I 
115TH CONGRESS 
2D SESSION 
H. R. 5197 
To direct the Secretary of Health and Human Services to conduct a dem-
onstration program to test alternative pain management protocols to 
limit the use of opioids in emergency departments. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 7, 2018 
Mr. PASCRELL (for himself, Mr. MCKINLEY, Ms. DEGETTE, and Mr. TIPTON) 
introduced the following bill; which was referred to the Committee on En-
ergy and Commerce 
A BILL 
To direct the Secretary of Health and Human Services to 
conduct a demonstration program to test alternative pain 
management protocols to limit the use of opioids in emer-
gency departments. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Alternatives to Opioids 
(ALTO) in the Emergency Department Act’’. 
SEC. 2. FINDINGS. 
The Congress finds as follows: 
VerDate Sep 11 2014 
03:56 Mar 14, 2018
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H5197.IH
H5197
dlhill on DSK3GLQ082PROD with BILLS
(1) Opioids contributed to the deaths of more 
than 42,000 people in 2016, more than any year on 
official record. Forty percent of all opioid overdose 
deaths involve a prescription opioid. 
(2) The economic burden of prescription opioid 
misuse in the United States is estimated to be 
$78,500,000,000 per year. This includes costs stem-
ming from health care, including addiction treat-
ment, lost productivity, and criminal justice involve-
ment. 
(3) Over 200 million opioid prescriptions are 
written in the United States each year, and 
2,000,000 Americans have the symptoms of sub-
stance use disorder. 
(4) Approximately 21 to 29 percent of patients 
prescribed opioids for chronic pain misuse them. 
(5) Emergency departments in several States, 
including in New Jersey and Colorado, have devel-
oped innovative programs to more widely utilize non- 
opioid pain treatments to reduce the use of opioids. 
SEC. 3. EMERGENCY DEPARTMENT ALTERNATIVES TO 
OPIOIDS DEMONSTRATION PROGRAM. 
(a) DEMONSTRATION PROGRAM GRANTS.—The Sec-
retary of Health and Human Services acting through the 
Assistant Secretary for Mental Health and Substance Use 
VerDate Sep 11 2014 
03:56 Mar 14, 2018
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H5197.IH
H5197
dlhill on DSK3GLQ082PROD with BILLS
(in this section referred to as the ‘‘Secretary’’) shall carry 
out a 3-year demonstration program under which the Sec-
retary shall award grants to eligible hospitals and emer-
gency departments, including freestanding emergency de-
partments, to develop, implement, enhance, or study alter-
native pain management protocols and treatments that 
promote the appropriate limited use of opioids in emer-
gency departments. 
(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), a hospital or emergency department 
shall submit an application to the Secretary at such time, 
in such manner, and containing such information as the 
Secretary may require. 
(c) GEOGRAPHIC DIVERSITY.—In awarding grants 
under this section, the Secretary shall seek to ensure geo-
graphical diversity among grant recipients. 
(d) USE OF FUNDS.—In addition to the activities de-
scribed in subsection (a), grants under this section shall 
be used to— 
(1) target common painful conditions, which 
may include renal colic, sciatica, headaches, mus-
culoskeletal pain, and extremity fractures; 
(2) train providers and other hospital personnel 
on protocols and use of treatments that promote the 
VerDate Sep 11 2014 
03:56 Mar 14, 2018
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H5197.IH
H5197
dlhill on DSK3GLQ082PROD with BILLS
appropriate limited use of opioids in the emergency 
department; 
(3) collect data, including data required for the 
reporting requirement established under subsection 
(f); and 
(4) provide alternatives to opioids to patients 
with painful conditions, not including patients who 
present with pain related to cancer, end-of-life symp-
tom palliation, or complex multisystem trauma. 
(e) DUTIES
OF
THE SECRETARY.—The Secretary 
shall offer to each recipient of a grant under subsection 
(a) technical support through a process that provides 
for— 
(1) the provision of information by the Sec-
retary on alternative pain management protocols and 
treatments, which may include— 
(A) non-opioid medications; 
(B) protocols and treatments that do not 
involve a medication; 
(C) alternative pain management protocols 
and treatments that are appropriate to use for 
specific common painful conditions, such as 
renal colic, back pain, pain from fractures, and 
other common painful conditions that present 
to the emergency department; 
VerDate Sep 11 2014 
22:10 Mar 16, 2018
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H5197.IH
H5197
dlhill on DSK3GLQ082PROD with BILLS
(D) the alternative pain management pro-
tocol or treatments, if any, that are appropriate 
for certain patient populations, such as geri-
atric patients, pregnant patients, and pediatric 
patients; and 
(E) any other information the Secretary 
determines necessary; and 
(2) the provision of information by emergency 
departments and providers that have successfully 
implemented alternatives to opioids programs in the 
emergency department, promoting non-opioid proto-
cols and medications while appropriately limiting the 
use of opioids. 
(f) REPORT TO THE SECRETARY.—Each recipient of 
a grant under this section shall submit to the Secretary 
annual evaluations of the progress of the program funded 
through the grant. These evaluations shall include— 
(1) a description of and specific information 
about the alternative pain management protocols 
and treatments employed; 
(2) data on the alternative pain management 
protocols and treatments employed, including— 
(A) during a baseline period before the 
program began, as defined by the Secretary; 
VerDate Sep 11 2014 
03:56 Mar 14, 2018
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H5197.IH
H5197
dlhill on DSK3GLQ082PROD with BILLS
(B) at various stages of the program, as 
determined by the Secretary; 
(C) the conditions for which the alternative 
pain management protocols and treatments 
were employed; and 
(D) data on patients’ self-reported pain 
rating, using a pain scale model provided by the 
Secretary, before and after the alternative pain 
management protocol or treatment was pro-
vided; 
(3) data on the opioid prescriptions written, in-
cluding— 
(A) during a baseline period before the 
program began, as defined by the Secretary; 
(B) at various stages of the program, as 
determined by the Secretary; 
(C) the conditions for which the opioids 
were prescribed; and 
(D) data on patients’ self-reported pain 
rating, using a pain scale model provided by the 
Secretary, before and after the opioid prescrip-
tion was provided; 
(4) the demographic characteristics of patients 
who were treated with an alternative pain manage-
VerDate Sep 11 2014 
03:56 Mar 14, 2018
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H5197.IH
H5197
dlhill on DSK3GLQ082PROD with BILLS
ment protocol, including age, sex, race, ethnicity, 
and insurance status and type; 
(5) data on patients who were eventually pre-
scribed opioids after alternative pain management 
protocols and treatments were employed; 
(6) data on patients who were transitioned to 
inpatient care following treatment with an alter-
native pain management protocol and treatment; 
and 
(7) any other information the Secretary deems 
necessary. 
(g) REPORT TO CONGRESS.—Not later than 120 days 
after completion of the demonstration program under this 
section, the Secretary shall submit a report to the Con-
gress on the results of the demonstration program and in-
clude in the report— 
(1) the number of applications received and the 
number funded; 
(2) a summary of the evaluations described in 
subsection (f), including standardized data; and 
(3) recommendations for broader implementa-
tion of pain management protocols that limit the use 
of opioids in emergency departments or other areas 
of the health care delivery system. 
VerDate Sep 11 2014 
03:56 Mar 14, 2018
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H5197.IH
H5197
dlhill on DSK3GLQ082PROD with BILLS
(h) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there is authorized to be appropriated 
$10,000,000 for each of fiscal years 2019 through 2021. 
Æ 
VerDate Sep 11 2014 
03:56 Mar 14, 2018
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6301
E:\BILLS\H5197.IH
H5197
dlhill on DSK3GLQ082PROD with BILLS