II 

114TH CONGRESS 

1ST SESSION S. 799 

To combat the rise of prenatal opioid abuse and neonatal abstinence 

syndrome. 

IN THE SENATE OF THE UNITED STATES 

MARCH 19, 2015 

Mr. MCCONNELL (for himself and Mr. CASEY) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To combat the rise of prenatal opioid abuse and neonatal 

abstinence syndrome. 

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 ‘‘Protecting Our Infants 

5 Act of 2015’’. 

6 SEC. 2. FINDINGS. 

7 Congress finds as follows: 

8 (1) Opioid prescription rates have risen dra9 matically over the past several years. According to 

10 the Centers for Disease Control and Prevention, in 


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1 some States, there are as many as 96 to 143 pre2 scriptions for opioids per 100 adults per year. 

3 (2) In recent years, there has been a steady rise 

4 in the number of overdose deaths involving heroin. 

5 According to the Centers for Disease Control and 

6 Prevention, the death rate for heroin overdose dou7 bled from 2010 to 2012. 

8 (3) At the same time, there has been an in9 crease in cases of neonatal abstinence syndrome (re10 ferred to in this section as ‘‘NAS’’). In the United 

11 States, the incidence of NAS has risen from 1.20 

12 per 1,000 hospital births in 2000 to 3.39 per 1,000 

13 hospital births in 2009. 

14 (4) NAS refers to medical issues associated 

15 with drug withdrawal in newborns due to exposure 

16 to opioids or other drugs in utero. 

17 (5) The average cost of treatment in a hospital 

18 for NAS increased from $39,400 in 2000 to $53,400 

19 in 2009. Most of these costs are born by the Med20 icaid program. 

21 (6) Preventing opioid abuse among pregnant 

22 women and women of childbearing age is crucial. 

23 (7) Medically-appropriate opioid use in preg24 nancy is not uncommon, and opioids are often the 


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1 safest and most appropriate treatment for moderate 

2 to severe pain for pregnant women. 

3 (8) Addressing NAS effectively requires a focus 

4 on women of childbearing age, pregnant women, and 

5 infants from preconception through early childhood. 

6 (9) NAS can result from the use of prescription 

7 drugs as prescribed for medical reasons, from the 

8 abuse of prescription drugs, or from the use of ille9 gal opioids like heroin. 

10 (10) For pregnant women who are abusing 

11 opioids, it is most appropriate to treat and manage 

12 maternal substance use in a non-punitive manner. 

13 (11) According to a report of the Government 

14 Accountability Office (referred to in this section as 

15 the ‘‘GAO report’’), more research is needed to opti16 mize the identification and treatment of babies with 

17 NAS and to better understand long-term impacts on 

18 children. 

19 (12) According to the GAO report, the Depart20 ment of Health and Human Services does not have 

21 a focal point to lead planning and coordinating ef22 forts to address prenatal opioid use and NAS across 

23 the department. 

24 (13) According to the GAO report, ‘‘given the 

25 increasing use of heroin and abuse of opioids preVerDate Sep 11 2014 23:38 Mar 24, 2015 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S799.IS S799

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1 scribed for pain management, as well as the in2 creased rate of NAS in the United States, it is im3 portant to improve the efficiency and effectiveness of 

4 planning and coordination of Federal efforts on pre5 natal opioid use and NAS’’. 

6 SEC. 3. DEVELOPING RECOMMENDATIONS FOR PRE7 VENTING AND TREATING PRENATAL OPIOID 

8 ABUSE AND NEONATAL ABSTINENCE SYN9 DROME. 

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

11 Human Services (referred to in this Act as the ‘‘Sec12 retary’’), acting through the Director of the Agency for 

13 Healthcare Research and Quality (referred to in this sec14 tion as the ‘‘Director’’), shall conduct a study and develop 

15 recommendations for preventing and treating prenatal 

16 opioid abuse and neonatal abstinence syndrome, soliciting 

17 input from nongovernmental entities, including organiza18 tions representing patients, health care providers, hos19 pitals, other treatment facilities, and other entities, as ap20 propriate. 

21 (b) REPORT.—Not later than 1 year after the date 

22 of enactment of this Act, the Director shall publish on the 

23 Internet Web site of the Agency for Healthcare Research 

24 and Quality a report on the study and recommendations 

25 under subsection (a). Such report shall address each of 


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1 the issues described in paragraphs (1) through (3) of sub2 section (c). 

3 (c) CONTENTS.—The study described in subsection 

4 (a) and the report under subsection (b) shall include— 

5 (1) a comprehensive assessment of existing re6 search with respect to the prevention, identification, 

7 treatment, and long-term outcomes of neonatal ab8 stinence syndrome, including the identification and 

9 treatment of pregnant women or women who may 

10 become pregnant who use opioids or other drugs; 

11 (2) an evaluation of— 

12 (A) the causes of and risk factors for 

13 opioid use disorders among women of reproduc14 tive age, including pregnant women; 

15 (B) the barriers to identifying and treating 

16 opioid use disorders among women of reproduc17 tive age, including pregnant and postpartum 

18 women and women with young children; 

19 (C) current practices in the health care 

20 system to respond to and treat pregnant women 

21 with opioid use disorders and infants born with 

22 neonatal abstinence syndrome; 

23 (D) medically indicated use of opioids dur24 ing pregnancy; 


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1 (E) access to treatment for opioid use dis2 orders in pregnant and postpartum women; and 

3 (F) access to treatment for infants with 

4 neonatal abstinence syndrome; and 

5 (3) recommendations on— 

6 (A) preventing, identifying, and treating 

7 neonatal abstinence syndrome in infants; 

8 (B) treating pregnant women who are de9 pendent on opioids; and 

10 (C) preventing opioid dependence among 

11 women of reproductive age, including pregnant 

12 women, who may be at risk of developing opioid 

13 dependence. 

14 SEC. 4. IMPROVING PREVENTION AND TREATMENT FOR 

15 PRENATAL OPIOID ABUSE AND NEONATAL 

16 ABSTINENCE SYNDROME. 

17 (a) REVIEW OF PROGRAMS.—The Secretary shall 

18 lead a review of planning and coordination within the De19 partment of Health and Human Services related to pre20 natal opioid use and neonatal abstinence syndrome. 

21 (b) STRATEGY TO CLOSE GAPS IN RESEARCH AND

22 PROGRAMMING.—In carrying out subsection (a), the Sec23 retary shall develop a strategy to address research and 

24 program gaps, including such gaps identified in findings 


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1 made by reports of the Government Accountability Office. 

2 Such strategy shall address— 

3 (1) gaps in research, including with respect 

4 to— 

5 (A) the most appropriate treatment of 

6 pregnant women with opioid use disorders; 

7 (B) the most appropriate treatment and 

8 management of infants with neonatal absti9 nence syndrome; and 

10 (C) the long-term effects of prenatal opioid 

11 exposure on children; and 

12 (2) gaps in programs, including— 

13 (A) the availability of treatment programs 

14 for pregnant and postpartum women and for 

15 newborns with neonatal abstinence syndrome; 

16 and 

17 (B) guidance and coordination in Federal 

18 efforts to address prenatal opioid use or neo19 natal abstinence syndrome. 

20 (c) REPORT.—Not later than 1 year after the date 

21 of enactment of this Act, the Secretary shall submit to 

22 the Committee on Health, Education, Labor, and Pen23 sions of the Senate and the Committee on Energy and 

24 Commerce of the House of Representatives a report on 


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1 the findings of the review described in subsection (a) and 

2 the strategy developed under subsection (b). 

3 SEC. 5. IMPROVING DATA ON AND PUBLIC HEALTH RE4 SPONSE TO NEONATAL ABSTINENCE SYN5 DROME. 

6 (a) DATA AND SURVEILLANCE.—The Director of the 

7 Centers for Disease Control and Prevention shall, as ap8 propriate— 

9 (1) provide technical assistance to States to im10 prove the availability and quality of data collection 

11 and surveillance activities regarding neonatal absti12 nence syndrome, including— 

13 (A) the incidence and prevalence of neo14 natal abstinence syndrome; 

15 (B) the identification of causes for neo16 natal abstinence syndrome, including new and 

17 emerging trends; and 

18 (C) the demographics and other relevant 

19 information associated with neonatal abstinence 

20 syndrome; 

21 (2) collect available surveillance data described 

22 in paragraph (1) from States, as applicable; and 

23 (3) make surveillance data collected pursuant to 

24 paragraph (2) publically available on an appropriate 

25 Internet Web site. 


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1 (b) PUBLIC HEALTH RESPONSE.—The Director of 

2 the Centers for Disease Control and Prevention shall en3 courage increased utilization of effective public health 

4 measures to reduce neonatal abstinence syndrome. 

Æ 


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