SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Promoting Responsible 
Opioid Management and Incorporating Scientific Exper-
tise Act’’ or the ‘‘Jason Simcakoski PROMISE Act’’. 
SEC. 2. IMPROVEMENT OF OPIOID SAFETY MEASURES BY 
DEPARTMENT OF VETERANS AFFAIRS. 
(a) EXPANSION OF OPIOID SAFETY INITIATIVE.— 
(1) INCLUSION OF ALL MEDICAL FACILITIES.— 
Not later than 180 days after the date of the enact-
ment of this Act, the Secretary of Veterans Affairs 
shall expand the Opioid Safety Initiative of the De-
partment of Veterans Affairs to include all medical 
facilities of the Department. 
(2) GUIDANCE.—The Secretary shall establish 
guidance that each health care provider of the De-
partment of Veterans Affairs, before initiating opioid 
therapy to treat a patient as part of the comprehen-
sive assessment conducted by the health care pro-
vider, use the Opioid Therapy Risk Report tool of 
the Department of Veterans Affairs (or any subse-
quent tool), which shall include information from the 
prescription drug monitoring program of each par-
ticipating State as applicable, that includes the most 
recent information to date relating to the patient 
that accessed such program to assess the risk for 
adverse outcomes of opioid therapy for the patient,
including the concurrent use of controlled substances 
such as benzodiazepines, as part of the comprehen-
sive assessment conducted by the health care pro-
vider. 
(3) ENHANCED
STANDARDS.—The Secretary 
shall establish enhanced standards with respect to 
the use of routine and random urine drug tests for 
all patients before and during opioid therapy to help 
prevent substance abuse, dependence, and diversion, 
including— 
(A) that such tests occur not less fre-
quently than once each year; and 
(B) that health care providers appro-
priately order, interpret and respond to the re-
sults from such tests to tailor pain therapy, 
safeguards, and risk management strategies to 
each patient. 
(b) PAIN MANAGEMENT EDUCATION
AND TRAIN-
ING.— 
(1) IN GENERAL.—In carrying out the Opioid 
Safety Initiative of the Department, the Secretary 
shall require all employees of the Department re-
sponsible for prescribing opioids to receive education 
and training described in paragraph (2).
(2) EDUCATION
AND
TRAINING.—Education 
and training described in this paragraph is edu-
cation and training on pain management and safe 
opioid prescribing practices for purposes of safely 
and effectively managing patients with chronic pain, 
including education and training on the following: 
(A) The implementation of and full compli-
ance with the VA/DOD Clinical Practice Guide-
line for Management of Opioid Therapy for 
Chronic Pain, including any update to such 
guideline. 
(B) The use of evidence-based pain man-
agement therapies, including cognitive-behav-
ioral therapy, non-opioid alternatives, and non- 
drug methods and procedures to managing pain 
and related health conditions including medical 
devices approved or cleared by the Food and 
Drug Administration for the treatment of pa-
tients with chronic pain and complementary al-
ternative medicines. 
(C) Screening and identification of patients 
with substance use disorder, including drug- 
seeking behavior, before prescribing opioids, as-
sessment of risk potential for patients devel-
oping an addiction, and referral of patients to
appropriate addiction treatment professionals if 
addiction is identified or strongly suspected. 
(D) Communication with patients on the 
potential harm associated with the use of 
opioids and other controlled substances, includ-
ing the need to safely store and dispose of sup-
plies relating to the use of opioids and other 
controlled substances. 
(E) Such other education and training as 
the Secretary considers appropriate to ensure 
that veterans receive safe and high-quality pain 
management care from the Department. 
(3) USE OF EXISTING PROGRAM.—In providing 
education and training described in paragraph (2), 
the Secretary shall use the Interdisciplinary Chronic 
Pain Management Training Team Program of the 
Department (or success program). 
(c) PAIN MANAGEMENT TEAMS.— 
(1) IN GENERAL.—In carrying out the Opioid 
Safety Initiative of the Department, the director of 
each medical facility of the Department shall iden-
tify and designate a pain management team of 
health care professionals, which may include board 
certified pain medicine specialists, responsible for co-
ordinating and overseeing pain management therapy
at such facility for patients experiencing acute and 
chronic pain that is non-cancer related. 
(2) ESTABLISHMENT OF PROTOCOLS.— 
(A) IN
GENERAL.—In consultation with 
the Directors of each Veterans Integrated Serv-
ice Network, the Secretary shall establish 
standard protocols for the designation of pain 
management teams at each medical facility 
within the Department. 
(B) CONSULTATION ON PRESCRIPTION OF 
OPIOIDS.—Each protocol established under sub-
paragraph (A) shall ensure that any health care 
provider without expertise in prescribing anal-
gesics or who has not completed the education 
and training under subsection (b), including a 
mental health care provider, does not prescribe 
opioids to a patient unless that health care pro-
vider— 
(i) consults with a health care pro-
vider with pain management expertise or 
who is on the pain management team of 
the medical facility; and 
(ii) refers the patient to the pain man-
agement team for any subsequent prescrip-
tions and related therapy.
(3) REPORT.— 
(A) IN GENERAL.—Not later than 1 year 
after the date of enactment of this Act, the di-
rector of each medical facility of the Depart-
ment shall submit to the Under Secretary for 
Health and the director of the Veterans Inte-
grated Service Network in which the medical fa-
cility is located a report identifying the health 
care professionals that have been designated as 
members of the pain management team at the 
medical facility pursuant to paragraph (1). 
(B) ELEMENTS.—Each report submitted 
under subparagraph (A) with respect to a med-
ical facility of the Department shall include— 
(i) a certification as to whether all 
members of the pain management team at 
the medical facility have completed the 
education and training required under sub-
section (b); 
(ii) a plan for the management and 
referral of patients to such pain manage-
ment team if health care providers without 
expertise in prescribing analgesics pre-
scribe opioid medications to treat acute
and chronic pain that is non-cancer re-
lated; and 
(iii) a certification as to whether the 
medical facility— 
(I) 
fully 
complies 
with 
the 
stepped-care model of pain manage-
ment and other pain management 
policies contained in Directive 2009– 
053 of the Veterans Health Adminis-
tration, or successor directive; or 
(II) does not fully comply with 
such stepped-care model of pain man-
agement and other pain management 
policies but is carrying out a correc-
tive plan of action to ensure such full 
compliance. 
(d) TRACKING AND MONITORING OF OPIOID USE.— 
(1) PRESCRIPTION
DRUG
MONITORING
PRO-
GRAMS
OF
STATES.—In carrying out the Opioid 
Safety Initiative and the Opioid Therapy Risk Re-
port tool of the Department, the Secretary shall— 
(A) ensure access by health care providers 
of the Department to information on controlled 
substances, 
including 
opioids 
and 
benzodiazepines, prescribed to veterans who re-
ceive care outside the Department through the 
prescription drug monitoring program of each 
State with such a program, including by seek-
ing to enter into memoranda of understanding 
with States to allow shared access of such infor-
mation between States and the Department; 
(B) include such information in the Opioid 
Therapy Risk Report; and 
(C) require health care providers of the 
Department to submit to the prescription drug 
monitoring program of each State information 
on prescriptions of controlled substances re-
ceived by veterans in that State under the laws 
administered by the Secretary. 
(2) REPORT ON TRACKING OF DATA ON OPIOID 
USE.—Not later than 18 months after the date of 
the enactment of this Act, the Secretary shall submit 
to the Committee on Veterans’ Affairs of the Senate 
and the Committee on Veterans’ Affairs of the 
House of Representatives a report on the feasibility 
and advisability of improving the Opioid Therapy 
Risk Report tool of the Department to allow for 
more advanced real-time tracking of and access to 
data on—
(A) the key clinical indicators with respect 
to the totality of opioid use by veterans; 
(B) concurrent prescribing by health care 
providers of the Department of opioids in dif-
ferent health care settings, including data on 
concurrent prescribing of opioids to treat men-
tal health disorders other than opioid use dis-
order; and 
(C) mail-order prescriptions of opioid pre-
scribed to veterans under the laws administered 
by the Secretary. 
(e) AVAILABILITY OF OPIOID RECEPTOR ANTAGO-
NISTS.— 
(1) INCREASED AVAILABILITY AND USE.— 
(A) IN
GENERAL.—The Secretary shall 
maximize the availability of opioid receptor an-
tagonists approved by the Food and Drug Ad-
ministration, including naloxone, to veterans. 
(B) AVAILABILITY, TRAINING, AND
DIS-
TRIBUTING.—In carrying out subparagraph 
(A), not later than 90 days after the date of the 
enactment of this Act, the Secretary shall— 
(i) equip each pharmacy of the De-
partment with opioid receptor antagonists 
approved by the Food and Drug Adminis-
tration to be dispensed to outpatients as 
needed; and 
(ii) expand the Overdose Education 
and Naloxone Distribution program of the 
Department to ensure that all veterans in 
receipt of health care under laws adminis-
tered by the Secretary who are at risk of 
opioid overdose may access such opioid re-
ceptor antagonists and training on the 
proper administration of such opioid recep-
tor antagonists. 
(C) VETERANS WHO ARE AT RISK.—For 
purposes of subparagraph (B), veterans who are 
at risk of opioid overdose include— 
(i) veterans receiving long-term opioid 
therapy; 
(ii) veterans receiving opioid therapy 
who have a history of substance use dis-
order or prior instances of overdose; and 
(iii) veterans who are at risk as deter-
mined by a health care provider who is 
treating the veteran. 
(2) REPORT.—Not later than 120 days after 
the date of the enactment of this Act, the Secretary 
shall submit to the Committee on Veterans’ Affairs
of the Senate and the Committee on Veterans’ Af-
fairs of the House of Representatives a report on 
carrying out paragraph (1), including an assessment 
of any remaining steps to be carried out by the Sec-
retary to carry out such paragraph. 
(f) INCLUSION OF CERTAIN INFORMATION AND CA-
PABILITIES IN OPIOID THERAPY RISK REPORT TOOL OF 
THE DEPARTMENT.— 
(1) INFORMATION.—The Secretary shall include 
in the Opioid Therapy Risk Report tool of the De-
partment— 
(A) information on the most recent time 
the tool was accessed by a health care provider 
of the Department with respect to each veteran; 
and 
(B) information on the results of the most 
recent urine drug test for each veteran. 
(2) CAPABILITIES.—The Secretary shall include 
in the Opioid Therapy Risk Report tool the ability 
of the health care providers of the Department to 
determine whether a health care provider of the De-
partment prescribed opioids to a veteran without 
checking the information in the tool with respect to 
the veteran.
(g) NOTIFICATIONS
OF RISK
IN COMPUTERIZED 
HEALTH RECORD.—The Secretary shall modify the com-
puterized patient record system of the Department to en-
sure that any health care provider that accesses the record 
of a veteran, regardless of the reason the veteran seeks 
care from the health care provider, will be immediately no-
tified whether the veteran— 
(1) is receiving opioid therapy and has a history 
of substance use disorder or prior instances of over-
dose; 
(2) has a history of opioid abuse; or 
(3) is at risk of becoming an opioid abuser as 
determined by a health care provider who is treating 
the veteran. 
(h) DEFINITIONS.—In this section: 
(1) The term ‘‘controlled substance’’ has the 
meaning given that term in section 102 of the Con-
trolled Substances Act (21 U.S.C. 802). 
(2) The term ‘‘State’’ means each of the several 
States, territories, and possessions of the United 
States, the District of Columbia, and the Common-
wealth of Puerto Rico.