IB 
Union Calendar No. 185 
114TH CONGRESS 
1ST SESSION H. R. 1462 
[Report No. 114–244] 
To combat the rise of prenatal opioid abuse and neonatal abstinence 
syndrome. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 19, 2015 
Ms. CLARK of Massachusetts (for herself and Mr. STIVERS) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
SEPTEMBER 8, 2015 
Additional sponsors: Mr. BARR, Mr. HASTINGS, Mr. ISRAEL, Mr. KEATING, 
Ms. MENG, Ms. MOORE, Ms. TSONGAS, Mr. YARMUTH, Mrs. LAWRENCE, 
Mr. MCGOVERN, Mr. NEWHOUSE, Mr. JENKINS of West Virginia, Mr. 
TONKO, Mr. CARTWRIGHT, Mr. KENNEDY, Mrs. BUSTOS, Mr. LANCE, 
Mrs. COMSTOCK, Ms. CASTOR of Florida, Mr. TURNER, Mr. MOULTON, 
Mr. COHEN, Mr. MOONEY of West Virginia, Mr. ROGERS of Kentucky, 
Mr. LYNCH, Mr. CRAMER, Mr. HARPER, Mr. DESAULNIER, Mrs. BROOKS 
of Indiana, Mr. HANNA, Mr. COLLINS of New York, Mr. GRIJALVA, Mr. 
LARSON of Connecticut, Mr. MULLIN, Mr. PETERS, Mr. DOLD, Mrs. 
BEATTY, Mr. AMODEI, Ms. KUSTER, Mr. GUTHRIE, Ms. DELBENE, Mr. 
HULTGREN, Mr. HECK of Nevada, Mr. YOUNG of Alaska, Mr. MCCAUL, 
Mr. BISHOP of Georgia, Mr. CICILLINE, Mr. WELCH, Mr. DOGGETT, Mr. 
BRADY of Pennsylvania, Mr. HINOJOSA, Mr. PIERLUISI, Mrs. BLACK, 
Ms. STEFANIK, Mr. TED LIEU of California, Mr. HIGGINS, Mr. LEVIN, 
Mrs. DINGELL, Mr. LUCAS, Ms. WASSERMAN SCHULTZ, Mr. WHITFIELD, 
Mr. PERLMUTTER, Mr. RODNEY DAVIS of Illinois, Mr. SWALWELL of 
California, Ms. SLAUGHTER, Ms. CLARKE of New York, Mr. ROE of Ten-
nessee, Mr. YOUNG of Iowa, Ms. PINGREE, Ms. SCHAKOWSKY, Mr. 
JOLLY, Mr. TIBERI, Mr. COOPER, Mr. CAPUANO, Mr. DUNCAN of Ten-
nessee, Mr. NEAL, Mr. FITZPATRICK, Mr. BILIRAKIS, Mr. YOUNG of Indi-
ana, Mr. SEAN PATRICK MALONEY of New York, Mr. CA´RDENAS, Mr. 
LOEBSACK, Ms. MATSUI, Mr. KILMER, Ms. KAPTUR, Mr. RYAN of Ohio, 
Mr. JOHNSON of Ohio, Mrs. NAPOLITANO, Mr. JOYCE, Ms. BROWNLEY 
of California, Ms. ESTY, Mr. MESSER, Ms. DELAURO, Mr. COSTELLO of 
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Pennsylvania, Ms. FUDGE, Ms. SINEMA, Ms. HERRERA BEUTLER, and 
Mr. MACARTHUR 
SEPTEMBER 8, 2015 
Committed to the Committee of the Whole House on the State of the Union 
and ordered to be printed 
A BILL 
To combat the rise of prenatal opioid abuse and neonatal 
abstinence syndrome. 
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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 ‘‘Protecting Our Infants 
Act of 2015’’. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
(1) Opioid prescription rates have risen dra-
matically over the past several years. According to 
the Centers for Disease Control and Prevention, in 
some States, there are as many as 96 to 143 pre-
scriptions for opioids per 100 adults per year. 
(2) In recent years, there has been a steady rise 
in the number of overdose deaths involving heroin. 
According to the Centers for Disease Control and 
Prevention, the death rate for heroin overdose dou-
bled from 2010 to 2012. 
(3) At the same time, there has been an in-
crease in cases of neonatal abstinence syndrome (re-
ferred to in this section as ‘‘NAS’’). In the United 
States, the incidence of NAS has risen from 1.20 
per 1,000 hospital births in 2000 to 3.39 per 1,000 
hospital births in 2009. 
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(4) NAS refers to medical issues associated 
with drug withdrawal in newborns due to exposure 
to opioids or other drugs in utero. 
(5) The average cost of treatment in a hospital 
for NAS increased from $39,400 in 2000 to $53,400 
in 2009. Most of these costs are born by the Med-
icaid program. 
(6) Preventing opioid abuse among pregnant 
women and women of childbearing age is crucial. 
(7) Medically appropriate opioid use in preg-
nancy is not uncommon, and opioids are often the 
safest and most appropriate treatment for moderate 
to severe pain for pregnant women. 
(8) Addressing NAS effectively requires a focus 
on women of childbearing age, pregnant women, and 
infants from preconception through early childhood. 
(9) NAS can result from the use of prescription 
drugs as prescribed for medical reasons, from the 
abuse of prescription drugs, or from the use of ille-
gal opioids like heroin. 
(10) For pregnant women who are abusing 
opioids, it is most appropriate to treat and manage 
maternal substance use in a non-punitive manner. 
(11) According to a report of the Government 
Accountability Office (referred to in this section as 
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the ‘‘GAO report’’), more research is needed to opti-
mize the identification and treatment of babies with 
NAS and to better understand long-term impacts on 
children. 
(12) According to the GAO report, the Depart-
ment of Health and Human Services does not have 
a focal point to lead planning and coordinating ef-
forts to address prenatal opioid use and NAS across 
the department. 
(13) According to the GAO report, ‘‘given the 
increasing use of heroin and abuse of opioids pre-
scribed for pain management, as well as the in-
creased rate of NAS in the United States, it is im-
portant to improve the efficiency and effectiveness of 
planning and coordination of Federal efforts on pre-
natal opioid use and NAS’’. 
SEC. 
3. 
DEVELOPING 
RECOMMENDATIONS 
FOR 
PRE-
VENTING AND TREATING PRENATAL OPIOID 
ABUSE AND NEONATAL ABSTINENCE SYN-
DROME. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (referred to in this Act as the ‘‘Sec-
retary’’), acting through the Director of the Agency for 
Healthcare Research and Quality (referred to in this sec-
tion as the ‘‘Director’’), shall conduct a study and develop 
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recommendations for preventing and treating prenatal 
opioid abuse and neonatal abstinence syndrome, soliciting 
input from nongovernmental entities, including organiza-
tions representing patients, health care providers, hos-
pitals, other treatment facilities, and other entities, as ap-
propriate. 
(b) REPORT.—Not later than 1 year after the date 
of enactment of this Act, the Director shall publish on the 
Internet Web site of the Agency for Healthcare Research 
and Quality a report on the study and recommendations 
under subsection (a). Such report shall address each of 
the issues described in paragraphs (1) through (3) of sub-
section (c). 
(c) CONTENTS.—The study described in subsection 
(a) and the report under subsection (b) shall include— 
(1) a comprehensive assessment of existing re-
search with respect to the prevention, identification, 
treatment, and long-term outcomes of neonatal ab-
stinence syndrome, including the identification and 
treatment of pregnant women or women who may 
become pregnant who use opioids or other drugs; 
(2) an evaluation of— 
(A) the causes of and risk factors for 
opioid use disorders among women of reproduc-
tive age, including pregnant women; 
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(B) the barriers to identifying and treating 
opioid use disorders among women of reproduc-
tive age, including pregnant and postpartum 
women and women with young children; 
(C) current practices in the health care 
system to respond to and treat pregnant women 
with opioid use disorders and infants born with 
neonatal abstinence syndrome; 
(D) medically indicated use of opioids dur-
ing pregnancy; 
(E) access to treatment for opioid use dis-
orders in pregnant and postpartum women; and 
(F) access to treatment for infants with 
neonatal abstinence syndrome; and 
(3) recommendations on— 
(A) preventing, identifying, and treating 
neonatal abstinence syndrome in infants; 
(B) treating pregnant women who are de-
pendent on opioids; and 
(C) preventing opioid dependence among 
women of reproductive age, including pregnant 
women, who may be at risk of developing opioid 
dependence. 
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SEC. 4. IMPROVING PREVENTION AND TREATMENT FOR 
PRENATAL OPIOID ABUSE AND NEONATAL 
ABSTINENCE SYNDROME. 
(a) REVIEW
OF PROGRAMS.—The Secretary shall 
lead a review of planning and coordination within the De-
partment of Health and Human Services related to pre-
natal opioid use and neonatal abstinence syndrome. 
(b) STRATEGY TO CLOSE GAPS IN RESEARCH AND 
PROGRAMMING.—In carrying out subsection (a), the Sec-
retary shall develop a strategy to address research and 
program gaps, including such gaps identified in findings 
made by reports of the Government Accountability Office. 
Such strategy shall address— 
(1) gaps in research, including with respect 
to— 
(A) the most appropriate treatment of 
pregnant women with opioid use disorders; 
(B) the most appropriate treatment and 
management of infants with neonatal absti-
nence syndrome; and 
(C) the long-term effects of prenatal opioid 
exposure on children; and 
(2) gaps in programs, including— 
(A) the availability of treatment programs 
for pregnant and postpartum women and for 
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newborns with neonatal abstinence syndrome; 
and 
(B) guidance and coordination in Federal 
efforts to address prenatal opioid use or neo-
natal abstinence syndrome. 
(c) REPORT.—Not later than 1 year after the date 
of enactment of this Act, the Secretary shall submit to 
the Committee on Health, Education, Labor, and Pen-
sions of the Senate and the Committee on Energy and 
Commerce of the House of Representatives a report on 
the findings of the review described in subsection (a) and 
the strategy developed under subsection (b). 
SEC. 5. IMPROVING DATA ON AND PUBLIC HEALTH RE-
SPONSE TO NEONATAL ABSTINENCE SYN-
DROME. 
(a) DATA AND SURVEILLANCE.—The Director of the 
Centers for Disease Control and Prevention shall, as ap-
propriate— 
(1) provide technical assistance to States to im-
prove the availability and quality of data collection 
and surveillance activities regarding neonatal absti-
nence syndrome, including— 
(A) the incidence and prevalence of neo-
natal abstinence syndrome; 
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Union Calendar No. 185 
114TH CONGRESS 
1ST SESSION 
H. R. 1462 
[Report No. 114–244] 
A BILL 
To combat the rise of prenatal opioid abuse and 
neonatal abstinence syndrome. 
SEPTEMBER 8, 2015 
Committed to the Committee of the Whole House on the 
State of the Union and ordered to be printed 
VerDate Sep 11 2014 
01:20 Sep 09, 2015
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