 

2 ‘‘SEC. 399OO. COOPERATIVE AGREEMENT PROGRAM TO RE3 DUCE DRUG OVERDOSE DEATHS. 

4 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

5 through the Director of the Centers for Disease Control 

6 and Prevention, shall enter into cooperative agreements 

7 with eligible entities to enable the eligible entities to re8 duce deaths occurring from overdoses of drugs. 

9 ‘‘(b) ELIGIBLE ENTITIES.—To be eligible to receive 

10 a cooperative agreement under this section, an entity shall 

11 be a State, local, or tribal government, a correctional insti12 tution, a law enforcement agency, a community agency, 

13 a professional organization in the field of poison control 

14 and surveillance, or a private nonprofit organization. 

15 ‘‘(c) APPLICATION.— 

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

17 cooperative agreement under this section shall sub18 mit to the Secretary an application at such time, in 

19 such manner, and containing such information as 

20 the Secretary may require. 

21 ‘‘(2) CONTENTS.—An application under para22 graph (1) shall include— 

23 ‘‘(A) a description of the activities to be 

24 funded through the cooperative agreement; and 

25 ‘‘(B) evidence that the eligible entity has 

26 the capacity to carry out such activities. 


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1 ‘‘(d) PRIORITY.—In entering into cooperative agree2 ments under subsection (a), the Secretary shall give pri3 ority to eligible entities that— 

4 ‘‘(1) are a public health agency or community5 based organization; and 

6 ‘‘(2) have expertise in preventing deaths occur7 ring from overdoses of drugs in populations at high 

8 risk of such deaths. 

9 ‘‘(e) ELIGIBLE ACTIVITIES.—As a condition of re10 ceipt of a cooperative agreement under this section, an eli11 gible entity shall agree to use the cooperative agreement 

12 to do each of the following: 

13 ‘‘(1) Purchase and distribute the drug naloxone 

14 or a similarly effective medication. 

15 ‘‘(2) Carry out one or more of the following ac16 tivities: 

17 ‘‘(A) Educating prescribers and phar18 macists about overdose prevention and naloxone 

19 prescription, or prescription of a similarly effec20 tive medication. 

21 ‘‘(B) Training first responders, other indi22 viduals in a position to respond to an overdose, 

23 and law enforcement and corrections officials on 

24 the effective response to individuals who have 

25 overdosed on drugs. Training pursuant to this 


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1 subparagraph may include any activity that is 

2 educational, instructional, or consultative in na3 ture, and may include volunteer training, 

4 awareness building exercises, outreach to indi5 viduals who are at-risk of a drug overdose, and 

6 distribution of educational materials. 

7 ‘‘(C) Implementing and enhancing pro8 grams to provide overdose prevention, recogni9 tion, treatment, and response to individuals in 

10 need of such services. 

11 ‘‘(D) Educating the public and providing 

12 outreach to the public about overdose preven13 tion and naloxone prescriptions, or prescriptions 

14 of other similarly effective medications. 

15 ‘‘(f) COORDINATING CENTER.— 

16 ‘‘(1) ESTABLISHMENT.—The Secretary shall es17 tablish and provide for the operation of a coordi18 nating center responsible for— 

19 ‘‘(A) collecting, compiling, and dissemi20 nating data on the programs and activities 

21 under this section, including tracking and eval22 uating the distribution and use of naloxone and 

23 other similarly effective medication; 

24 ‘‘(B) evaluating such data and, based on 

25 such evaluation, developing best practices for 


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1 preventing deaths occurring from drug 

2 overdoses; 

3 ‘‘(C) making such best practices specific to 

4 the type of community involved; 

5 ‘‘(D) coordinating and harmonizing data 

6 collection measures; 

7 ‘‘(E) evaluating the effects of the program 

8 on overdose rates: and 

9 ‘‘(F) education and outreach to the public 

10 about overdose prevention and prescription of 

11 naloxone and other similarly effective medica12 tion. 

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

14 receipt of a cooperative agreement under this sec15 tion, an eligible entity shall agree to prepare and 

16 submit, not later than 90 days after the end of the 

17 cooperative agreement period, a report to such co18 ordinating center and the Secretary describing the 

19 results of the activities supported through the coop20 erative agreement. 

21 ‘‘(g) DURATION.—The period of a cooperative agree22 ment under this section shall be 4 years. 

23 ‘‘(h) DEFINITION.—In this part, the term ‘drug’ 

24 means— 


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1 ‘‘(1) a drug, as defined in section 201 of the 

2 Federal Food, Drug, and Cosmetic Act (21 U.S.C. 

3 321); and 

4 ‘‘(2) includes controlled substances, as defined 

5 in section 102 of the Controlled Substances Act (21 

6 U.S.C. 802). 

7 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There 

8 are authorized to be appropriated $20,000,000 to carry 

9 out this section for each of the fiscal years 2015 through 

10 2019. 

11 ‘‘SEC. 399OO–1. SURVEILLANCE CAPACITY BUILDING. 

12 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

13 through the Director of the Centers for Disease Control 

14 and Prevention, shall award cooperative agreements to eli15 gible entities to improve fatal and nonfatal drug overdose 

16 surveillance and reporting capabilities, including— 

17 ‘‘(1) providing training to improve identification 

18 of drug overdose as the cause of death by coroners 

19 and medical examiners; 

20 ‘‘(2) establishing, in cooperation with the Na21 tional Poison Data System, coroners, and medical 

22 examiners, a comprehensive national program for 

23 surveillance of, and reporting to an electronic data24 base on, drug overdose deaths in the United States; 

25 and 


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

4 an electronic database on, fatal and nonfatal drug 

5 overdose occurrences, including epidemiological and 

6 toxicologic analysis and trends. 

7 ‘‘(b) ELIGIBLE ENTITY.—To be eligible to receive a 

8 cooperative agreement under this section, an entity shall 

9 be— 

10 ‘‘(1) a State, local, or tribal government; or 

11 ‘‘(2) the National Poison Data System working 

12 in conjunction with a State, local, or tribal govern13 ment. 

14 ‘‘(c) APPLICATION.— 

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

16 cooperative agreement under this section shall sub17 mit to the Secretary an application at such time, in 

18 such manner, and containing such information as 

19 the Secretary may require. 

20 ‘‘(2) CONTENTS.—The application described in 

21 paragraph (1) shall include— 

22 ‘‘(A) a description of the activities to be 

23 funded through the cooperative agreement; and 

24 ‘‘(B) evidence that the eligible entity has 

25 the capacity to carry out such activities. 


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1 ‘‘(d) REPORT.—As a condition of receipt of a cooper2 ative agreement under this section, an eligible entity shall 

3 agree to prepare and submit, not later than 90 days after 

4 the end of the cooperative agreement period, a report to 

5 the Secretary describing the results of the activities sup6 ported through the cooperative agreement. 

7 ‘‘(e) NATIONAL POISON DATA SYSTEM.—In this sec8 tion, the term ‘National Poison Data System’ means the 

9 system operated by the American Association of Poison 

10 Control Centers, in partnership with the Centers for Dis11 ease Control and Prevention, for real-time local, State, 

12 and national electronic reporting, and the corresponding 

13 database network. 

14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated to carry out this section 

16 $5,000,000 for each of the fiscal years 2015 through 

17 2019. 

18 ‘‘SEC. 399OO–2. REDUCING OVERDOSE DEATHS. 

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

20 than 180 days after the date of the enactment of this sec21 tion, the Secretary, in consultation with a task force com22 prised of stakeholders, shall develop a plan to reduce the 

23 number of deaths occurring from overdoses of drugs and 

24 shall submit the plan to Congress. The plan shall in25 clude— 


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

2 health campaign to educate prescribers and the pub3 lic about overdose prevention and prescription of 

4 naloxone and other similarly effective medication; 

5 ‘‘(2) recommendations for improving and ex6 panding overdose prevention programming; and 

7 ‘‘(3) recommendations for such legislative or 

8 administrative action as the Secretary determines 

9 appropriate. 

10 ‘‘(b) TASK FORCE REPRESENTATION.— 

11 ‘‘(1) REQUIRED MEMBERS.—The task force 

12 under subsection (a) shall include at least one rep13 resentative of each of the following: 

14 ‘‘(A) Individuals directly impacted by drug 

15 overdose. 

16 ‘‘(B) Direct service providers who engage 

17 individuals at risk of a drug overdose. 

18 ‘‘(C) Drug overdose prevention advocates. 

19 ‘‘(D) The National Institute on Drug 

20 Abuse. 

21 ‘‘(E) The Center for Substance Abuse 

22 Treatment. 

23 ‘‘(F) The Centers for Disease Control and 

24 Prevention. 


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1 ‘‘(G) The Health Resources and Services 

2 Administration. 

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

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

5 Policy. 

6 ‘‘(J) The American Medical Association. 

7 ‘‘(K) The American Association of Poison 

8 Control Centers. 

9 ‘‘(L) The Federal Bureau of Prisons. 

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

11 Services. 

12 ‘‘(N) The Department of Justice. 

13 ‘‘(O) The Department of Defense. 

14 ‘‘(P) The Department of Veterans Affairs. 

15 ‘‘(Q) First responders. 

16 ‘‘(R) Law enforcement. 

17 ‘‘(S) State agencies responsible for drug 

18 overdose prevention. 

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

20 the representatives required by paragraph (1), the 

21 task force under subsection (a) may include other in22 dividuals with expertise relating to drug overdoses or 

23 representatives of entities with expertise relating to 

24 drug overdoses, as the Secretary determines appro25 priate.’’. 


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1 SEC. 4. OVERDOSE PREVENTION RESEARCH. 

2 Subpart 15 of part C of title IV of the Public Health 

3 Service Act (42 U.S.C. 285o et seq.) is amended by adding 

4 at the end the following: 

5 ‘‘SEC. 464Q. OVERDOSE PREVENTION RESEARCH. 

6 ‘‘(a) OVERDOSE RESEARCH.—The Director of the In7 stitute shall prioritize and conduct or support research on 

8 drug overdose and overdose prevention. The primary aims 

9 of this research shall include— 

10 ‘‘(1) an examination of circumstances that con11 tribute to drug overdose and identification of drugs 

12 associated with fatal overdose; 

13 ‘‘(2) an evaluation of existing overdose preven14 tion methods; 

15 ‘‘(3) pilot programs or research trials on new 

16 overdose prevention strategies or programs that have 

17 not been studied in the United States; 

18 ‘‘(4) scientific research concerning the effective19 ness of overdose prevention programs, including how 

20 to effectively implement and sustain such programs; 

21 ‘‘(5) comparative effectiveness research of 

22 model programs; and 

23 ‘‘(6) implementation of science research con24 cerning effective overdose prevention programming 

25 examining how to implement and sustain overdose 

26 prevention programming. 


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1 ‘‘(b) FORMULATIONS OF NALOXONE.—The Director 

2 of the Institute shall support research on the development 

3 of formulations of naloxone, and other similarly effective 

4 medications, and dosage delivery devices specifically in5 tended to be used by lay persons or first responders for 

6 the prehospital treatment of unintentional drug overdose. 

7 ‘‘(c) DEFINITION.—In this section, the term ‘drug’ 

8 has the meaning given such term in section 399OO. 

9 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 

10 are authorized to be appropriated to carry out this section 

11 $5,000,000 for each of the fiscal years 2015 through 

12 2019.’’. 

Æ 


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