[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2755 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2755

            To prevent deaths occurring from drug overdoses.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 31, 2014

Mr. Reed (for himself, Mr. Durbin, Mr. Whitehouse, Mr. Markey, and Mr. 
Leahy) introduced the following bill; which was read twice and referred 
       to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 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 ``Overdose Prevention Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) According to the Centers for Disease Control and 
        Prevention, each day in the United States, more than 100 people 
        die from a drug overdose. Among people 25 to 64 years old, drug 
        overdose causes more deaths than motor vehicle accidents.
            (2) The Centers for Disease Control and Prevention reports 
        that more than 41,000 people in the United States died from a 
        drug overdose in 2011 alone. Nearly 80 percent of those deaths 
        were due to unintentional drug overdoses, and many could have 
        been prevented.
            (3) Deaths resulting from unintentional drug overdoses 
        increased more than 300 percent between 1980 and 1998, and 
        nearly tripled between 1999 and 2011.
            (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 Indians 
        (as defined in section 4 of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450b)) 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. Veterans who served in Vietnam, Iraq, or 
        Afghanistan and who have combat injuries, posttraumatic stress 
        disorder, 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 held a 
        public workshop in collaboration with the National Institute on 
        Drug Abuse and the Centers for Disease Control and Prevention, 
        and with participation from the Substance Abuse and Mental 
        Health Services Administration and the Office of National Drug 
        Control Policy, 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, 
        Georgia, Illinois, Kentucky, Maine, Maryland, Massachusetts, 
        Minnesota, New Jersey, New Mexico, New York, North Carolina, 
        Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, Utah, Vermont, 
        Virginia, Washington, Wisconsin, 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) The American Medical Association, the Nation's largest 
        physician organization, supports further implementation of 
        community-based programs that offer naloxone and other opioid 
        overdose prevention services.
            (15) Community-based overdose prevention programs have 
        successfully prevented deaths from opioid overdoses by making 
        rescue training and naloxone available to first responders, 
        parents, and other bystanders who may encounter an overdose. A 
        study funded by the Centers for Disease Control and Prevention 
        of community-based overdose prevention programs provided by the 
        Massachusetts Department of Public Health found that 
        communities with access to overdose prevention programs 
        experienced lower mortality rates from opioid overdoses than 
        communities that did not have access to overdose prevention 
        programs during the study period.
            (16) Over 50,000 potential bystanders have been trained by 
        overdose prevention programs in the United States. A Centers 
        for Disease Control and Prevention 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 more than 4,800 people who reported 
        more than 500 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) In Illinois, the Department of Human Services, 
        Division of Alcoholism and Substance Abuse has enrolled over 20 
        drug overdose prevention programs with over 100 designated 
        sites across Illinois targeting multiple service populations. 
        These enrollees include police departments, county health 
        departments, medical facilities, licensed substance abuse 
        treatment programs, and community organizations. Statewide, 
        over 2,000 police officers and more than 600 others have been 
        trained thus far. The DuPage County Illinois Health Department 
        has trained over 1,200 police officers and has reported 12 
        overdose reversals.
            (19) The Office of National Drug Control Policy 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.
            (20) Research shows that the cost per year of life gained 
        by making naloxone available to reverse overdoses is within the 
        range of what people in the United States usually pay for 
        health treatments.
            (21) 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.
            (22) People affected by drug overdose gather on August 31 
        of each year in communities nationwide for Overdose Awareness 
        Day, to mourn and pay tribute to loved ones and raise awareness 
        about overdose risk and prevention.

SEC. 3. OVERDOSE PREVENTION PROGRAMS.

    Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) 
is amended by adding at the end the following:

                 ``PART W--OVERDOSE PREVENTION PROGRAMS

``SEC. 399OO. COOPERATIVE AGREEMENT PROGRAM TO REDUCE DRUG OVERDOSE 
              DEATHS.

    ``(a) Program Authorized.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall enter 
into cooperative agreements with eligible entities to enable the 
eligible entities to reduce deaths occurring from overdoses of drugs.
    ``(b) Eligible Entities.--To be eligible to receive a cooperative 
agreement under this section, an entity shall be 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.
    ``(c) Application.--
            ``(1) In general.--An eligible entity desiring a 
        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 cooperative agreement; and
                    ``(B) evidence that the eligible entity has the 
                capacity to carry out such activities.
    ``(d) Priority.--In entering into 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.
    ``(e) Eligible Activities.--As a condition of receipt of a 
cooperative agreement under this section, an eligible entity shall 
agree to use the cooperative agreement to do each of the following:
            ``(1) Purchase and distribute the drug naloxone or a 
        similarly effective medication.
            ``(2) Carry out one or more of the following activities:
                    ``(A) Educating prescribers and pharmacists about 
                overdose prevention and naloxone prescription, or 
                prescription of a similarly effective medication.
                    ``(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 
                training, 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) Educating the public and providing outreach 
                to the public about overdose prevention and naloxone 
                prescriptions, or prescriptions of other similarly 
                effective medications.
    ``(f) 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, 
                including tracking and evaluating the distribution and 
                use of naloxone and other similarly effective 
                medication;
                    ``(B) evaluating such data and, based on such 
                evaluation, developing best practices for preventing 
                deaths occurring from drug overdoses;
                    ``(C) making such best practices specific to the 
                type of community involved;
                    ``(D) coordinating and harmonizing data collection 
                measures;
                    ``(E) evaluating the effects of the program on 
                overdose rates: and
                    ``(F) education and outreach to the public about 
                overdose prevention and prescription of naloxone and 
                other similarly effective medication.
            ``(2) Reports to center.--As a condition on receipt of a 
        cooperative agreement under this section, an eligible entity 
        shall agree to prepare and submit, not later than 90 days after 
        the end of the cooperative agreement period, a report to such 
        coordinating center and the Secretary describing the results of 
        the activities supported through the cooperative agreement.
    ``(g) Duration.--The period of a cooperative agreement under this 
section shall be 4 years.
    ``(h) Definition.--In this part, the term `drug' means--
            ``(1) a drug, as defined in section 201 of the Federal 
        Food, Drug, and Cosmetic Act (21 U.S.C. 321); and
            ``(2) includes controlled substances, as defined in section 
        102 of the Controlled Substances Act (21 U.S.C. 802).
    ``(i) Authorization of Appropriations.--There are authorized to be 
appropriated $20,000,000 to carry out this section for each of the 
fiscal years 2015 through 2019.

``SEC. 399OO-1. SURVEILLANCE CAPACITY BUILDING.

    ``(a) Program Authorized.--The Secretary, acting through the 
Director of the Centers for Disease Control and Prevention, shall award 
cooperative agreements to eligible entities to improve fatal and 
nonfatal drug overdose surveillance and reporting capabilities, 
including--
            ``(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; and
            ``(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) Eligible Entity.--To be eligible to receive a cooperative 
agreement under this section, an entity shall be--
            ``(1) a State, local, or tribal government; or
            ``(2) the National Poison Data System working in 
        conjunction with a State, local, or tribal government.
    ``(c) Application.--
            ``(1) In general.--An eligible entity desiring a 
        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 cooperative agreement; and
                    ``(B) evidence that the eligible entity has the 
                capacity to carry out such activities.
    ``(d) Report.--As a condition of receipt of a cooperative agreement 
under this section, an eligible entity shall agree to prepare and 
submit, not later than 90 days after the end of the cooperative 
agreement period, a report to the Secretary describing the results of 
the activities supported through the cooperative agreement.
    ``(e) National Poison Data System.--In this section, the term 
`National Poison Data System' means the system operated by the American 
Association of Poison Control Centers, in partnership with the Centers 
for Disease Control and Prevention, for real-time local, State, and 
national electronic reporting, and the corresponding database network.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of the 
fiscal years 2015 through 2019.

``SEC. 399OO-2. 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 prescription of naloxone and other similarly effective 
        medication;
            ``(2) recommendations for improving and expanding overdose 
        prevention programming; and
            ``(3) recommendations for such legislative or 
        administrative action as the Secretary determines appropriate.
    ``(b) Task Force Representation.--
            ``(1) Required members.--The task force under 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 National Institute on Drug Abuse.
                    ``(E) The Center for Substance Abuse Treatment.
                    ``(F) The Centers for Disease Control and 
                Prevention.
                    ``(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 Federal Bureau of Prisons.
                    ``(M) The Centers for Medicare & Medicaid Services.
                    ``(N) The Department of Justice.
                    ``(O) The Department of Defense.
                    ``(P) The Department of Veterans Affairs.
                    ``(Q) First responders.
                    ``(R) Law enforcement.
                    ``(S) State agencies responsible for drug overdose 
                prevention.
            ``(2) Additional members.--In addition to the 
        representatives required by paragraph (1), the task force under 
        subsection (a) may include other individuals with expertise 
        relating to drug overdoses or representatives of entities with 
        expertise relating to drug overdoses, as the Secretary 
        determines appropriate.''.

SEC. 4. OVERDOSE PREVENTION RESEARCH.

    Subpart 15 of part C of title IV of the Public Health Service Act 
(42 U.S.C. 285o et seq.) is amended by adding at the end the following:

``SEC. 464Q. OVERDOSE PREVENTION RESEARCH.

    ``(a) Overdose Research.--The Director of the Institute shall 
prioritize and conduct or support research on drug overdose and 
overdose prevention. The primary aims of this research shall include--
            ``(1) an examination of circumstances that contribute to 
        drug overdose and identification of drugs associated with fatal 
        overdose;
            ``(2) an 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;
            ``(5) comparative effectiveness research of model programs; 
        and
            ``(6) implementation of science research concerning 
        effective overdose prevention programming examining how to 
        implement and sustain overdose prevention programming.
    ``(b) Formulations of Naloxone.--The Director of the Institute 
shall support research on the development of formulations of naloxone, 
and other similarly effective medications, and dosage delivery devices 
specifically intended to be used by lay persons or first responders for 
the prehospital treatment of unintentional drug overdose.
    ``(c) Definition.--In this section, the term `drug' has the meaning 
given such term in section 399OO.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of the 
fiscal years 2015 through 2019.''.
                                 <all>