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Calendar No. 566
106th CONGRESS
2d Session
H. R. 2260
[Report No. 106-299]
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 28, 1999
Received
November 19, 1999
Read twice and referred to the Committee on the Judiciary
May 23, 2000
Reported by Mr. Hatch, with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
_______________________________________________________________________
AN ACT
To amend the Controlled Substances Act to promote pain management and
palliative care without permitting assisted suicide and euthanasia, and
for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
<DELETED>SECTION 1. SHORT TITLE.</DELETED>
<DELETED> This Act may be cited as the ``Pain Relief Promotion Act
of 1999''.</DELETED>
<DELETED>TITLE I--USE OF CONTROLLED SUBSTANCES CONSISTENT WITH THE
CONTROLLED SUBSTANCES ACT</DELETED>
<DELETED>SEC. 101. REINFORCING EXISTING STANDARD FOR LEGITIMATE USE OF
CONTROLLED SUBSTANCES.</DELETED>
<DELETED> Section 303 of the Controlled Substances Act (21 U.S.C.
823) is amended by adding at the end the following:</DELETED>
<DELETED> ``(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 administering of a controlled substance
that is consistent with public health and safety, even if the use of
such a substance may increase the risk of death. Nothing in this
section authorizes intentionally dispensing, distributing, or
administering a controlled substance for the purpose of causing death
or assisting another person in causing death.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(3) Paragraph (2) applies only to conduct occurring
after the date of the enactment of this subsection.''.</DELETED>
<DELETED>SEC. 102. EDUCATION AND TRAINING PROGRAMS.</DELETED>
<DELETED> Section 502(a) of the Controlled Substances Act (21 U.S.C.
872(a)) is amended--</DELETED>
<DELETED> (1) by striking ``and'' at the end of paragraph
(5);</DELETED>
<DELETED> (2) by striking the period at the end of paragraph
(6) and inserting ``; and''; and</DELETED>
<DELETED> (3) by adding at the end the following:</DELETED>
<DELETED> ``(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 investigation and
enforcement actions by law enforcement personnel may
accommodate such use.''.</DELETED>
<DELETED>TITLE II--PROMOTING PALLIATIVE CARE</DELETED>
<DELETED>SEC. 201. ACTIVITIES OF AGENCY FOR HEALTH CARE POLICY AND
RESEARCH.</DELETED>
<DELETED> 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:</DELETED>
<DELETED>``SEC. 906. PROGRAM FOR PALLIATIVE CARE RESEARCH AND
QUALITY.</DELETED>
<DELETED> ``(a) In General.--The Administrator shall carry out a
program to accomplish the following:</DELETED>
<DELETED> ``(1) Develop and advance scientific understanding
of palliative care.</DELETED>
<DELETED> ``(2) Collect and disseminate protocols and
evidence-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 providers, health professions schools,
and hospices, and to the general public.</DELETED>
<DELETED> ``(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 curative treatment or
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.''.</DELETED>
<DELETED>SEC. 202. ACTIVITIES OF HEALTH RESOURCES AND SERVICES
ADMINISTRATION.</DELETED>
<DELETED> (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--</DELETED>
<DELETED> (1) by redesignating sections 754 through 757 as
sections 755 through 758, respectively; and</DELETED>
<DELETED> (2) by inserting after section 753 the following
section:</DELETED>
<DELETED>``SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PALLIATIVE
CARE.</DELETED>
<DELETED> ``(a) In General.--The Secretary, in consultation with the
Administrator for Health Care Policy and Research, may make awards of
grants, cooperative agreements, and contracts to health professions
schools, hospices, and other public and private entities for the
development and implementation of programs to provide education and
training to health care professionals in palliative care.</DELETED>
<DELETED> ``(b) Priorities.--In making awards under subsection (a),
the Secretary shall give priority to awards for the implementation of
programs under such subsection.</DELETED>
<DELETED> ``(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--</DELETED>
<DELETED> ``(1) means for alleviating pain and discomfort of
patients, especially terminally ill patients, including the
medically appropriate use of controlled substances;</DELETED>
<DELETED> ``(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 efforts may unintentionally increase
the risk of death; and</DELETED>
<DELETED> ``(3) recent findings, developments, and
improvements in the provision of palliative care.</DELETED>
<DELETED> ``(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.</DELETED>
<DELETED> ``(e) Evaluation of Programs.--The Secretary shall
(directly or through grants or contracts) provide for the evaluation of
programs implemented under subsection (a) in order to determine the
effect of such programs on knowledge and practice regarding palliative
care.</DELETED>
<DELETED> ``(f) Peer Review Groups.--In carrying out section 799(f)
with respect to this section, the Secretary shall ensure that the
membership of each peer review group involved includes one or more
individuals with expertise and experience in palliative care.</DELETED>
<DELETED> ``(g) 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 curative treatment or
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.''.</DELETED>
<DELETED> (b) Authorization of Appropriations; Allocation.--
</DELETED>
<DELETED> (1) In general.--Section 758 of the Public Health
Service Act (as redesignated by subsection (a)(1) of this
section) is amended in subsection (b)(1)(C) by striking
``sections 753, 754, and 755'' and inserting ``sections 753,
754, 755, and 756''.</DELETED>
<DELETED> (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.</DELETED>
<DELETED>SEC. 203. EFFECTIVE DATE.</DELETED>
<DELETED> The amendments made by this title take effect October 1,
1999, or upon the date of the enactment of this Act, whichever occurs
later.</DELETED>
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Pain Relief Promotion Act of 2000''.
SEC. 2. FINDINGS.
Congress finds that--
(1) in the first decade of the new millennium there should
be a new emphasis on pain management and palliative care;
(2) the use of certain narcotics and other drugs or
substances with a potential for abuse is strictly regulated
under the Controlled Substances Act;
(3) the dispensing and distribution of certain controlled
substances by properly registered practitioners for legitimate
medical purposes are permitted under the Controlled Substances
Act and implementing regulations;
(4) the dispensing or distribution of certain controlled
substances for the purpose of relieving pain and discomfort
even if it increases the risk of death is a legitimate medical
purpose and is permissible under the Controlled Substances Act;
(5) inadequate treatment of pain, especially for chronic
diseases and conditions, irreversible diseases such as cancer,
and end-of-life care, is a serious public health problem
affecting hundreds of thousands of patients every year;
physicians should not hesitate to dispense or distribute
controlled substances when medically indicated for these
conditions; and
(6) for the reasons set forth in section 101 of the
Controlled Substances Act (21 U.S.C. 801), the dispensing and
distribution of controlled substances for any purpose affect
interstate commerce.
TITLE I--PROMOTING PAIN MANAGEMENT AND PALLIATIVE CARE
SEC. 101. ACTIVITIES OF AGENCY FOR HEALTHCARE RESEARCH AND QUALITY.
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:
``SEC. 903. PROGRAM FOR PAIN MANAGEMENT AND PALLIATIVE CARE RESEARCH
AND QUALITY.
``(a) In General.--Subject to subsections (e) and (f) of section
902, the Director shall carry out a program to accomplish the
following:
``(1) Promote and advance scientific understanding of pain
management and palliative care.
``(2) Collect and disseminate protocols and evidence-based
practices regarding pain management and 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 providers, health professions schools,
and hospices, and to the general public.
``(b) Definition.--In this section, the term `pain management and
palliative care' means--
``(1) the active, total care of patients whose disease or
medical condition is not responsive to curative treatment or
whose prognosis is limited due to progressive, far-advanced
disease; and
``(2) the evaluation, diagnosis, treatment, and management
of primary and secondary pain, whether acute, chronic,
persistent, intractable, or associated with the end of life;
the purpose of which is to diagnose and alleviate pain and other
distressing signs and symptoms and to enhance the quality of life, not
to hasten or postpone death.''.
SEC. 102. ACTIVITIES OF HEALTH RESOURCES AND SERVICES ADMINISTRATION.
(a) In General.--Part D of title VII of the Public Health Service
Act (42 U.S.C. 294 et seq.) is amended--
(1) by redesignating sections 754 through 757 as sections
755 through 758, respectively; and
(2) by inserting after section 753 the following:
``SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PAIN MANAGEMENT AND
PALLIATIVE CARE.
``(a) In General.--The Secretary, in consultation with the Director
of the Agency for Healthcare Research and Quality, may award grants,
cooperative agreements, and contracts to health professions schools,
hospices, and other public and private entities for the development and
implementation of programs to provide education and training to health
care professionals in pain management and palliative care.
``(b) Priority.--In making awards under subsection (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 to be
carried out with the award will include information and education on--
``(1) means for diagnosing and alleviating pain and other
distressing signs and symptoms of patients, especially
terminally ill patients, including the medically appropriate
use of controlled substances;
``(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 efforts may unintentionally increase the
risk of death; and
``(3) recent findings, developments, and improvements in
the provision of pain management and 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,
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