US Codex
Bill
Notes

H.R. 4641 — what changed

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.

From Reported in House to Engrossed in House. 1 section amended between Reported in House and Engrossed in House.

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)
changed the Office of National Drug Control Policy; andPolicy;
(L)
changed the Substance Abuse and Mental Health Services Administration;Administration; and
(M)
added the Office of Women’s Health;
(2)
State medical boards;
(3)
changed subject to subsection (e), physicians, dentists, and nonphysician prescribers;
(4)
hospitals;
(5)
changed subject to subsection (e), pharmacists and pharmacies;
(6)
added first responders;
(7)
renumbered was (4)(8) experts in the fields of pain research and addiction research;
(8)
added experts in the fields of adolescent and young adult addiction research;
(9)
renumbered was (4)(9) representatives of—
(A)
renumbered was (4)(9)(2) pain management professional organizations;
(B)
renumbered was (4)(9)(3) the mental health treatment community;
(C)
renumbered was (4)(9)(4) the addiction treatment and recovery community;
(D)
added pain advocacy groups;
(E)
added veteran service organizations; and
(D)
removed pain advocacy groups; and
(F)
renumbered was (4)(9)(6) groups with expertise on overdose reversal;
(10)
renumbered was (4)(10) a person in recovery from addiction to medication for chronic pain;
(11)
added a person in recovery from addiction to medication for chronic pain, whose addiction began in adolescence or young adulthood;
(12)
added a person with chronic pain;
(13)
added an expert on active duty military, armed forces personnel, and veteran health and prescription opioid addiction;
(14)
added an expert in the field of minority health; and
(9)
removed a person with chronic pain; and
(15)
renumbered was (4)(12) other stakeholders, as the Secretary determines appropriate.
(d)
added Condition on participation on task force— An individual representing a profession or entity described in paragraph (3) or (5) of subsection (c) may not serve as a member of the task force unless such individual—
(1)
added is currently licensed in a State in which such individual is practicing (as defined by such State) such profession (or, in the case of an individual representing an entity, a State in which the entity is engaged in business); and
(2)
added is currently practicing (as defined by such State) such profession (or, in the case of an individual representing an entity, the entity is in operation).
(e)
renumbered was (5) Duties— The task force shall—
(1)
renumbered was (5)(3) 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)
renumbered was (5)(3)(2) existing pain management research;
(B)
added research on trends in areas and communities in which the prescription opioid abuse rate and fatality rate exceed the national average prescription opioid abuse rate and fatality rate;
(C)
renumbered was (5)(3)(3) recommendations from relevant conferences and existing relevant evidence-based guidelines;
(D)
added 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, medical device alternatives to opioids to reduce opioid monotherapy in appropriate cases and the coordination of information collected from State prescription drug monitoring programs for the purpose of preventing the diversion of pain medication;
(E)
added ongoing efforts at the Federal, State, and local levels to examine the potential benefits of electronic prescribing of opioids, including any public comments collected in the course of those efforts;
(C)
removed 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;
(F)
renumbered was (5)(3)(5) the management of high-risk populations, other than populations who suffer pain, who—
(i)
renumbered was (5)(3)(5)(2) may use or be prescribed benzodiazepines, alcohol, and diverted opioids; or
(ii)
added receive opioids in the course of medical care;
(G)
added the distinct needs of adolescents and young adults with respect to pain management, pain medication, substance use disorder, and medication-assisted treatment;
(ii)
removed receive opioids in the course of medical care; and
(H)
renumbered was (5)(3)(6) the 2016 Guideline for Prescribing Opioids for Chronic Pain issued by the Centers for Disease Control and Prevention;
(I)
added the practice of co-prescribing naloxone for both pain patients receiving chronic opioid therapy and patients being treated for opioid use disorders;
(J)
added research that has been, or is being, conducted or supported by the Federal Government on prevention of, treatment for, and recovery from substance use by and substance use disorders among adolescents and young adults relative to any unique circumstances (including social and biological circumstances) of adolescents and young adults that may make adolescent-specific and young adult-specific treatment protocols necessary, including any effects that substance use and substance use disorders may have on brain development and the implications for treatment and recovery;
(K)
added Federal non-research programs and activities that address prevention of, treatment for, and recovery from substance use by and substance use disorders among adolescents and young adults, including an assessment of the effectiveness of such programs and activities in—
(i)
added preventing substance use by and substance use disorders among adolescents and young adults;
(ii)
added treating such adolescents and young adults in a way that accounts for any unique circumstances faced by adolescents and young adults; and
(iii)
added supporting long-term recovery among adolescents and young adults; and
(L)
added gaps that have been identified by Federal officials and experts in Federal efforts relating to prevention of, treatment for, and recovery from substance use by and substance use disorders among adolescents and young adults, including gaps in research, data collection, and measures to evaluate the effectiveness of Federal efforts, and the reasons for such gaps;
(2)
added solicit and take into consideration public comment on the practices developed under paragraph (1), amending such best practices if appropriate;
(3)
added 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;
(4)
added review, modify, and update best practices for pain management and prescribing pain medication, specifically as it pertains to physician education and consumer education; and
(5)
added examine and identify—
(A)
added the extent of the need for the development of new pharmacological, nonpharmacological, and medical device alternatives to opioids;
(B)
added the current status of research efforts to develop such alternatives; and
(C)
added the pharmacological, nonpharmacological, and medical device alternatives to opioids that are currently available that could be better utilized.
(f)
added Consideration of study results— In reviewing, modifying, and updating, best practices for pain management and prescribing pain medication, the task force shall take into consideration existing private sector, State, and local government efforts related to pain management and prescribing pain medication.
(2)
removed solicit and take into consideration public comment on the practices developed under paragraph (1), amending such best practices if appropriate; and
(3)
removed 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.
(g)
renumbered was (6) Limitation— The task force shall not have rulemaking authority.
(h)
renumbered was (7) 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)
added the strategy for disseminating best practices for pain management (including chronic and acute pain) and prescribing pain medication, as developed under subsection (e);
(2)
added 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));
(3)
added 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;
(4)
added the modified and updated best practices described in subsection (e)(4); and
(5)
added the results of the examination and identification conducted pursuant to subsection (e)(4), and recommendations regarding—
(A)
added the development of new pharmacological, nonpharmacological, and medical device alternatives to opioids; and
(B)
added the improved utilization of pharmacological, nonpharmacological, and medical device alternatives to opioids that are currently available.
(1)
removed the strategy for disseminating best practices for pain management (including chronic and acute pain) and prescribing pain medication, as developed under subsection (d);
(2)
removed 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)
removed 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.