[House Report 114-536]
[From the U.S. Government Publishing Office]
114th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 114-536
======================================================================
TO PROVIDE FOR THE ESTABLISHMENT OF AN INTER-AGENCY TASK FORCE TO
REVIEW, MODIFY, AND UPDATE BEST PRACTICES FOR PAIN MANAGEMENT AND
PRESCRIBING PAIN MEDICATION, AND FOR OTHER PURPOSES
_______
May 3, 2016.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Upton, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
[To accompany H.R. 4641]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 4641) to provide for the establishment of an
inter-agency task force to review, modify, and update best
practices for pain management and prescribing pain medication,
and for other purposes, having considered the same, report
favorably thereon with an amendment and recommend that the bill
as amended do pass.
CONTENTS
Page
Purpose and Summary.............................................. 3
Background and Need for Legislation.............................. 3
Hearings......................................................... 3
Committee Consideration.......................................... 3
Committee Votes.................................................. 4
Committee Oversight Findings..................................... 4
Statement of General Performance Goals and Objectives............ 4
New Budget Authority, Entitlement Authority, and Tax Expenditures 4
Earmark, Limited Tax Benefits, and Limited Tariff Benefits....... 4
Committee Cost Estimate.......................................... 4
Congressional Budget Office Estimate............................. 4
Federal Mandates Statement....................................... 5
Duplication of Federal Programs.................................. 5
Disclosure of Directed Rule Makings.............................. 6
Advisory Committee Statement..................................... 6
Applicability to Legislative Branch.............................. 6
Section-by-Section Analysis of the Legislation................... 6
Changes in Existing Law Made by the Bill, as Reported............ 6
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. DEVELOPMENT OF BEST PRACTICES FOR THE USE OF PRESCRIPTION
OPIOIDS.
(a) Definitions.--In this section--
(1) the term ``Secretary'' means the Secretary of Health and
Human Services; and
(2) the term ``task force'' means the Pain Management Best
Practices Inter-Agency Task Force convened under subsection
(b).
(b) Inter-Agency Task Force.--Not later than December 14, 2018, the
Secretary, in cooperation with the Secretary of Veterans Affairs, the
Secretary of Defense, and the Administrator of the Drug Enforcement
Administration, shall convene a Pain Management Best Practices Inter-
Agency Task Force to review, modify, and update, as appropriate, best
practices for pain management (including chronic and acute pain) and
prescribing pain medication.
(c) Membership.--The task force shall be comprised of--
(1) representatives of--
(A) the Department of Health and Human Services;
(B) the Department of Veterans Affairs;
(C) the Food and Drug Administration;
(D) the Department of Defense;
(E) the Drug Enforcement Administration;
(F) the Centers for Disease Control and Prevention;
(G) the Health Resources and Services Administration;
(H) the Indian Health Service;
(I) the National Academy of Medicine;
(J) the National Institutes of Health;
(K) the Office of National Drug Control Policy; and
(L) the Substance Abuse and Mental Health Services
Administration;
(2) State medical boards;
(3) physicians, dentists, and nonphysician prescribers;
(4) hospitals;
(5) pharmacists and pharmacies;
(6) experts in the fields of pain research and addiction
research;
(7) representatives of--
(A) pain management professional organizations;
(B) the mental health treatment community;
(C) the addiction treatment and recovery community;
(D) pain advocacy groups; and
(E) groups with expertise on overdose reversal;
(8) a person in recovery from addiction to medication for
chronic pain;
(9) a person with chronic pain; and
(10) other stakeholders, as the Secretary determines
appropriate.
(d) Duties.--The task force shall--
(1) not later than 180 days after the date on which the task
force is convened under subsection (b), review, modify, and
update, as appropriate, best practices for pain management
(including chronic and acute pain) and prescribing pain
medication, taking into consideration--
(A) existing pain management research;
(B) recommendations from relevant conferences and
existing relevant evidence-based guidelines;
(C) ongoing efforts at the State and local levels and
by medical professional organizations to develop
improved pain management strategies, including
consideration of differences within and between classes
of opioids, the availability of opioids with abuse
deterrent technology, and pharmacological,
nonpharmacological, and medical device alternatives to
opioids to reduce opioid monotherapy in appropriate
cases;
(D) the management of high-risk populations, other
than populations who suffer pain, who--
(i) may use or be prescribed benzodiazepines,
alcohol, and diverted opioids; or
(ii) receive opioids in the course of medical
care; and
(E) the 2016 Guideline for Prescribing Opioids for
Chronic Pain issued by the Centers for Disease Control
and Prevention;
(2) solicit and take into consideration public comment on the
practices developed under paragraph (1), amending such best
practices if appropriate; and
(3) develop a strategy for disseminating information about
the best practices developed under paragraphs (1) and (2) to
prescribers, pharmacists, State medical boards, educational
institutions that educate prescribers and pharmacists, and
other parties, as the Secretary determines appropriate.
(e) Limitation.--The task force shall not have rulemaking authority.
(f) Report.--Not later than 270 days after the date on which the task
force is convened under subsection (b), the task force shall submit to
Congress a report that includes--
(1) the strategy for disseminating best practices for pain
management (including chronic and acute pain) and prescribing
pain medication, as developed under subsection (d);
(2) the results of a feasibility study on linking the best
practices described in paragraph (1) to receiving and renewing
registrations under section 303(f) of the Controlled Substances
Act (21 U.S.C. 823(f)); and
(3) recommendations for effectively applying the best
practices described in paragraph (1) to improve prescribing
practices at medical facilities, including medical facilities
of the Veterans Health Administration and Indian Health
Service.
PURPOSE AND SUMMARY
H.R. 4641 would establish an interagency task force to
review, modify, and update best practices for acute and chronic
pain management.
BACKGROUND AND NEED FOR LEGISLATION
Health care professionals need accurate, evidence-based
information to provide quality care to patients with acute and
chronic pain while minimizing the potential for the development
of substance use disorder and overdose when prescribing
opioids. This bill will ensure that current treatment
guidelines and best practices continue to be reviewed and, if
appropriate, updated in a transparent manner by a wide-range of
government agencies, experts in the field, and patient
representatives.
HEARINGS
On October 8, 2015, the Subcommittee on Health held a
hearing entitled ``Examining Legislative Proposals to Combat
Our Nation's Drug Abuse Crisis'' and received testimony from:
Allen Anderson, President, American
Orthopaedic Society for Sports Medicine;
Michael Botticelli, Director, Office of
National Drug Control Policy;
Richard Frank, Assistant Secretary for
Planning and Evaluation, Department of Health and Human
Services;
Paul Halverson, Dean, Indiana University;
Richard M. Fairbanks School of Public
Health;
Kenneth Katz, Lehigh Valley Health Network,
Department of Emergency Medicine;
Chapman Sledge, Chief Medical Officer,
Cumberland Heights; and,
Robert Corey Waller, Chair, Legislative
Advocacy Committee, American Society of Addiction
Medicine.
COMMITTEE CONSIDERATION
On April 20, 2016, the Subcommittee on Health met in open
markup session and forwarded H.R. 4641, as amended, to the full
Committee by a voice vote. On April 26, 27, and 28, 2016, the
full Committee met in open markup session and ordered H.R.
4641, as amended, favorably reported to the House by a voice
vote.
COMMITTEE VOTES
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list the record votes
on the motion to report legislation and amendments thereto.
There were no record votes taken in connection with ordering
H.R. 4641 reported.
COMMITTEE OVERSIGHT FINDINGS
Pursuant to clause 3(c)(1) of rule XIII of the Rules of the
House of Representatives, the Committee held a hearing and made
findings that are reflected in this report.
STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES
The purpose of this act is to ensure health care providers
have evidence-based guidelines and best practices for treating
patients with acute and chronic pain.
NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES
In compliance with clause 3(c)(2) of rule XIII of the Rules
of the House of Representatives, the Committee finds that H.R.
4641 would result in no new or increased budget authority,
entitlement authority, or tax expenditures or revenues.
EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS
In compliance with clause 9(e), 9(f), and 9(g) of rule XXI
of the Rules of the House of Representatives, the Committee
finds that H.R. 4641 contains no earmarks, limited tax
benefits, or limited tariff benefits.
COMMITTEE COST ESTIMATE
The Committee adopts as its own the cost estimate prepared
by the Director of the Congressional Budget Office pursuant to
section 402 of the Congressional Budget Act of 1974.
CONGRESSIONAL BUDGET OFFICE ESTIMATE
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate
provided by the Congressional Budget Office pursuant to section
402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 3, 2016.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
U.S. House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 4641, a bill to
provide for the establishment of an inter-agency task force to
review, modify, and update best practices for pain management
and prescribing pain medication, and for other purposes.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Andrea Noda.
Sincerely,
Keith Hall.
Enclosure.
H.R. 4641--A bill to provide for the establishment of an inter-agency
task force to review, modify, and update best practices for
pain management and prescribing pain medication, and for other
purposes.
H.R. 4641 would require the Secretary of the Department of
Health and Human Services (HHS) to establish a task force to
review and modify best practices for the treatment of pain. The
Secretary of HHS would be required to coordinate with the
Secretary of Veterans Affairs, the Secretary of Defense, and
the Administrator of the Drug Enforcement Administration. Task
force members would include representatives from relevant
federal agencies, medical professionals, researchers, and
individuals who have specific expertise in pain management and
addiction to pain medication. The task force would issue a
report to Congress on its findings, which would include a
strategy for disseminating information to relevant medical
professionals about best practices in pain management.
CBO estimates that implementing H.R. 4641 would cost $2
million over the 2016-2021 period, assuming appropriation of
the estimated amounts, mostly to cover administrative expenses
associated with the task force. Estimated outlays are based on
information from affected agencies and historical spending for
similar types of initiatives. Enacting H.R. 4641 would not
affect direct spending or revenues; therefore, pay-as-you-go
procedures do not apply.
CBO estimates that enacting H.R. 4641 would not increase
net direct spending or on-budget deficits in any of the four
consecutive 10-year period beginning in 2027.
The bill contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act and
would impose no costs on state, local, or tribal governments.
The CBO staff contact for this estimate is Andrea Noda. The
estimate was approved by Holly Harvey, Deputy Assistant
Director for Budget Analysis.
FEDERAL MANDATES STATEMENT
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
DUPLICATION OF FEDERAL PROGRAMS
No provision of H.R. 4641 establishes or reauthorizes a
program of the Federal Government known to be duplicative of
another Federal program, a program that was included in any
report from the Government Accountability Office to Congress
pursuant to section 21 of Public Law 111-139, or a program
related to a program identified in the most recent Catalog of
Federal Domestic Assistance.
DISCLOSURE OF DIRECTED RULE MAKINGS
The Committee estimates that enacting H.R. 4641 does not
direct any specific rule making within the meaning of 5 U.S.C.
551.
ADVISORY COMMITTEE STATEMENT
No advisory committees within the meaning of section 5(b)
of the Federal Advisory Committee Act were created by this
legislation.
APPLICABILITY TO LEGISLATIVE BRANCH
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION
Section 1. Development of best practices for the use of prescription
opioids
The bill would require the Secretary of Health and Human
Services to convene a Pain Management Best Practices Inter-
Agency Task Force. The Task Force shall be comprised of
representatives from several Federal agencies; state medical
boards; health care practitioners; pharmacists; experts from
both the pain and addiction recovery community; and other
stakeholders.
The Task Force shall be convened no later than December 14,
2018, and, within 180 days, review, modify, and update best
practices for acute and chronic pain management. The Task Force
shall, among other things, consider existing pain management
research and guidelines, including the 2016 Guideline for
Prescribing Opioids for Chronic Pain issued by the Centers for
Disease Control and Prevention, as well as ongoing State,
local, and medical professional organization efforts to develop
pain management strategies. Further, the Task Force shall
develop a strategy for the dissemination of such best practices
to health care professionals and report to Congress within 270
days.
CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED
This legislation does not amend any existing Federal
statute.
[all]