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by section 103 of Public Law 105–392 (112 Stat. 3541),
is amended—
(1) by redesignating sections 754 through 757
as sections 755 through 758, respectively; and
(2) by inserting after section 753 the following
section:
‘‘SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN
PALLIATIVE CARE.
‘‘(a) IN GENERAL.—The Secretary, in consultation
with the Administrator for Health Care Policy and Re-
search, may make awards of grants, cooperative agree-
ments, and contracts to health professions schools, hos-
pices, and other public and private entities for the develop-
ment and implementation of programs to provide edu-
cation and training to health care professionals in pallia-
tive care.
‘‘(b) PRIORITIES.—In making awards under sub-
section (a), the Secretary shall give priority to awards for
the implementation of programs under such subsection.
‘‘(c) CERTAIN TOPICS.—An award may be made
under subsection (a) only if the applicant for the award
agrees that the program carried out with the award will
include information and education on—
‘‘(1) means for alleviating pain and discomfort
of patients, especially terminally ill patients, includ-
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ing the medically appropriate use of controlled sub-
stances;
‘‘(2) applicable laws on controlled substances,
including laws permitting health care professionals
to dispense or administer controlled substances as
needed to relieve pain even in cases where such ef-
forts may unintentionally increase the risk of death;
and
‘‘(3) recent findings, developments, and im-
provements in the provision of palliative care.
‘‘(d)
PROGRAM
SITES.—Education
and
training
under subsection (a) may be provided at or through health
professions schools, residency training programs and other
graduate programs in the health professions, entities that
provide continuing medical education, hospices, and such
other programs or sites as the Secretary determines to be
appropriate.
‘‘(e) EVALUATION
OF PROGRAMS.—The Secretary
shall (directly or through grants or contracts) provide for
the evaluation of programs implemented under subsection
(a) in order to determine the effect of such programs on
knowledge and practice regarding palliative care.
‘‘(f) PEER REVIEW GROUPS.—In carrying out section
799(f) with respect to this section, the Secretary shall en-
sure that the membership of each peer review group in-
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volved includes one or more individuals with expertise and
experience in palliative care.
‘‘(g) DEFINITION.—For purposes of this section, the
term ‘palliative care’ means the active, total care of pa-
tients whose disease or medical condition is not responsive
to curative treatment or whose prognosis is limited due
to progressive, far-advanced disease. The purpose of such
care is to alleviate pain and other distressing symptoms
and to enhance the quality of life, not to hasten or post-
pone death.’’.
(b) AUTHORIZATION OF APPROPRIATIONS; ALLOCA-
TION.—
(1) IN GENERAL.—Section 758 of the Public
Health Service Act (as redesignated by subsection
(a)(1) of this section) is amended in subsection
(b)(1)(C) by striking ‘‘sections 753, 754, and 755’’
and inserting ‘‘sections 753, 754, 755, and 756’’.
(2) AMOUNT.—With respect to section 758 of
the Public Health Service Act (as redesignated by
subsection (a)(1) of this section), the dollar amount
specified in subsection (b)(1)(C) of such section is
deemed to be increased by $5,000,000.
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SEC. 203. EFFECTIVE DATE.
The amendments made by this title take effect Octo-
ber 1, 1999, or upon the date of the enactment of this
Act, whichever occurs later.
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Pain Relief Promotion
Act of 2000’’.
SEC. 2. FINDINGS.
Congress finds that—
(1) in the first decade of the new millennium
there should be a new emphasis on pain management
and palliative care;
(2) the use of certain narcotics and other drugs
or substances with a potential for abuse is strictly
regulated under the Controlled Substances Act;
(3) the dispensing and distribution of certain
controlled substances by properly registered practi-
tioners for legitimate medical purposes are permitted
under the Controlled Substances Act and imple-
menting regulations;
(4) the dispensing or distribution of certain con-
trolled substances for the purpose of relieving pain
and discomfort even if it increases the risk of death
is a legitimate medical purpose and is permissible
under the Controlled Substances Act;
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(5) inadequate treatment of pain, especially for
chronic diseases and conditions, irreversible diseases
such as cancer, and end-of-life care, is a serious pub-
lic health problem affecting hundreds of thousands of
patients every year; physicians should not hesitate to
dispense or distribute controlled substances when
medically indicated for these conditions; and
(6) for the reasons set forth in section 101 of the
Controlled Substances Act (21 U.S.C. 801), the dis-
pensing and distribution of controlled substances for
any purpose affect interstate commerce.
TITLE I—PROMOTING PAIN MAN-
AGEMENT 
AND 
PALLIATIVE
CARE
SEC. 101. ACTIVITIES OF AGENCY FOR HEALTHCARE RE-
SEARCH AND QUALITY.
Part A of title IX of the Public Health Service Act
(42 U.S.C. 299 et seq.) is amended by adding at the end
the following:
‘‘SEC. 903. PROGRAM FOR PAIN MANAGEMENT AND PALLIA-
TIVE CARE RESEARCH AND QUALITY.
‘‘(a) IN GENERAL.—Subject to subsections (e) and (f)
of section 902, the Director shall carry out a program to
accomplish the following:
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‘‘(1) Promote and advance scientific under-
standing of pain management and palliative care.
‘‘(2) Collect and disseminate protocols and evi-
dence-based practices regarding pain management
and palliative care, with priority given to pain man-
agement for terminally ill patients, and make such
information available to public and private health
care programs and providers, health professions
schools, and hospices, and to the general public.
‘‘(b) DEFINITION.—In this section, the term ‘pain
management and palliative care’ means—
‘‘(1) the active, total care of patients whose dis-
ease or medical condition is not responsive to curative
treatment or whose prognosis is limited due to pro-
gressive, far-advanced disease; and
‘‘(2) the evaluation, diagnosis, treatment, and
management of primary and secondary pain, whether
acute, chronic, persistent, intractable, or associated
with the end of life;
the purpose of which is to diagnose and alleviate pain and
other distressing signs and symptoms and to enhance the
quality of life, not to hasten or postpone death.’’.
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SEC. 102. ACTIVITIES OF HEALTH RESOURCES AND SERV-
ICES ADMINISTRATION.
(a) IN GENERAL.—Part D of title VII of the Public
Health Service Act (42 U.S.C. 294 et seq.) is amended—
(1) by redesignating sections 754 through 757 as
sections 755 through 758, respectively; and
(2) by inserting after section 753 the following:
‘‘SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN
PAIN MANAGEMENT AND PALLIATIVE CARE.
‘‘(a) IN GENERAL.—The Secretary, in consultation
with the Director of the Agency for Healthcare Research and
Quality, may award grants, cooperative agreements, and
contracts to health professions schools, hospices, and other
public and private entities for the development and imple-
mentation of programs to provide education and training
to health care professionals in pain management and pal-
liative care.
‘‘(b) PRIORITY.—In making awards under subsection
(a), the Secretary shall give priority to awards for the im-
plementation of programs under such subsection.
‘‘(c) CERTAIN TOPICS.—An award may be made under
subsection (a) only if the applicant for the award agrees
that the program to be carried out with the award will in-
clude information and education on—
‘‘(1) means for diagnosing and alleviating pain
and other distressing signs and symptoms of patients,
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especially terminally ill patients, including the medi-
cally appropriate use of controlled substances;
‘‘(2) applicable laws on controlled substances, in-
cluding laws permitting health care professionals to
dispense or administer controlled substances as needed
to relieve pain even in cases where such efforts may
unintentionally increase the risk of death; and
‘‘(3) recent findings, developments, and improve-
ments in the provision of pain management and pal-
liative care.
‘‘(d) PROGRAM
SITES.—Education and training
under subsection (a) may be provided at or through health
professions schools, residency training programs and other
graduate programs in the health professions, entities that
provide continuing medical education, hospices, and such
other programs or sites as the Secretary determines to be
appropriate.
‘‘(e) EVALUATION OF PROGRAMS.—The Secretary shall
(directly or through grants or contracts) provide for the
evaluation of programs implemented under subsection (a)
in order to determine the effect of such programs on knowl-
edge and practice regarding pain management and pallia-
tive care.
‘‘(f) PEER REVIEW GROUPS.—In carrying out section
799(f) with respect to this section, the Secretary shall ensure
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that the membership of each peer review group involved in-
cludes individuals with expertise and experience in pain
management and palliative care for the population of pa-
tients whose needs are to be served by the program.
‘‘(g) DEFINITION.—In this section, the term ‘pain
management and palliative care’ means—
‘‘(1) the active, total care of patients whose dis-
ease or medical condition is not responsive to curative
treatment or whose prognosis is limited due to pro-
gressive, far-advanced disease; and
‘‘(2) the evaluation, diagnosis, treatment, and
management of primary and secondary pain, whether
acute, chronic, persistent, intractable, or associated
with the end of life;
the purpose of which is to diagnose and alleviate pain and
other distressing signs and symptoms and to enhance the
quality of life, not to hasten or postpone death.’’.
(b) AUTHORIZATION
OF APPROPRIATIONS; ALLOCA-
TION.—
(1) IN
GENERAL.—Section 758 of the Public
Health Service Act (as redesignated by subsection
(a)(1) of this section) is amended, in subsection
(b)(1)(C), by striking ‘‘sections 753, 754, and 755’’
and inserting ‘‘sections 753, 754, 755, and 756’’.
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(2) AMOUNT.—With respect to section 758 of the
Public Health Service Act (as redesignated by sub-
section (a)(1) of this section), the dollar amount spec-
ified in subsection (b)(1)(C) of such section is deemed
to be increased by $5,000,000.
SEC. 103. DECADE OF PAIN CONTROL AND RESEARCH.
The calendar decade beginning January 1, 2001, is
designated as the ‘‘Decade of Pain Control and Research’’.
SEC. 104. EFFECTIVE DATE.
The amendments made by this title shall take effect
on the date of enactment of this Act.
TITLE II—USE OF CONTROLLED
SUBSTANCES 
CONSISTENT
WITH THE CONTROLLED SUB-
STANCES ACT
SEC. 201. REINFORCING EXISTING STANDARD FOR LEGITI-
MATE USE OF CONTROLLED SUBSTANCES.
(a) IN GENERAL.—Section 303 of the Controlled Sub-
stances Act (21 U.S.C. 823) is amended by adding at the
end the following:
‘‘(i)(1) For purposes of this Act and any regulations
to implement this Act, alleviating pain or discomfort in the
usual course of professional practice is a legitimate medical
purpose for the dispensing, distributing, or administering
of a controlled substance that is consistent with public
HR 2260 RS1S
health and safety, even if the use of such a substance may
increase the risk of death. Nothing in this section authorizes
intentionally dispensing, distributing, or administering a
controlled substance for the purpose of causing death or as-
sisting another person in causing death.
‘‘(2)(A) Notwithstanding any other provision of this
Act, in determining whether a registration is consistent
with the public interest under this Act, the Attorney Gen-
eral shall give no force and effect to State law authorizing
or permitting assisted suicide or euthanasia.
‘‘(B) Paragraph (2) applies only to conduct occurring
after the date of enactment of this subsection.
‘‘(3) Nothing in this subsection shall be construed to
alter the roles of the Federal and State governments in regu-
lating the practice of medicine. Regardless of whether the
Attorney General determines pursuant to this section that
the registration of a practitioner is inconsistent with the
public interest, it remains solely within the discretion of
State authorities to determine whether action should be
taken with respect to the State professional license of the
practitioner or State prescribing privileges.
‘‘(4) Nothing in the Pain Relief Promotion Act of 2000
(including the amendments made by such Act) shall be
construed—
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‘‘(A) to modify the Federal requirements that a
controlled substance be dispensed only for a legitimate
medical purpose pursuant to paragraph (1); or
‘‘(B) to provide the Attorney General with the
authority to issue national standards for pain man-
agement and palliative care clinical practice, re-
search, or quality;
except that the Attorney General may take such other ac-
tions as may be necessary to enforce this Act.’’.
(b) PAIN RELIEF.—Section 304(c) of the Controlled
Substances Act (21 U.S.C. 824(c)) is amended—
(1) by striking ‘‘(c) Before’’ and inserting the fol-
lowing:
‘‘(c) PROCEDURES.—
‘‘(1) ORDER TO SHOW CAUSE.—Before’’; and
(2) by adding at the end the following:
‘‘(2) BURDEN
OF
PROOF.—At any proceeding
under paragraph (1), where the order to show cause
is based on the alleged intentions of the applicant or
registrant to cause or assist in causing death, and the
practitioner claims a defense under paragraph (1) of
section 303(i), the Attorney General shall have the
burden of proving, by clear and convincing evidence,
that the practitioner’s intent was to dispense, dis-
tribute, or administer a controlled substance for the
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purpose of causing death or assisting another person
in causing death. In meeting such burden, it shall not
be sufficient to prove that the applicant or registrant
knew that the use of controlled substance may in-
crease the risk of death.’’.
SEC. 202. EDUCATION AND TRAINING PROGRAMS.
Section 502(a) of the Controlled Substances Act (21
U.S.C. 872(a)) is amended—
(1) by striking ‘‘and’’ at the end of paragraph
(5);
(2) by striking the period at the end of para-
graph (6) and inserting ‘‘; and’’; and
(3) by adding at the end the following:
‘‘(7) educational and training programs for Fed-
eral, State, and local personnel, incorporating rec-
ommendations, subject to the provisions of subsections
(e) and (f) of section 902 of the Public Health Service
Act, by the Secretary of Health and Human Services,
on the means by which investigation and enforcement
actions by law enforcement personnel may better ac-
commodate the necessary and legitimate use of con-
trolled substances in pain management and palliative
care.
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Nothing in this subsection shall be construed to alter the
roles of the Federal and State governments in regulating
the practice of medicine.’’.
SEC. 203. FUNDING AUTHORITY.
Notwithstanding any other provision of law, the oper-
ation of the diversion control fee account program of the
Drug Enforcement Administration shall be construed to in-
clude carrying out section 303(i) of the Controlled Sub-
stances Act (21 U.S.C. 823(i)), as added by this Act, and
subsections (a)(4) and (c)(2) of section 304 of the Controlled
Substances Act (21 U.S.C. 824), as amended by this Act.
SEC. 204. EFFECTIVE DATE.
The amendments made by this title shall take effect
on the date of enactment of this Act.
Calendar No. 566
106TH CONGRESS
2D SESSION
H. R. 2260
[Report No. 106–299]
AN ACT
To amend the Controlled Substances Act to pro-
mote pain management and palliative care with-
out permitting assisted suicide and euthanasia,
and for other purposes.
MAY 23, 2000
Reported with an amendment