Home > 106th Congressional Bills > H.R. 5545 (ih) To provide for reauthorization of small business loan and other programs, and for other purposes. [Introduced in House] ...H.R. 5545 (ih) To provide for reauthorization of small business loan and other programs, and for other purposes. [Introduced in House] ...
106th CONGRESS
2d Session
H. R. 5544
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
October 25, 2000
Mr. Hyde introduced the following bill; which was referred to the
Committee on Commerce, and in addition to the Committee on the
Judiciary, for a period to be subsequently determined by the Speaker,
in each case for consideration of such provisions as fall within the
jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
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,
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 HEALTH CARE 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,
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 (a) in order to determine the effect of
such programs on knowledge and practice regarding pain management and
palliative care.
``(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 individuals with expertise
and experience in pain management and palliative care for the
population of patients whose needs are to be served by the program.
``(g) 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.''.
(b) Authorization of Appropriations; Allocation.--
(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''.
(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. 103. EFFECTIVE DATE.
The amendments made by this title shall take effect on the date of
enactment of this Act.
TITLE II--USE OF CONTROLLED SUBSTANCES CONSISTENT WITH THE CONTROLLED
SUBSTANCES ACT
SEC. 201. REINFORCING EXISTING STANDARD FOR LEGITIMATE USE OF
CONTROLLED SUBSTANCES.
(a) In General.--Section 303 of the Controlled Substances Act (21
U.S.C. 823) is amended by adding at the end the following:
``(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.
``(2)(A) 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.
``(B) Paragraph (2) applies only to conduct occurring after the
date of enactment of this subsection.
``(3) Nothing in this subsection shall be construed to alter the
roles of the Federal and State governments in regulating the practice
of medicine. Regardless of whether the Attorney General determines
pursuant to this section that the registration of a practitioner is
inconsistent with the public interest, it remains solely within the
discretion of State authorities to determine whether action should be
taken with respect to the State professional license of the
practitioner or State prescribing privileges.
``(4) Nothing in the Pain Relief Promotion Act of 2000 (including
the amendments made by such Act) shall be construed--
``(A) to modify the Federal requirements that a controlled
substance be dispensed only for a legitimate medical purpose
pursuant to paragraph (1); or
``(B) to provide the Attorney General with the authority to
issue national standards for pain management and palliative
care clinical practice, research, or quality;
except that the Attorney General may take such other actions as may be
necessary to enforce this Act.''.
(b) Pain Relief.--Section 304(c) of the Controlled Substances Act
(21 U.S.C. 824(c)) is amended--
(1) by striking ``(c) Before'' and inserting the following:
``(c) Procedures.--
``(1) Order to show cause.--Before''; and
(2) by adding at the end the following:
``(2) Burden of proof.--At any proceeding under paragraph
(1), where the order to show cause is based on the alleged
intentions of the applicant or registrant to cause or assist in
causing death, and the practitioner claims a defense under
paragraph (1) of section 303(i), the Attorney General shall
have the burden of proving, by clear and convincing evidence,
that the practitioner's intent was to dispense, distribute, or
administer a controlled substance for the purpose of causing
death or assisting another person in causing death. In meeting
such burden, it shall not be sufficient to prove that the
applicant or registrant knew that the use of controlled
substance may increase the risk of death.''.
SEC. 202. 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 paragraph (6) and
inserting ``; and''; and
(3) by adding at the end the following:
``(7) educational and training programs for Federal, State,
and local personnel, incorporating recommendations, subject to
the provisions of subsections (e) and (f) of section 902 of the
Public Health Service Act, by the Secretary of Health and Human
Services, on the means by which investigation and enforcement
actions by law enforcement personnel may better accommodate the
necessary and legitimate use of controlled substances in pain
management and palliative care.
Nothing in this subsection shall be construed to alter the roles of the
Federal and State governments in regulating the practice of
medicine.''.
SEC. 203. FUNDING AUTHORITY.
Notwithstanding any other provision of law, the operation of the
diversion control fee account program of the Drug Enforcement
Administration shall be construed to include carrying out section
303(i) of the Controlled Substances Act (21 U.S.C. 823(i)), as added by
this Act, and subsections (a)(4) and (c)(2) of section 304 of the
Controlled Substances Act (21 U.S.C. 824), as amended by this Act.
SEC. 204. EFFECTIVE DATE.
The amendments made by this title shall take effect on the date of
enactment of this Act.
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