[Congressional Record Volume 161, Number 128 (Tuesday, September 8, 2015)]
[House]
[Pages H5798-H5801]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   PROTECTING OUR INFANTS ACT OF 2015

  Mr. GUTHRIE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 1462) to combat the rise of prenatal opioid abuse and 
neonatal abstinence syndrome.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 1462

       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 ``Protecting Our Infants Act 
     of 2015''.

     SEC. 2. FINDINGS.

       Congress finds as follows:
       (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.
       (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.
       (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.
       (4) NAS refers to medical issues associated with drug 
     withdrawal in newborns due to exposure to opioids or other 
     drugs in utero.
       (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.
       (6) Preventing opioid abuse among pregnant women and women 
     of childbearing age is crucial.

[[Page H5799]]

       (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.
       (8) Addressing NAS effectively requires a focus on women of 
     childbearing age, pregnant women, and infants from 
     preconception through early childhood.
       (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.
       (10) For pregnant women who are abusing opioids, it is most 
     appropriate to treat and manage maternal substance use in a 
     non-punitive manner.
       (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.
       (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.
       (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''.

     SEC. 3. DEVELOPING RECOMMENDATIONS FOR PREVENTING AND 
                   TREATING PRENATAL OPIOID ABUSE AND NEONATAL 
                   ABSTINENCE SYNDROME.

       (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.
       (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).
       (c) Contents.--The study 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 other drugs;
       (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 born with neonatal abstinence syndrome;
       (D) medically indicated use 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
       (3) recommendations on--
       (A) preventing, identifying, and treating neonatal 
     abstinence syndrome in infants;
       (B) treating pregnant women who are dependent on opioids; 
     and
       (C) preventing opioid dependence among women of 
     reproductive age, including pregnant women, who may be at 
     risk of developing opioid dependence.

     SEC. 4. IMPROVING PREVENTION AND TREATMENT FOR PRENATAL 
                   OPIOID ABUSE AND NEONATAL ABSTINENCE SYNDROME.

       (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.
       (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--
       (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; and
       (2) gaps in programs, including--
       (A) the availability of treatment programs for pregnant and 
     postpartum women and for newborns with neonatal abstinence 
     syndrome; and
       (B) guidance and coordination in Federal efforts to address 
     prenatal opioid use or 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 on the findings of the review 
     described in subsection (a) and the strategy developed under 
     subsection (b).

     SEC. 5. IMPROVING DATA ON AND PUBLIC HEALTH RESPONSE TO 
                   NEONATAL ABSTINENCE SYNDROME.

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

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Kentucky (Mr. Guthrie) and the gentleman from Texas (Mr. Gene Green) 
each will control 20 minutes.
  The Chair recognizes the gentleman from Kentucky.


                             General Leave

  Mr. GUTHRIE. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous materials in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Kentucky?
  There was no objection.
  Mr. GUTHRIE. Mr. Speaker, I yield myself as much time as I may 
consume.
  I rise today in support of H.R. 1462, the Protecting Our Infants Act 
of 2015, introduced by my colleagues, Ms. Clark of Massachusetts and 
Mr. Stivers.
  Over the past several years, opioid addiction has risen dramatically 
in the United States, reaching epidemic proportions. The death rate for 
heroin overdose doubled in just 2 years, from 2010 to 2012.
  One of the issues that has arisen as a result of this epidemic is 
neonatal abstinence syndrome, known as NAS.
  These are infants born addicted to opioids and suffer medical issues 
associated with drug withdrawal. Symptoms can last for weeks, keeping 
otherwise healthy infants confined to the hospital at the start of 
their lives.
  NAS can result from the use of prescription drugs or from the use of 
illegal opioids. Sadly, over the past 15 years, a prevalence of NAS has 
tripled in the United States. This is a rapidly growing problem that 
needs to be addressed for the safety of our mothers and children.
  H.R. 1462 would address the increasing problem of prenatal opioid 
abuse and neonatal abstinence syndrome. Preventing opioid abuse among 
pregnant women and women of childbearing age is crucial in addressing 
NAS.
  The Government Accountability Office has identified that more 
research is needed in this area to help treat babies born with NAS and 
mothers addicted to opioids.
  This legislation would help fill this research gap by studying issues 
and developing recommendations for preventing and treating prenatal 
opioid abuse and neonatal abstinence syndrome.
  Mr. Speaker, I urge my colleagues to support this bill. I reserve the 
balance of my time.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself as much time as 
I may consume.
  I rise in support of H.R. 1462, the Protecting Our Infants Act, led 
by Representatives Katherine Clark and Steve Stivers.
  The Centers for Disease Control and Prevention has found drug 
overdose to be the leading cause of injury death in the United States.

[[Page H5800]]

  According to a recent study by the New England Journal of Medicine, 
from 2004 to 2013, the incidence rate of neonatal abstinence syndrome, 
NAS, has quadrupled.
  NAS refers to medical complications in newborns associated with drug 
withdrawal due to exposure to opioids and other drugs during pregnancy.
  Babies born with NAS often require weeks of hospitalization and can 
suffer from seizures and other severe complications.
  There is an urgent need for further research to facilitate the 
identification and treatment of infants with NAS and determine long-
term health impacts.
  The GAO and other experts identified specific research gaps related 
to best practices for treating pregnant women with opioid use 
disorders, the long-term effects of prenatal drug exposure, and best 
practices in the screening, diagnosis, and treatment of NAS.
  The Protecting Our Infants Act takes proactive steps to help reduce 
the number of newborns born exposed to opioids and other drugs and to 
improve their care if they are exposed.
  It will facilitate the development of recommendations for treatment 
and coordinate a national strategy to close the known gaps in research 
and coordination. It will also help States improve data collection and 
surveillance activities.
  I want to thank Representatives Clark of Massachusetts and Stivers 
for their leadership. I also want to thank Chairman Upton, Ranking 
Member Pallone, Chairman Pitts, and my colleagues on the Energy and 
Commerce Committee for advancing this important legislation.
  I urge my colleagues to support H.R. 1462. I reserve the balance of 
my time.
  Mr. GUTHRIE. Mr. Speaker, I yield 3 minutes to the gentleman from 
West Virginia (Mr. Jenkins).
  Mr. JENKINS of West Virginia. Mr. Speaker, every day in hospitals 
across the Third Congressional District of West Virginia and the 
country babies begin their lives going through drug withdrawal because 
they were exposed during pregnancy. As you have heard, it is the 
diagnosis known as neonatal abstinence syndrome, or NAS.
  No baby--no baby--deserves to start his or her life in withdrawal 
from heroin or other opioids. But, sadly, the rate of babies born with 
NAS, again, as you have heard, has skyrocketed nationally.
  Doctors, nurses, and caregivers are providing innovative care for 
newborns with NAS, but there are still gaps in research and our 
understanding of how best to care for our most vulnerable.
  The Protecting Our Infants Act makes significant strides in 
addressing this nationwide gap and developing these strategies, and I 
am proud to be a cosponsor of this bill.
  West Virginia has been at the forefront of this epidemic, with NAS 
rates much higher than the national average.
  Our nurses and doctors are tirelessly working to care for newborns 
with NAS, and having additional resources and research will only 
further their efforts in providing the best possible care.
  I have met with caregivers throughout my district to discuss their 
approaches to treating NAS, and I know this legislation will help in 
their efforts to treat these babies.
  While we must continue to guarantee that newborns receive the 
absolute best care, we must also address the issue of addiction in 
pregnant and postnatal women.
  This legislation will help identify and develop treatment methods for 
expectant mothers with opioid addictions, leading to healthier outcomes 
for mother and baby alike.
  NAS is a nationwide crisis, one that impacts urban, rural, and 
suburban areas. Nearly every district in America has been touched by 
heroin and opioid addiction. We must address the impact this addiction 
has on our most vulnerable in society, our newborn babies.
  I commend Congresswoman Clark for her efforts on this important 
legislation, and I urge my colleagues to support this bill.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield such time as she may 
consume to the gentlewoman from Massachusetts (Ms. Clark), the 
cosponsor of the bill.
  Ms. CLARK of Massachusetts. Mr. Speaker, I thank the gentleman from 
Texas for yielding.
  Our Nation is experiencing a deadly opiate epidemic, an epidemic that 
knows no boundaries and destroys lives, families, and communities.
  Today 58 babies--one baby every 25 minutes--will be born suffering 
from the same pain adults describe as the worst pain of their lives. It 
is the pain of drug withdrawal.
  Neonatal abstinence syndrome, or NAS for short, occurs when babies 
are born dependent on opioids, and it is one of the chief causes of the 
significant surge of newborns in neonatal intensive care units across 
the Nation.
  Over the last decade, the number of infants born dependent on 
powerful drugs has grown nearly fivefold. In States like Massachusetts, 
NAS is occurring at a rate three times the national average.
  NAS births are five times more costly than healthy ones. Costs have 
risen to more than $1.5 billion a year, 80 percent of which are paid 
for by Medicaid.
  Because of this skyrocketing rise of NAS cases and costs, doctors are 
desperately trying to find the most effective method of diagnosis and 
treatment.

                              {time}  1630

  There is little coordination of data and best practices and protocols 
among States, healthcare systems, and practitioners; and no medications 
have been approved by the U.S. Food and Drug Administration for 
treating these babies.
  The Protecting Our Infants Act is the first Federal bill to take 
proactive steps in addressing the rise of NAS. With broad bipartisan 
support in both Chambers, this is an opportunity for Congress to make a 
difference for babies suffering from opioid exposure and the families 
struggling with addiction.
  This bill directs the Department of Health and Human Services to 
develop the protocols for treating and preventing NAS. The Protecting 
Our Infants Act helps babies suffering from opioid withdrawal by making 
sure they get the best care available.
  This act will ensure that every hospital has access to the best 
practices and that States have the public health data they need to 
address this crisis. This is good for families, good for our healthcare 
providers, and good for our Nation's bottom line.
  I want to thank my colleagues in the House and, in particular, 
Congressman Steve Stivers for his partnership in this bill. I am 
grateful for his deep commitment to addressing this problem and 
crafting a solution. I am also grateful to Senators McConnell and Casey 
for sponsoring this legislation in the Senate.
  Today, we have a chance to help the youngest of those suffering from 
the opioid crisis.
  I urge my colleagues to pass the bipartisan Protecting Our Infants 
Act.
  Mr. GENE GREEN of Texas. I reserve the balance of my time.
  Mr. GUTHRIE. I yield 5 minutes to the gentleman from Ohio (Mr. 
Stivers), my friend.
  Mr. STIVERS. Mr. Speaker, I rise today to support a bill that my 
colleague from Massachusetts, Representative Katherine Clark, and I 
introduced, H.R. 1462, the Protect Our Infants Act. I want to thank 
Representative Clark for her leadership, her hard work, and her 
commitment to protecting America's children.
  This bill has the support of 95 bipartisan cosponsors. It is a 
targeted effort to address a national epidemic of babies being born 
addicted to drugs.
  Recent data has shown that this issue, called neonatal abstinence 
syndrome, is sadly on the rise throughout the country. A baby is born 
with neonatal abstinence syndrome every 25 minutes, and symptoms can 
last for months and lead to weeks of hospitalization and have a 
lifelong impact.
  A report by the Journal of the American Medical Association showed 
that the number of newborns diagnosed with NAS tripled from 2000 to 
2009. In my home State of Ohio, the rate of neonatal abstinence 
syndrome grew over 600 percent between 2004 and 2011.
  It has taken a heavy toll on Ohio's healthcare system and Ohio's 
families. Treating newborns with NAS was associated with over $70 
million in charges and approximately 19,000 hospital stays, and that 
was back in 2011. It has been on the rise ever since.
  This issue is especially devastating to our families and especially 
devastating to the youngest among us, the

[[Page H5801]]

babies who are born addicted to drugs. I recently heard from a 
grandmother to three babies who were born with NAS. She was pleading 
for help for her innocent grandchildren, and she wanted to make sure we 
did something about this terrible disease.
  I am proud to say that the response in my district has been strong to 
our bill. There is a healthcare system called Adena Regional Medical 
Center in Chillicothe, Ohio, and they actually have an incredible 
program which was piloted with a bunch of OB/GYNs, and they started 
with just 15 pregnant women who were addicted to drugs, and they have 
served those women. Now, they are on their second class to try to get 
those women off of drugs before they deliver.
  I am happy to report that, because of the support of the Adena Health 
System, none of the women in that group delivered a baby with NAS. Due 
to the success of the pilot, there is a permanent program that is 
starting now, and it already has a wait list, so I am really excited to 
say that there are people out there showing real leadership.
  Last week, I hosted my fourth annual opiate roundtable in my district 
to bring together a lot of issues, and we talked about this bill and 
how important it was, so I am so proud that it is on the floor today.
  Mr. Speaker, I urge all my colleagues to support the Protecting Our 
Infants Act, H.R. 1462, to help our Nation's most innocent citizens. 
Again, I want to thank Katherine Clark for her incredible leadership on 
this bill and her commitment.
  Mr. GENE GREEN of Texas. Mr. Speaker, I have no other speakers, and 
in closing, I encourage our colleagues to support this bill.
  I yield back the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, during the hearing in the Committee on 
Energy and Commerce, one of the physicians testifying, a neonatologist, 
turned out to practice with my first cousin, so I got to do research 
further into what is moving forward in this bill.
  I learned even more from personal stories about how important it is 
and how critical this is and how sad it is for children to be born 
addicted and how the opportunity is for us to help.
  I certainly appreciate my friend from Massachusetts, Ms. Clark, and 
my friend from Ohio, Mr. Stivers. I would encourage all my colleagues 
to vote for H.R. 1462, Protecting Our Infants Act of 2015.
  I yield back the balance of my time.
  Mr. PALLONE. Mr. Speaker, I support H.R. 1462 the ``Protecting Our 
Infants Act of 2015.'' This legislation would address the urgent need 
for a comprehensive strategy for one of the harmful outcome of our 
nation's opioid epidemic. Neonatal abstinence syndrome, or NAS, occurs 
in newborns who were exposed to opioids, including pain killers, while 
in their mother's womb. NAS is associated with negative health outcomes 
like preterm births and low birthweight.
  I'm saddened to say that the opioid epidemic has resulted in a steep 
increase in the occurrence of NAS over the past decade. H.R. 1462 would 
require HHS to develop recommendations for the treatment and prevention 
of prenatal opiate abuse and neonatal abstinence syndrome. It would 
also require the collection of data to better monitor the problem.
  I want to thank Representative Katherine Clark for her leadership on 
this issue and I urge my colleagues to join me in supporting this 
necessary legislation.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Kentucky (Mr. Guthrie) that the House suspend the rules 
and pass the bill, H.R. 1462.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

                          ____________________