[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 799 Reported in Senate (RS)]

<DOC>





                                                       Calendar No. 246
114th CONGRESS
  1st Session
                                 S. 799

  To combat the rise of prenatal opioid abuse and neonatal abstinence 
                               syndrome.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 19, 2015

Mr. McConnell (for himself and Mr. Casey, Ms. Ayotte, Mr. Portman, Mr. 
Isakson, Ms. Baldwin, Mr. Whitehouse, Mr. Corker, Mr. Brown, Mr. Coons, 
 Mrs. Gillibrand, Mrs. Capito, Mrs. Fischer, Mr. Vitter, Mr. Boozman, 
   Mr. Cotton, Mr. Donnelly, Mr. King, Mr. Carper, Ms. Collins, Mrs. 
 Murray, and Mr. Toomey) introduced the following bill; which was read 
 twice and referred to the Committee on Health, Education, Labor, and 
                                Pensions

                            October 1, 2015

 Reported by Mr. Alexander, with an amendment and an amendment to the 
                                 title
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 A BILL


 
  To combat the rise of prenatal opioid abuse and neonatal abstinence 
                               syndrome.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Protecting Our Infants Act 
of 2015''.</DELETED>

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    Congress finds as follows:</DELETED>
        <DELETED>    (1) Opioid prescription rates have risen 
        dramatically over the past several years. According to the 
        Centers for Disease Control and Prevention, in some States, 
        there are as many as 96 to 143 prescriptions for opioids per 
        100 adults per year.</DELETED>
        <DELETED>    (2) In recent years, there has been a steady rise 
        in the number of overdose deaths involving heroin. According to 
        the Centers for Disease Control and Prevention, the death rate 
        for heroin overdose doubled from 2010 to 2012.</DELETED>
        <DELETED>    (3) At the same time, there has been an increase 
        in cases of neonatal abstinence syndrome (referred to in this 
        section as ``NAS''). In the United States, the incidence of NAS 
        has risen from 1.20 per 1,000 hospital births in 2000 to 3.39 
        per 1,000 hospital births in 2009.</DELETED>
        <DELETED>    (4) NAS refers to medical issues associated with 
        drug withdrawal in newborns due to exposure to opioids or other 
        drugs in utero.</DELETED>
        <DELETED>    (5) The average cost of treatment in a hospital 
        for NAS increased from $39,400 in 2000 to $53,400 in 2009. Most 
        of these costs are born by the Medicaid program.</DELETED>
        <DELETED>    (6) Preventing opioid abuse among pregnant women 
        and women of childbearing age is crucial.</DELETED>
        <DELETED>    (7) Medically-appropriate opioid use in pregnancy 
        is not uncommon, and opioids are often the safest and most 
        appropriate treatment for moderate to severe pain for pregnant 
        women.</DELETED>
        <DELETED>    (8) Addressing NAS effectively requires a focus on 
        women of childbearing age, pregnant women, and infants from 
        preconception through early childhood.</DELETED>
        <DELETED>    (9) NAS can result from the use of prescription 
        drugs as prescribed for medical reasons, from the abuse of 
        prescription drugs, or from the use of illegal opioids like 
        heroin.</DELETED>
        <DELETED>    (10) For pregnant women who are abusing opioids, 
        it is most appropriate to treat and manage maternal substance 
        use in a non-punitive manner.</DELETED>
        <DELETED>    (11) According to a report of the Government 
        Accountability Office (referred to in this section as the ``GAO 
        report''), more research is needed to optimize the 
        identification and treatment of babies with NAS and to better 
        understand long-term impacts on children.</DELETED>
        <DELETED>    (12) According to the GAO report, the Department 
        of Health and Human Services does not have a focal point to 
        lead planning and coordinating efforts to address prenatal 
        opioid use and NAS across the department.</DELETED>
        <DELETED>    (13) According to the GAO report, ``given the 
        increasing use of heroin and abuse of opioids prescribed for 
        pain management, as well as the increased rate of NAS in the 
        United States, it is important to improve the efficiency and 
        effectiveness of planning and coordination of Federal efforts 
        on prenatal opioid use and NAS''.</DELETED>

<DELETED>SEC. 3. DEVELOPING RECOMMENDATIONS FOR PREVENTING AND TREATING 
              PRENATAL OPIOID ABUSE AND NEONATAL ABSTINENCE 
              SYNDROME.</DELETED>

<DELETED>    (a) In General.--The Secretary of Health and Human 
Services (referred to in this Act as the ``Secretary''), acting through 
the Director of the Agency for Healthcare Research and Quality 
(referred to in this section as the ``Director''), shall conduct a 
study and develop recommendations for preventing and treating prenatal 
opioid abuse and neonatal abstinence syndrome, soliciting input from 
nongovernmental entities, including organizations representing 
patients, health care providers, hospitals, other treatment facilities, 
and other entities, as appropriate.</DELETED>
<DELETED>    (b) Report.--Not later than 1 year after the date of 
enactment of this Act, the Director shall publish on the Internet Web 
site of the Agency for Healthcare Research and Quality a report on the 
study and recommendations under subsection (a). Such report shall 
address each of the issues described in paragraphs (1) through (3) of 
subsection (c).</DELETED>
<DELETED>    (c) Contents.--The study described in subsection (a) and 
the report under subsection (b) shall include--</DELETED>
        <DELETED>    (1) a comprehensive assessment of existing 
        research with respect to the prevention, identification, 
        treatment, and long-term outcomes of neonatal abstinence 
        syndrome, including the identification and treatment of 
        pregnant women or women who may become pregnant who use opioids 
        or other drugs;</DELETED>
        <DELETED>    (2) an evaluation of--</DELETED>
                <DELETED>    (A) the causes of and risk factors for 
                opioid use disorders among women of reproductive age, 
                including pregnant women;</DELETED>
                <DELETED>    (B) the barriers to identifying and 
                treating opioid use disorders among women of 
                reproductive age, including pregnant and postpartum 
                women and women with young children;</DELETED>
                <DELETED>    (C) current practices in the health care 
                system to respond to and treat pregnant women with 
                opioid use disorders and infants born with neonatal 
                abstinence syndrome;</DELETED>
                <DELETED>    (D) medically indicated use of opioids 
                during pregnancy;</DELETED>
                <DELETED>    (E) access to treatment for opioid use 
                disorders in pregnant and postpartum women; 
                and</DELETED>
                <DELETED>    (F) access to treatment for infants with 
                neonatal abstinence syndrome; and</DELETED>
        <DELETED>    (3) recommendations on--</DELETED>
                <DELETED>    (A) preventing, identifying, and treating 
                neonatal abstinence syndrome in infants;</DELETED>
                <DELETED>    (B) treating pregnant women who are 
                dependent on opioids; and</DELETED>
                <DELETED>    (C) preventing opioid dependence among 
                women of reproductive age, including pregnant women, 
                who may be at risk of developing opioid 
                dependence.</DELETED>

<DELETED>SEC. 4. IMPROVING PREVENTION AND TREATMENT FOR PRENATAL OPIOID 
              ABUSE AND NEONATAL ABSTINENCE SYNDROME.</DELETED>

<DELETED>    (a) Review of Programs.--The Secretary shall lead a review 
of planning and coordination within the Department of Health and Human 
Services related to prenatal opioid use and neonatal abstinence 
syndrome.</DELETED>
<DELETED>    (b) Strategy to Close Gaps in Research and Programming.--
In carrying out subsection (a), the Secretary shall develop a strategy 
to address research and program gaps, including such gaps identified in 
findings made by reports of the Government Accountability Office. Such 
strategy shall address--</DELETED>
        <DELETED>    (1) gaps in research, including with respect to--
        </DELETED>
                <DELETED>    (A) the most appropriate treatment of 
                pregnant women with opioid use disorders;</DELETED>
                <DELETED>    (B) the most appropriate treatment and 
                management of infants with neonatal abstinence 
                syndrome; and</DELETED>
                <DELETED>    (C) the long-term effects of prenatal 
                opioid exposure on children; and</DELETED>
        <DELETED>    (2) gaps in programs, including--</DELETED>
                <DELETED>    (A) the availability of treatment programs 
                for pregnant and postpartum women and for newborns with 
                neonatal abstinence syndrome; and</DELETED>
                <DELETED>    (B) guidance and coordination in Federal 
                efforts to address prenatal opioid use or neonatal 
                abstinence syndrome.</DELETED>
<DELETED>    (c) Report.--Not later than 1 year after the date of 
enactment of this Act, the Secretary shall submit to the Committee on 
Health, Education, Labor, and Pensions of the Senate and the Committee 
on Energy and Commerce of the House of Representatives a report on the 
findings of the review described in subsection (a) and the strategy 
developed under subsection (b).</DELETED>

<DELETED>SEC. 5. IMPROVING DATA ON AND PUBLIC HEALTH RESPONSE TO 
              NEONATAL ABSTINENCE SYNDROME.</DELETED>

<DELETED>    (a) Data and Surveillance.--The Director of the Centers 
for Disease Control and Prevention shall, as appropriate--</DELETED>
        <DELETED>    (1) provide technical assistance to States to 
        improve the availability and quality of data collection and 
        surveillance activities regarding neonatal abstinence syndrome, 
        including--</DELETED>
                <DELETED>    (A) the incidence and prevalence of 
                neonatal abstinence syndrome;</DELETED>
                <DELETED>    (B) the identification of causes for 
                neonatal abstinence syndrome, including new and 
                emerging trends; and</DELETED>
                <DELETED>    (C) the demographics and other relevant 
                information associated with neonatal abstinence 
                syndrome;</DELETED>
        <DELETED>    (2) collect available surveillance data described 
        in paragraph (1) from States, as applicable; and</DELETED>
        <DELETED>    (3) make surveillance data collected pursuant to 
        paragraph (2) publically available on an appropriate Internet 
        Web site.</DELETED>
<DELETED>    (b) Public Health Response.--The Director of the Centers 
for Disease Control and Prevention shall encourage increased 
utilization of effective public health measures to reduce neonatal 
abstinence syndrome.</DELETED>

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Protecting Our Infants Act of 
2015''.

SEC. 2. ADDRESSING PROBLEMS RELATED TO PRENATAL OPIOID USE.

    (a) Review of Programs.--The Secretary of Health and Human Services 
(referred to in this Act as the ``Secretary'') shall conduct a review 
of planning and coordination related to prenatal opioid use, including 
neonatal abstinence syndrome, within the agencies of the Department of 
Health and Human Services.
    (b) Strategy.--In carrying out subsection (a), the Secretary shall 
develop a strategy to address gaps in research and gaps, overlap, and 
duplication among Federal programs, including those identified in 
findings made by reports of the Government Accountability Office. Such 
strategy shall address--
            (1) gaps in research, including with respect to--
                    (A) the most appropriate treatment of pregnant 
                women with opioid use disorders;
                    (B) the most appropriate treatment and management 
                of infants with neonatal abstinence syndrome; and
                    (C) the long-term effects of prenatal opioid 
                exposure on children;
            (2) gaps, overlap, or duplication in--
                    (A) substance use disorder treatment programs for 
                pregnant and postpartum women; and
                    (B) treatment program options for newborns with 
                neonatal abstinence syndrome;
            (3) gaps, overlap, or duplication in Federal efforts 
        related to education about, and prevention of, neonatal 
        abstinence syndrome; and
            (4) coordination of Federal efforts to address neonatal 
        abstinence syndrome.
    (c) Report.--Not later than 1 year after the date of enactment of 
this Act, the Secretary shall submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representatives a report concerning 
the findings of the review conducted under subsection (a) and the 
strategy developed under subsection (b).

SEC. 3. DEVELOPING RECOMMENDATIONS FOR PREVENTING AND TREATING PRENATAL 
              OPIOID USE DISORDERS.

    (a) In General.--The Secretary shall conduct a study and develop 
recommendations for preventing and treating prenatal opioid use 
disorders, including the effects of such disorders on infants. In 
carrying out this subsection the Secretary shall--
            (1) take into consideration--
                    (A) the review and strategy conducted and developed 
                under section 2; and
                    (B) the lessons learned from previous opioid 
                epidemics; and
            (2) solicit input from States, localities, and Federally 
        recognized Indian tribes or tribal organizations (as defined in 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450b)), and nongovernmental entities, including 
        organizations representing patients, health care providers, 
        hospitals, other treatment facilities, and other entities, as 
        appropriate.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the Secretary shall make available on the appropriate 
Internet Website of the Department of Health and Human Services a 
report on the recommendations under subsection (a). Such report shall 
address each of the issues described in subsection (c).
    (c) Contents.--The recommendations described in subsection (a) and 
the report under subsection (b) shall include--
            (1) a comprehensive assessment of existing research with 
        respect to the prevention, identification, treatment, and long-
        term outcomes of neonatal abstinence syndrome, including the 
        identification and treatment of pregnant women or women who may 
        become pregnant who use opioids or have opioid use disorders;
            (2) an evaluation of--
                    (A) the causes of, and risk factors for, opioid use 
                disorders among women of reproductive age, including 
                pregnant women;
                    (B) the barriers to identifying and treating opioid 
                use disorders among women of reproductive age, 
                including pregnant and postpartum women and women with 
                young children;
                    (C) current practices in the health care system to 
                respond to, and treat, pregnant women with opioid use 
                disorders and infants affected by such disorders;
                    (D) medically indicated uses of opioids during 
                pregnancy;
                    (E) access to treatment for opioid use disorders in 
                pregnant and postpartum women; and
                    (F) access to treatment for infants with neonatal 
                abstinence syndrome; and
                    (G) differences in prenatal opioid use and use 
                disorders in pregnant women between demographic groups; 
                and
            (3) recommendations on--
                    (A) preventing, identifying, and treating the 
                effects of prenatal opioid use on infants;
                    (B) treating pregnant women who have opioid use 
                disorders;
                    (C) preventing opioid use disorders among women of 
                reproductive age, including pregnant women, who may be 
                at risk of developing opioid use disorders; and
                    (D) reducing disparities in opioid use disorders 
                among pregnant women.

SEC. 4. IMPROVING DATA AND THE PUBLIC HEALTH RESPONSE.

    The Secretary may continue activities, as appropriate, related to--
            (1) providing technical assistance to support States and 
        Federally recognized Indian Tribes in collecting information on 
        neonatal abstinence syndrome through the utilization of 
        existing surveillance systems and collaborating with States and 
        Federally recognized Indian Tribes to improve the quality, 
        consistency, and collection of such data; and
            (2) providing technical assistance to support States in 
        implementing effective public health measures, such as 
        disseminating information to educate the public, health care 
        providers, and other stakeholders on prenatal opioid use and 
        neonatal abstinence syndrome.
            Amend the title so as to read: ``To address problems 
        related to prenatal opioid use.''.
                                                       Calendar No. 246

114th CONGRESS

  1st Session

                                 S. 799

_______________________________________________________________________

                                 A BILL

  To combat the rise of prenatal opioid abuse and neonatal abstinence 
                               syndrome.

_______________________________________________________________________

                            October 1, 2015

        Reported with an amendment and an amendment to the title