[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4169 Introduced in House (IH)]

113th CONGRESS
  2d Session
                                H. R. 4169

            To prevent deaths occurring from drug overdoses.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 6, 2014

    Ms. Edwards (for herself, Ms. Bass, Mr. Carson of Indiana, Mr. 
 Cummings, Mr. Ellison, Mr. Keating, Ms. Lee of California, Mr. Lynch, 
 Mr. Michaud, Mr. Rangel, Mr. Ryan of Ohio, Ms. Schwartz, Mr. Serrano, 
  Ms. Shea-Porter, Mr. Tierney, Mr. Tonko, Ms. Wilson of Florida, Mr. 
 Foster, and Mr. Ben Ray Lujan of New Mexico) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
            To prevent deaths occurring from drug overdoses.

    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 ``Stop Overdose Stat Act'' or the 
``S.O.S. Act''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) According to the Centers for Disease Control and 
        Prevention (CDC), each day in the United States more than 100 
        people die from a drug overdose. Among people 25 to 64 years 
        old, drug overdose caused more deaths than motor vehicle 
        accidents.
            (2) The CDC reports that more than 38,000 people in the 
        United States died from a drug overdose in 2010 alone. Seventy-
        eight percent of these deaths were due to unintentional drug 
        overdoses, and many could have been prevented.
            (3) Deaths resulting from unintentional drug overdoses 
        increased more than 400 percent between 1980 and 1999, and more 
        than doubled between 1999 and 2010.
            (4) Ninety-one percent of all unintentional poisoning 
        deaths are due to drugs. Since 1999, in the United States the 
        population of Non-Hispanic Whites and the population of 
        American Indians and Alaska Natives have seen the highest rates 
        of unintentional drug poisoning deaths.
            (5) Opioid medications such as oxycodone and hydrocodone 
        are involved in 55 percent of all unintentional drug poisoning 
        deaths.
            (6) Between 1999 and 2010, opioid medication overdose 
        fatalities increased by more than 400 percent among women and 
        265 percent among men.
            (7) Military veterans are at elevated risk of experiencing 
        a drug overdose. Vietnam, Iraq, and Afghanistan veterans with 
        combat injuries, posttraumatic stress disorder (PTSD), and 
        other co-occurring mental health diagnoses are at elevated risk 
        of fatal drug overdose from opioid medications.
            (8) Rural and suburban regions are disproportionately 
        affected by opioid medication overdoses. Urban centers also 
        continue to struggle with overdose, which is the leading cause 
        of death among homeless adults.
            (9) In the year 2009 alone, estimated lost productivity and 
        direct medical costs from opioid medication poisonings exceeded 
        $20,000,000,000.
            (10) Both fatal and nonfatal overdoses place a heavy burden 
        on public health and public safety resources, yet there is no 
        coordinated cross-Federal agency response to prevent overdose 
        fatalities.
            (11) Naloxone is a medication that rapidly reverses 
        overdose from heroin and opioid medications.
            (12) In 2012, the Food and Drug Administration (FDA) held a 
        public workshop in collaboration with the National Institute on 
        Drug Abuse (NIDA) and the CDC, and with participation from the 
        Substance Abuse and Mental Health Services Administration 
        (SAMHSA) and the Office of National Drug Control Policy 
        (ONDCP), to discuss making naloxone more widely available 
        outside of conventional medical settings to reduce the 
        incidence of opioid overdose fatalities.
            (13) Lawmakers in California, Colorado, Connecticut, 
        Illinois, Kentucky, Massachusetts, Maryland, New Jersey, New 
        Mexico, New York, North Carolina, Oregon, Rhode Island, 
        Vermont, Virginia, Washington, and the District of Columbia 
        have removed legal impediments to increasing naloxone 
        prescription and its use by bystanders who are in a position to 
        respond to an overdose.
            (14) Health practitioners are often not fully aware of 
        overdose symptoms and prevention methods, impacting their 
        ability to adequately inform patients and caregivers on how to 
        recognize symptoms, respond effectively by seeking emergency 
        assistance, and provide naloxone and other first aid in order 
        to save a life.
            (15) The American Medical Association (AMA), the Nation's 
        largest physician organization, supports further implementation 
        of community-based programs that offer naloxone and other 
        opioid overdose prevention services.
            (16) Community-based overdose prevention programs have 
        successfully prevented deaths from opioid overdoses by making 
        rescue trainings and naloxone available to first responders, 
        parents, and other bystanders who may encounter an overdose. 
        Over 50,000 potential bystanders have been trained by overdose 
        prevention programs in the United States. A CDC report credits 
        overdose prevention programs with saving more than 10,000 lives 
        since 1996.
            (17) At least 188 local overdose prevention programs are 
        operating in the United States, including in major cities such 
        as Baltimore, Chicago, Los Angeles, New York City, Boston, San 
        Francisco, and Philadelphia, and statewide in New Mexico, 
        Massachusetts, and New York. Between 2006 and 2009, overdose 
        prevention programs facilitated by the Massachusetts Department 
        of Public Health trained nearly 3,000 people who reported more 
        than 300 rescues. Since 2004, a program administered by the 
        Baltimore City Health Department has trained more than 3,000 
        people who reported more than 220 rescues. Project Lazarus, an 
        overdose prevention program in Wilkes County, North Carolina, 
        reduced overdose deaths 69 percent between 2009 and 2011.
            (18) The ONDCP supports equipping first responders to help 
        reverse overdoses. Police officers on patrol in Quincy, 
        Massachusetts, have conducted 170 overdose rescues with 
        naloxone since 2010. The police department has reported a 95-
        percent success rate with overdose rescue attempts by police 
        officers. In Suffolk County, New York, police officers have 
        saved more than 50 lives with naloxone.
            (19) Research shows that the cost per year of life gained 
        by making naloxone available to reverse overdoses is within the 
        range of what Americans usually pay for health treatments.
            (20) Overdose prevention programs are needed in 
        correctional facilities, addiction treatment programs, and 
        other places where people are at higher risk of overdosing 
        after a period of abstinence.
            (21) People affected by drug overdose gather each year in 
        communities nationwide on August 31st for Overdose Awareness 
        Day to mourn and pay tribute to loved ones and raise awareness 
        about overdose risk and prevention.

SEC. 3. OVERDOSE PREVENTION GRANT PROGRAM.

    (a) Program Authorized.--The Secretary, acting through the Director 
of the CDC, shall award grants or cooperative agreements to eligible 
entities to enable the eligible entities to reduce deaths occurring 
from overdoses of drugs.
    (b) Application.--
            (1) In general.--An eligible entity desiring a grant or 
        cooperative agreement under this section shall submit to the 
        Secretary an application at such time, in such manner, and 
        containing such information as the Secretary may require.
            (2) Contents.--An application under paragraph (1) shall 
        include--
                    (A) a description of the activities to be funded 
                through the grant or cooperative agreement; and
                    (B) a demonstration that the eligible entity has 
                the capacity to carry out such activities.
    (c) Priority.--In awarding grants and cooperative agreements under 
subsection (a), the Secretary shall give priority to eligible entities 
that--
            (1) are a public health agency or community-based 
        organization; and
            (2) have expertise in preventing deaths occurring from 
        overdoses of drugs in populations at high risk of such deaths.
    (d) Eligible Activities.--
            (1) Required activity.--As a condition on receipt of a 
        grant or cooperative agreement under this section, an eligible 
        entity shall agree to use the grant or cooperative agreement to 
        purchase and distribute the drug naloxone.
            (2) Additional activities.--In addition to the activity 
        described in paragraph (1), an eligible entity shall use a 
        grant or cooperative agreement under this section to carry out 
        one or more of the following activities:
                    (A) Educating prescribers and pharmacists about 
                overdose prevention and naloxone prescription.
                    (B) Training first responders, other individuals in 
                a position to respond to an overdose, and law 
                enforcement and corrections officials on the effective 
                response to individuals who have overdosed on drugs. 
                Training pursuant to this subparagraph may include any 
                activity that is educational, instructional, or 
                consultative in nature, and may include volunteer 
                trainings, awareness building exercises, outreach to 
                individuals who are at-risk of a drug overdose, and 
                distribution of educational materials.
                    (C) Implementing and enhancing programs to provide 
                overdose prevention, recognition, treatment, and 
                response to individuals in need of such services.
                    (D) Expanding activities described in paragraph 
                (1).
                    (E) Expanding activities described in subparagraph 
                (A) or (B).
    (e) Coordinating Center.--
            (1) Establishment.--The Secretary shall establish and 
        provide for the operation of a coordinating center responsible 
        for--
                    (A) collecting, compiling, and disseminating data 
                on the programs and activities under this section;
                    (B) evaluating such data and, based on such 
                evaluation, developing best practices for preventing 
                deaths occurring from drug overdoses; and
                    (C) making such best practices specific to the type 
                of community involved.
            (2) Reports to center.--As a condition on receipt of a 
        grant or cooperative agreement under this section, an eligible 
        entity shall agree to prepare and submit, not later than 90 
        days after the end of the grant or cooperative agreement 
        period, a report to such coordinating center and the Secretary 
        describing the results of the activities supported through the 
        grant or cooperative agreement.
    (f) Matching Funds.--
            (1) In general.--As a condition on receipt of a grant or 
        cooperative agreement under this section, an eligible entity 
        shall agree that, with respect to the costs to be incurred by 
        the eligible entity in carrying out the activities for which 
        the grant or cooperative agreement is awarded, the eligible 
        entity will make available non-Federal contributions in an 
        amount equal to not less than 50 percent of the Federal funds 
        provided through the grant or cooperative agreement.
            (2) Satisfying matching requirement.--The non-Federal 
        contributions required under paragraph (1) may be--
                    (A) in cash or in-kind, including services, fairly 
                evaluated; and
                    (B) from--
                            (i) any private source; or
                            (ii) a State, tribal, or local agency.
            (3) Waiver.--The Secretary may waive or reduce the non-
        Federal contribution required by paragraph (1) if the eligible 
        entity involved demonstrates that the eligible entity cannot 
        meet the contribution requirement due to financial hardship.
    (g) Duration.--The period of a grant or cooperative agreement under 
this section shall be 4 years.
    (h) Authorization of Appropriations.--There are authorized to be 
appropriated $10,000,000 to carry out this section for each of the 
fiscal years 2014 through 2018.

SEC. 4. SURVEILLANCE CAPACITY BUILDING.

    (a) Program Authorized.--The Secretary, acting through the Director 
of the CDC, shall award grants or cooperative agreements to State, 
local, or tribal governments, or the National Poison Data System 
working in conjunction with State, local, or tribal governments, to 
improve fatal and nonfatal drug overdose surveillance and reporting 
capabilities, including the following:
            (1) Providing training to improve identification of drug 
        overdose as the cause of death by coroners and medical 
        examiners.
            (2) Establishing, in cooperation with the National Poison 
        Data System, coroners, and medical examiners, a comprehensive 
        national program for surveillance of, and reporting to an 
        electronic database on, drug overdose deaths in the United 
        States.
            (3) Establishing, in cooperation with the National Poison 
        Data System, a comprehensive national program for surveillance 
        of, and reporting to an electronic database on, fatal and 
        nonfatal drug overdose occurrences, including epidemiological 
        and toxicologic analysis and trends.
    (b) Application.--
            (1) In general.--A State, local, or tribal government or 
        the National Poison Data System desiring a grant or cooperative 
        agreement under this section shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may require.
            (2) Contents.--The application described in paragraph (1) 
        shall include--
                    (A) a description of the activities to be funded 
                through the grant or cooperative agreement; and
                    (B) a demonstration that the State, local, or 
                tribal government or the National Poison Data System 
                has the capacity to carry out such activities.
    (c) Report.--As a condition on receipt of a grant or cooperative 
agreement under this section, a State, local, or tribal government or 
the National Poison Data System shall agree to prepare and submit, not 
later than 90 days after the end of the grant or cooperative agreement 
period, a report to the Secretary describing the results of the 
activities supported through the grant or cooperative agreement.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of the 
fiscal years 2014 through 2018.

SEC. 5. REDUCING OVERDOSE DEATHS.

    Part J of title III of the Public Health Service Act (42 U.S.C. 
280b et seq.) is amended by inserting after section 393D (42 U.S.C. 
280b-1f) the following:

``SEC. 393F. REDUCING OVERDOSE DEATHS.

    ``(a) Prevention of Drug Overdose.--Not later than 180 days after 
the date of the enactment of this section, the Secretary, in 
consultation with a task force comprised of stakeholders, shall develop 
a plan to reduce the number of deaths occurring from overdoses of drugs 
and shall submit the plan to Congress. The plan shall include--
            ``(1) a plan for implementation of a public health campaign 
        to educate prescribers and the public about overdose prevention 
        and naloxone prescription;
            ``(2) recommendations for improving and expanding overdose 
        prevention programming; and
            ``(3) recommendations for such legislative or 
        administrative action as the Secretary considers appropriate.
    ``(b) Task Force Representation.--
            ``(1) Required members.--The task force referred to in 
        subsection (a) shall include at least one representative of 
        each of the following:
                    ``(A) Individuals directly impacted by drug 
                overdose.
                    ``(B) Direct service providers who engage 
                individuals at risk of a drug overdose.
                    ``(C) Drug overdose prevention advocates.
                    ``(D) The NIDA.
                    ``(E) The Center for Substance Abuse Treatment.
                    ``(F) The CDC.
                    ``(G) The Health Resources and Services 
                Administration.
                    ``(H) The Food and Drug Administration.
                    ``(I) The Office of National Drug Control Policy.
                    ``(J) The American Medical Association.
                    ``(K) The American Association of Poison Control 
                Centers.
                    ``(L) The Bureau of Prisons.
                    ``(M) The Centers for Medicare & Medicaid Services.
                    ``(N) The Department of Justice.
            ``(2) Additional members.--In addition to the 
        representatives required by paragraph (1), the task force 
        referred to in subsection (a) may include other representatives 
        of individuals or entities with expertise relating to drug 
        overdoses.''.

SEC. 6. OVERDOSE PREVENTION RESEARCH.

    (a) Overdose Research.--The Director of the NIDA shall prioritize 
and conduct or support research on drug overdose and overdose 
prevention. The primary aims of this research shall include--
            (1) examination of circumstances that contribute to drug 
        overdose and identification of drugs associated with fatal 
        overdose;
            (2) evaluation of existing overdose prevention methods;
            (3) pilot programs or research trials on new overdose 
        prevention strategies or programs that have not been studied in 
        the United States;
            (4) scientific research concerning the effectiveness of 
        overdose prevention programs, including how to effectively 
        implement and sustain such programs; and
            (5) comparative effectiveness research on overdose 
        prevention programs.
    (b) Formulations of Naloxone.--The Director of the NIDA shall 
support research on the development of formulations of naloxone and 
dosage delivery devices specifically intended to be used by lay persons 
or first responders for the prehospital treatment of unintentional drug 
overdose.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of the 
fiscal years 2014 through 2018.

SEC. 7. OFFSET OF COSTS AND PERSONNEL.

    Notwithstanding any other provision of law, the Secretary shall--
            (1) eliminate such initiatives, positions, and programs as 
        the Secretary deems necessary to ensure any and all costs 
        incurred to carry out the provisions of this Act, and the 
        amendments made by this Act, are entirely offset;
            (2) ensure no net increase in personnel are added to carry 
        out the provisions of this Act, with any new full- or part-time 
        employees or equivalents offset by eliminating an equivalent 
        number of existing staff;
            (3) not later than 60 days after the date of the enactment 
        of this Act, report to the Congress on the actions taken to 
        ensure compliance with paragraphs (1) and (2), including the 
        specific initiatives, positions, and programs that have been 
        eliminated to ensure that the costs of carrying out this Act 
        will be offset; and
            (4) not implement any other provision of this Act (other 
        than paragraphs (1), (2), and (3)) or any amendment made by 
        this Act until the Secretary has certified that the actions 
        specified in paragraphs (1), (2), and (3) have been completed.

SEC. 8. DEFINITIONS.

    In this Act:
            (1) CDC.--The term ``CDC'' means the Centers for Disease 
        Control and Prevention.
            (2) Drug.--The term ``drug''--
                    (A) means a drug (as that term is defined in 
                section 201 of the Federal Food, Drug, and Cosmetic Act 
                (21 U.S.C. 321)); and
                    (B) includes any controlled substance (as that term 
                is defined in section 102 of the Controlled Substances 
                Act (21 U.S.C. 802)).
            (3) Eligible entity.--The term ``eligible entity'' means an 
        entity that is a State, local, or tribal government, a 
        correctional institution, a law enforcement agency, a community 
        agency, a professional organization in the field of poison 
        control and surveillance, or a private nonprofit organization.
            (4) National poison data system.--The term ``National 
        Poison Data System'' means the system operated by the American 
        Association of Poison Control Centers, in partnership with the 
        CDC, for real-time local, State, and national electronic 
        reporting, and the corresponding database network.
            (5) NIDA.--The term ``NIDA'' means the National Institute 
        on Drug Abuse.
            (6) ONDCP.--The term ``ONDCP'' means the Office of National 
        Drug Control Policy.
            (7) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (8) State.--The term ``State'' means any of the several 
        States, the District of Columbia, Puerto Rico, the Northern 
        Mariana Islands, the United States Virgin Islands, Guam, 
        American Samoa, and any other territory or possession of the 
        United States.
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