Union Calendar No. 229
106TH CONGRESS
1ST SESSION
H. R. 2260
[Report No. 106–378, Parts I and II]
A BILL
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.
OCTOBER 18, 1999
Reported from the Committee on Commerce with amend-
ments, committed to the Committee of the Whole
House on the State of the Union, and ordered to be
printed
IB
Union Calendar No. 229
106TH CONGRESS
1ST SESSION
H. R. 2260
[Report No. 106–378, Parts I and II]
To amend the Controlled Substances Act to promote pain management and
palliative care without permitting assisted suicide and euthanasia, and
for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JUNE 17, 1999
Mr. HYDE (for himself, Mr. STUPAK, Mr. ADERHOLT, Mr. BAKER, Mr.
BALLENGER, Mr. BARCIA, Mr. BARTON of Texas, Mr. BLUNT, Mr. BRY-
ANT, Mr. BURR of North Carolina, Mr. BURTON of Indiana, Mr. CANADY
of Florida, Mr. CHABOT, Mr. COBURN, Mr. COLLINS, Mr. CUNNINGHAM,
Mr. DICKEY, Mr. DOOLITTLE, Mr. DOYLE, Mrs. EMERSON, Mr. EVER-
ETT, Mr. FOSSELLA, Mr. GRAHAM, Mr. GOODE, Mr. GOODLATTE, Mr.
HALL of Texas, Mr. HAYES, Mr. HERGER, Mr. HOEKSTRA, Mr. HUTCH-
INSON, Mr. ISTOOK, Mr. JOHN, Mr. KING, Mr. KNOLLENBERG, Mr. LA-
FALCE, Mr. LAHOOD, Mr. LARGENT, Mr. LEWIS of Kentucky, Mr.
LUCAS of Kentucky, Mr. LUCAS of Oklahoma, Mr. MCINTYRE, Mr. MIL-
LER of Florida, Mrs. MYRICK, Mr. NUSSLE, Mr. NETHERCUTT, Mr. PE-
TERSON of Pennsylvania, Mr. PETERSON of Minnesota, Mr. PHELPS, Mr.
PICKERING, Mr. PITTS, Mr. PORTMAN, Mr. RAHALL, Mr. ROGAN, Mr.
ROGERS, Mr. SALMON, Mr. SCHAFFER, Mr. SENSENBRENNER, Mr.
SHIMKUS, Mr. SHOWS, Mr. SKELTON, Mr. SMITH of Texas, Mr. SMITH
of New Jersey, Mr. SPENCE, Mr. STEARNS, Mr. TANCREDO, Mr. TERRY,
Mr. WALSH, Mr. WAMP, and Mr. WELDON of Florida) introduced the fol-
lowing bill; which was referred to the Committee on Commerce, and in
addition to the Committee on the Judiciary, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
OCTOBER 13, 1999
Reported from the Committee on the Judiciary
OCTOBER 18, 1999
Additional sponsors: Mr. DEMINT, Mrs. NORTHUP, Mr. BARTLETT of Mary-
land, Mr. CALVERT, Mr. POMBO, Mr. HOSTETTLER, Mr. ARMEY, Mr.
ENGLISH, Mr. TAYLOR of Mississippi, Mr. HUNTER, Mr. PACKARD, Mr.
EHLERS, Mr. BARR of Georgia, Mr. GOODLING, Mr. WATTS of Okla-
homa, Mr. THUNE, Mr. SOUDER, Mr. DEAL of Georgia, Mr. KILDEE, Mr.
BRADY of Texas, Mr. RADANOVICH, Mr. HILLEARY, Mr. GIBBONS, Mr.
MORAN of Kansas, Mr. COBLE, Mr. HASTINGS of Washington, Mr.
LATOURETTE, Mr. TALENT, Mr. TAUZIN, Mr. NORWOOD, Mr. JONES of
North Carolina, Mr. OXLEY, Mr. WOLF, Mr. MCINNIS, Mr. LIPINSKI,
Mr. PEASE, Mr. RYUN of Kansas, Mr. JENKINS, Mr. HILL of Montana,
Mr. COSTELLO, Mr. SUNUNU, Mr. CAMP, Mr. MASCARA, Mr. WICKER,
Mr. WATKINS, Mr. FORBES, Mr. HALL of Ohio, Mr. PETRI, Mr.
MCINTOSH, Mr. TAYLOR of North Carolina, Mr. CHAMBLISS, Mr. KLINK,
Mr. SIMPSON, Mr. DIAZ-BALART, Mr. TIAHRT, Mrs. KELLY, Mr.
FLETCHER, Mr. RILEY, Mr. GUTKNECHT, Mr. LATHAM, Mr. WHITFIELD,
Mr. CRANE, Mr. BACHUS, Mrs. CUBIN, Mr. BARRETT of Nebraska, Mr.
SWEENEY, Mr. SAM JOHNSON of Texas, Mr. UPTON, Mr. CANNON, Ms.
PRYCE of Ohio, Mr. HEFLEY, Mr. GARY MILLER of California, Mr.
VITTER, Mr. KINGSTON, Mr. COMBEST, Mr. SESSIONS, Mr. COOK, Mr.
CALLAHAN, Mr. DUNCAN, Mr. RYAN of Wisconsin, Mr. QUINN, Mr. BLI-
LEY, Mr. GALLEGLY, Mr. MICA, Mr. BROWN of Ohio, Mr. GREEN of Wis-
consin, Mr. BATEMAN, Mr. NEAL of Massachusetts, Mr. LAZIO, Mr.
SHADEGG, Mr. BILIRAKIS, Mr. ISAKSON, Mr. REYNOLDS, Mrs. FOWLER,
Mr. BERRY, Mr. WELLER, and Mr. FRANKS of New Jersey
OCTOBER 18, 1999
Reported from the Committee on Commerce with amendments, committed to
the Committee of the Whole House on the State of the Union, and or-
dered to be printed
[Omit the part struck through and insert the part printed in italic]
A BILL
To amend the Controlled Substances Act to promote pain
management and palliative care without permitting as-
sisted suicide and euthanasia, and for other purposes.
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 ‘‘Pain Relief Promotion
Act of 1999’’.
TITLE I—USE OF CONTROLLED
SUBSTANCES 
CONSISTENT
WITH THE CONTROLLED SUB-
STANCES ACT
SEC. 101. REINFORCING EXISTING STANDARD FOR LEGITI-
MATE USE OF CONTROLLED SUBSTANCES.
Section 303 of the Controlled Substances Act (21
U.S.C. 823) is amended by adding at the end the fol-
lowing:
‘‘(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 admin-
istering of a controlled substance that is consistent with
public health and safety, even if the use of such a sub-
stance may increase the risk of death. Nothing in this sec-
tion authorizes intentionally dispensing, distributing, or
administering a controlled substance for the purpose of
causing death or assisting another person in causing
death.
‘‘(2) Notwithstanding any other provision of this Act,
in determining whether a registration is consistent with
the public interest under this Act, the Attorney General
shall give no force and effect to State law authorizing or
permitting assisted suicide or euthanasia.
‘‘(3) Paragraph (2) applies only to conduct occurring
after the date of enactment of this subsection.’’.
SEC. 102. 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
local, State, and Federal personnel, incorporating
recommendations by the Secretary of Health and
Human Services, on the necessary and legitimate
use of controlled substances in pain management
and palliative care, and means by which investiga-
tion and enforcement actions by law enforcement
personnel may accommodate such use.’’.
TITLE II—PROMOTING
PALLIATIVE CARE
SEC. 201. ACTIVITIES OF AGENCY FOR HEALTH CARE POL-
ICY AND RESEARCH.
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 section:
‘‘SEC. 906. PROGRAM FOR PALLIATIVE CARE RESEARCH
AND QUALITY.
‘‘(a) IN GENERAL.—The Administrator shall carry
out a program to accomplish the following:
‘‘(1) Develop and advance scientific under-
standing of palliative care.
‘‘(2) Collect and disseminate protocols and evi-
dence-based practices regarding palliative care, with
priority given to pain management for terminally ill
patients, and make such information available to
public and private health care programs and pro-
viders, health professions schools, and hospices, and
to the general public.
‘‘(b) DEFINITION.—For purposes of this section, the
term ‘palliative care’ means the active total care of pa-
tients 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 postpone death.’’.
‘‘(b) DEFINITION.—For purposes of this section, the
term ‘palliative care’ means the active, total care of patients
whose disease or medical condition is not responsive to cu-
rative treatment or whose prognosis is limited due to pro-
gressive, far-advanced disease. The purpose of such care is
to alleviate pain and other distressing symptoms and to en-
hance the quality of life, not to hasten or postpone death.’’.
SEC. 202. 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.), as amended
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-
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
(b)(1)(C) by striking ‘‘sections 753, 754, and 755’’
and inserting ‘‘section 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.
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.