IIB 
115TH CONGRESS 
2D SESSION 
H. R. 5812 
IN THE SENATE OF THE UNITED STATES 
JUNE 13, 2018 
Received; read twice and referred to the Committee on Health, Education, 
Labor, and Pensions 
AN ACT 
To amend the Public Health Service Act to authorize the 
Director of the Centers for Disease Control and Preven-
tion to carry out certain activities to prevent controlled 
substances overdoses, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Creating Opportunities 
that Necessitate New and Enhanced Connections That 
Improve Opioid Navigation Strategies Act of 2018’’ or the 
‘‘CONNECTIONS Act’’. 
SEC. 2. PREVENTING OVERDOSES OF CONTROLLED SUB-
STANCES. 
Part P of title III of the Public Health Service Act 
(42 U.S.C. 280g et seq.) is amended by adding at the end 
the following new section: 
‘‘SEC. 399V–7. PREVENTING OVERDOSES OF CONTROLLED 
SUBSTANCES. 
‘‘(a) EVIDENCE-BASED PREVENTION GRANTS.— 
‘‘(1) IN GENERAL.—The Director of the Cen-
ters for Disease Control and Prevention may— 
‘‘(A) to the extent practicable, carry out 
any evidence-based prevention activity described 
in paragraph (2); 
‘‘(B) provide training and technical assist-
ance to States, localities, and Indian tribes for 
purposes of carrying out any such activity; and 
‘‘(C) award grants to States, localities, and 
Indian tribes for purposes of carrying out any 
such activity. 
‘‘(2) EVIDENCE-BASED
PREVENTION
ACTIVI-
TIES.—An evidence-based prevention activity de-
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scribed in this paragraph is any of the following ac-
tivities: 
‘‘(A) With respect to a State, improving 
the efficiency and use of the State prescription 
drug monitoring program by— 
‘‘(i) encouraging all authorized users 
(as specified by the State) to register with 
and use the program and making the pro-
gram easier to use; 
‘‘(ii) enabling such users to access any 
updates to information collected by the 
program in as close to real-time as pos-
sible; 
‘‘(iii) providing for a mechanism for 
the program to automatically flag any po-
tential misuse or abuse of controlled sub-
stances and any detection of inappropriate 
prescribing practices relating to such sub-
stances; 
‘‘(iv) enhancing interoperability be-
tween the program and any electronic 
health records system, including by inte-
grating the use of electronic health records 
into the program for purposes of improving 
clinical decisionmaking; 
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‘‘(v) continually updating program ca-
pabilities to respond to technological inno-
vation for purposes of appropriately ad-
dressing a controlled substance overdose 
epidemic as such epidemic may occur and 
evolve; 
‘‘(vi) facilitating data sharing between 
the program and the prescription drug 
monitoring 
programs 
of 
neighboring 
States; and 
‘‘(vii) meeting the purpose of the pro-
gram established under section 399O, as 
described in section 399O(a). 
‘‘(B) Achieving community or health sys-
tem interventions through activities such as— 
‘‘(i) establishing or improving con-
trolled substances prescribing interventions 
for insurers and health systems; 
‘‘(ii) enhancing the use of evidence- 
based controlled substances prescribing 
guidelines across sectors and health care 
settings; and 
‘‘(iii) implementing strategies to align 
the prescription of controlled substances 
with the guidelines described in clause (ii). 
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‘‘(C) Evaluating interventions to better un-
derstand what works to prevent overdoses, in-
cluding those involving prescription and illicit 
controlled substances. 
‘‘(D) Implementing projects to advance an 
innovative prevention approach with respect to 
new and emerging public health crises and op-
portunities to address such crises, such as en-
hancing public education and awareness on the 
risks associated with opioids. 
‘‘(b) ENHANCED SURVEILLANCE OF CONTROLLED 
SUBSTANCE OVERDOSE GRANTS.— 
‘‘(1) IN GENERAL.—The Director of the Cen-
ters for Disease Control and Prevention may— 
‘‘(A) to the extent practicable, carry out 
any controlled substance overdose surveillance 
activity described in paragraph (2); 
‘‘(B) provide training and technical assist-
ance to States for purposes of carrying out any 
such activity; 
‘‘(C) award grants to States for purposes 
of carrying out any such activity; and 
‘‘(D) coordinate with the Assistant Sec-
retary for Mental Health and Substance Use to 
collect data pursuant to section 505(d)(1)(A) 
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(relating to the number of individuals admitted 
to the emergency rooms of hospitals as a result 
of the abuse of alcohol or other drugs). 
‘‘(2) CONTROLLED SUBSTANCE OVERDOSE SUR-
VEILLANCE
ACTIVITIES.—A controlled substance 
overdose surveillance activity described in this para-
graph is any of the following activities: 
‘‘(A) Enhancing the timeliness of reporting 
data to the public, including data on fatal and 
nonfatal overdoses of controlled substances. 
‘‘(B) Enhancing comprehensiveness of data 
on controlled substances overdoses by collecting 
information on such overdoses from appropriate 
sources such as toxicology reports, autopsy re-
ports, death scene investigations, and other risk 
factors. 
‘‘(C) Using data to help identify risk fac-
tors associated with controlled substances 
overdoses. 
‘‘(D) With respect to a State, supporting 
entities involved in providing information to in-
form efforts within the State, such as by coro-
ners and medical examiners, to improve accu-
rate testing and reporting of causes and con-
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tributing 
factors 
to 
controlled 
substances 
overdoses. 
‘‘(E) Working to enable information shar-
ing regarding controlled substances overdoses 
among data sources. 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) CONTROLLED
SUBSTANCE.—The term 
‘controlled substance’ has the meaning given that 
term in section 102 of the Controlled Substances 
Act. 
‘‘(2) INDIAN TRIBE.—The term ‘Indian tribe’ 
has the meaning given that term in section 4 of the 
Indian Self-Determination and Education Assistance 
Act. 
‘‘(d) AUTHORIZATION
OF
APPROPRIATIONS.—For 
purposes of carrying out this section and section 399O, 
there is authorized to be appropriated $486,000,000 for 
each of fiscal years 2019 through 2023.’’. 
SEC. 3. PRESCRIPTION DRUG MONITORING PROGRAM. 
Section 399O of the Public Health Service Act (42 
U.S.C. 280g–3) is amended to read as follows: 
‘‘SEC. 399O. PRESCRIPTION DRUG MONITORING PROGRAM. 
‘‘(a) PROGRAM.— 
‘‘(1) IN GENERAL.—Each fiscal year, the Sec-
retary, in consultation with the Director of National 
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Drug Control Policy, acting through the Director of 
the Centers for Disease Control and Prevention, the 
Assistant Secretary for Mental Health and Sub-
stance Use, and the National Coordinator for Health 
Information Technology, shall support States for the 
purpose of improving the efficiency and use of 
PDMPs, including— 
‘‘(A) establishment and implementation of 
a PDMP; 
‘‘(B) maintenance of a PDMP; 
‘‘(C) improvements to a PDMP by— 
‘‘(i) enhancing functional components 
to work toward— 
‘‘(I) universal use of PDMPs 
among providers and their delegates, 
to the extent that State laws allow, 
within a State; 
‘‘(II) more timely inclusion of 
data within a PDMP; 
‘‘(III) active management of the 
PDMP, in part by sending proactive 
or unsolicited reports to providers to 
inform prescribing; and 
‘‘(IV) ensuring the highest level 
of ease in use and access of PDMPs 
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by providers and their delegates, to 
the extent that State laws allow; 
‘‘(ii) improving the intrastate inter-
operability of PDMPs by— 
‘‘(I) making PDMPs more ac-
tionable by integrating PDMPs within 
electronic health records and health 
information technology infrastructure; 
and 
‘‘(II) linking PDMP data to 
other data systems within the State, 
including— 
‘‘(aa) the data of pharmacy 
benefit managers, medical exam-
iners and coroners, and the 
State’s Medicaid program; 
‘‘(bb) worker’s compensation 
data; and 
‘‘(cc) prescribing data of 
providers of the Department of 
Veterans Affairs and the Indian 
Health Service within the State; 
‘‘(iii) improving the interstate inter-
operability of PDMPs through— 
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‘‘(I) sharing of dispensing data in 
near-real time across State lines; and 
‘‘(II) integration of automated 
queries for multistate PDMP data 
and analytics into clinical workflow to 
improve the use of such data and ana-
lytics by practitioners and dispensers; 
or 
‘‘(iv) improving the ability to include 
treatment availability resources and refer-
ral capabilities within the PDMP. 
‘‘(2) STATE LEGISLATION.—As a condition on 
the receipt of support under this section, the Sec-
retary shall require a State to demonstrate that the 
State has enacted legislation or regulations— 
‘‘(A) to provide for the implementation of 
the PDMP; and 
‘‘(B) to permit the imposition of appro-
priate penalties for the unauthorized use and 
disclosure of information maintained by the 
PDMP. 
‘‘(b) PDMP STRATEGIES.—The Secretary shall en-
courage a State, in establishing, improving, or maintaining 
a PDMP, to implement strategies that improve— 
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‘‘(1) the reporting of dispensing in the State of 
a controlled substance to an ultimate user so the re-
porting occurs not later than 24 hours after the dis-
pensing event; 
‘‘(2) the consultation of the PDMP by each pre-
scribing practitioner, or their designee, in the State 
before initiating treatment with a controlled sub-
stance, or any substance as required by the State to 
be reported to the PDMP, and over the course of 
ongoing treatment for each prescribing event; 
‘‘(3) the consultation of the PDMP before dis-
pensing a controlled substance, or any substance as 
required by the State to be reported to the PDMP; 
‘‘(4) the proactive notification to a practitioner 
when patterns indicative of controlled substance mis-
use by a patient, including opioid misuse, are de-
tected; 
‘‘(5) the availability of data in the PDMP to 
other States, as allowable under State law; and 
‘‘(6) the availability of nonidentifiable informa-
tion to the Centers for Disease Control and Preven-
tion for surveillance, epidemiology, statistical re-
search, or educational purposes. 
‘‘(c) DRUG MISUSE AND ABUSE.—In consultation 
with practitioners, dispensers, and other relevant and in-
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terested stakeholders, a State receiving support under this 
section— 
‘‘(1) shall establish a program to notify practi-
tioners and dispensers of information that will help 
to identify and prevent the unlawful diversion or 
misuse of controlled substances; and 
‘‘(2) may, to the extent permitted under State 
law, notify the appropriate authorities responsible 
for carrying out drug diversion investigations if the 
State determines that information in the PDMP 
maintained by the State indicates an unlawful diver-
sion or abuse of a controlled substance. 
‘‘(d) EVALUATION AND REPORTING.—As a condition 
on receipt of support under this section, the State shall 
report on interoperability with PDMPs of other States and 
Federal agencies, where appropriate, intrastate interoper-
ability with health information technology systems such as 
electronic health records, health information exchanges, 
and e-prescribing, where appropriate, and whether or not 
the State provides automatic, up-to-date, or daily informa-
tion about a patient when a practitioner (or the designee 
of a practitioner, where permitted) requests information 
about such patient. 
‘‘(e) EVALUATION AND REPORTING.—A State receiv-
ing support under this section shall provide the Secretary 
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with aggregate nonidentifiable information, as permitted 
by State law, to enable the Secretary— 
‘‘(1) to evaluate the success of the State’s pro-
gram in achieving the purpose described in sub-
section (a); or 
‘‘(2) to prepare and submit to the Congress the 
report required by subsection (i)(2). 
‘‘(f) EDUCATION AND ACCESS TO THE MONITORING 
SYSTEM.—A State receiving support under this section 
shall take steps to— 
‘‘(1) facilitate prescribers and dispensers, and 
their delegates, as permitted by State law, to use the 
PDMP, to the extent practicable; and 
‘‘(2) educate prescribers and dispensers, and 
their delegates on the benefits of the use of PDMPs. 
‘‘(g) ELECTRONIC FORMAT.—The Secretary may 
issue guidelines specifying a uniform electronic format for 
the reporting, sharing, and disclosure of information pur-
suant to PDMPs. 
‘‘(h) RULES OF CONSTRUCTION.— 
‘‘(1) FUNCTIONS OTHERWISE AUTHORIZED BY 
LAW.—Nothing in this section shall be construed to 
restrict the ability of any authority, including any 
local, State, or Federal law enforcement, narcotics 
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control, licensure, disciplinary, or program authority, 
to perform functions otherwise authorized by law. 
‘‘(2) ADDITIONAL
PRIVACY
PROTECTIONS.— 
Nothing in this section shall be construed as pre-
empting any State from imposing any additional pri-
vacy protections. 
‘‘(3) FEDERAL
PRIVACY
REQUIREMENTS.— 
Nothing in this section shall be construed to super-
sede any Federal privacy or confidentiality require-
ment, including the regulations promulgated under 
section 264(c) of the Health Insurance Portability 
and Accountability Act of 1996 (Public Law 104– 
191; 110 Stat. 2033) and section 543 of this Act. 
‘‘(4) NO
FEDERAL
PRIVATE
CAUSE
OF
AC-
TION.—Nothing in this section shall be construed to 
create a Federal private cause of action. 
‘‘(i) PROGRESS REPORT.—Not later than 3 years 
after the date of enactment of the CONNECTIONS Act, 
the Secretary shall— 
‘‘(1) complete a study that— 
‘‘(A) determines the progress of States in 
establishing and implementing PDMPs con-
sistent with this section; 
‘‘(B) provides an analysis of the extent to 
which the operation of PDMPs has— 
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‘‘(i) reduced inappropriate use, abuse, 
diversion of, and overdose with, controlled 
substances; 
‘‘(ii) established or strengthened ini-
tiatives to ensure linkages to substance use 
disorder treatment services; or 
‘‘(iii) affected patient access to appro-
priate care in States operating PDMPs; 
‘‘(C) determine the progress of States in 
achieving interstate interoperability and intra-
state interoperability of PDMPs, including an 
assessment of technical, legal, and financial 
barriers to such progress and recommendations 
for addressing these barriers; 
‘‘(D) determines the progress of States in 
implementing near real-time electronic PDMPs; 
‘‘(E) provides an analysis of the privacy 
protections in place for the information re-
ported to the PDMP in each State receiving 
support under this section and any rec-
ommendations of the Secretary for additional 
Federal or State requirements for protection of 
this information; 
‘‘(F) determines the progress of States in 
implementing technological alternatives to cen-
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tralized data storage, such as peer-to-peer file 
sharing or data pointer systems, in PDMPs and 
the potential for such alternatives to enhance 
the privacy and security of individually identifi-
able data; and 
‘‘(G) evaluates the penalties that States 
have enacted for the unauthorized use and dis-
closure of information maintained in PDMPs, 
and the criteria used by the Secretary to deter-
mine whether such penalties qualify as appro-
priate for purposes of subsection (a)(2); and 
‘‘(2) submit a report to the Congress on the re-
sults of the study. 
‘‘(j) ADVISORY COUNCIL.— 
‘‘(1) ESTABLISHMENT.—A State may establish 
an advisory council to assist in the establishment, 
improvement, or maintenance of a PDMP consistent 
with this section. 
‘‘(2) LIMITATION.—A State may not use Fed-
eral funds for the operations of an advisory council 
to assist in the establishment, improvement, or 
maintenance of a PDMP. 
‘‘(3) SENSE OF CONGRESS.—It is the sense of 
the Congress that, in establishing an advisory coun-
cil to assist in the establishment, improvement, or 
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maintenance of a PDMP, a State should consult 
with appropriate professional boards and other inter-
ested parties. 
‘‘(k) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘controlled substance’ means a 
controlled substance (as defined in section 102 of 
the Controlled Substances Act) in schedule II, III, 
or IV of section 202 of such Act. 
‘‘(2) The term ‘dispense’ means to deliver a 
controlled substance to an ultimate user by, or pur-
suant to the lawful order of, a practitioner, irrespec-
tive of whether the dispenser uses the internet or 
other means to effect such delivery. 
‘‘(3) The term ‘dispenser’ means a physician, 
pharmacist, or other person that dispenses a con-
trolled substance to an ultimate user. 
‘‘(4) The term ‘interstate interoperability’ with 
respect to a PDMP means the ability of the PDMP 
to electronically share reported information with an-
other State if the information concerns either the 
dispensing of a controlled substance to an ultimate 
user who resides in such other State, or the dis-
pensing of a controlled substance prescribed by a 
practitioner whose principal place of business is lo-
cated in such other State. 
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‘‘(5) The term ‘intrastate interoperability’ with 
respect to a PDMP means the integration of PDMP 
data within electronic health records and health in-
formation technology infrastructure or linking of a 
PDMP to other data systems within the State, in-
cluding the State’s Medicaid program, workers’ com-
pensation programs, and medical examiners or coro-
ners. 
‘‘(6) The term ‘nonidentifiable information’ 
means information that does not identify a practi-
tioner, dispenser, or an ultimate user and with re-
spect to which there is no reasonable basis to believe 
that the information can be used to identify a practi-
tioner, dispenser, or an ultimate user. 
‘‘(7) The term ‘PDMP’ means a prescription 
drug monitoring program that is State-controlled. 
‘‘(8) The term ‘practitioner’ means a physician, 
dentist, veterinarian, scientific investigator, phar-
macy, hospital, or other person licensed, registered, 
or otherwise permitted, by the United States or the 
jurisdiction in which the individual practices or does 
research, to distribute, dispense, conduct research 
with respect to, administer, or use in teaching or 
chemical analysis, a controlled substance in the 
course of professional practice or research. 
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‘‘(9) The term ‘State’ means each of the 50 
States, the District of Columbia, and any common-
wealth or territory of the United States. 
‘‘(10) The term ‘ultimate user’ means a person 
who has obtained from a dispenser, and who pos-
sesses, a controlled substance for the person’s own 
use, for the use of a member of the person’s house-
hold, or for the use of an animal owned by the per-
son or by a member of the person’s household. 
‘‘(11) The term ‘clinical workflow’ means the 
integration of automated queries for prescription 
drug monitoring programs data and analytics into 
health information technologies such as electronic 
health record systems, health information exchanges, 
and/or pharmacy dispensing software systems, thus 
streamlining provider access through automated que-
ries.’’. 
Passed the House of Representatives June 12, 2018. 
Attest: 
KAREN L. HAAS, 
Clerk. 
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