[Congressional Record Volume 162, Number 74 (Wednesday, May 11, 2016)]
[House]
[Pages H2256-H2259]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




             CO-PRESCRIBING TO REDUCE OVERDOSES ACT OF 2016

  Mr. GUTHRIE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3680) to provide for the Secretary of Health and Human 
Services to carry out a grant program for co-prescribing opioid 
overdose reversal drugs, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3680

       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 ``Co-Prescribing to Reduce 
     Overdoses Act of 2016''.

     SEC. 2. OPIOID OVERDOSE REVERSAL DRUGS PRESCRIBING GRANT 
                   PROGRAM.

       (a) Establishment.--

[[Page H2257]]

       (1) In general.--Not later than six months after the date 
     of the enactment of this Act, the Secretary of Health and 
     Human Services may establish, in accordance with this 
     section, a five-year opioid overdose reversal drugs 
     prescribing grant program (in this Act referred to as the 
     ``grant program'').
       (2) Maximum grant amount.--A grant made under this section 
     may not be for more than $200,000 per grant year.
       (3) Eligible entity.--For purposes of this section, the 
     term ``eligible entity'' means a federally qualified health 
     center (as defined in section 1861(aa) of the Social Security 
     Act (42 U.S.C. 1395x(aa)), an opioid treatment program under 
     part 8 of title 42, Code of Federal Regulations, any 
     practitioner dispensing narcotic drugs pursuant to section 
     303(g) of the Controlled Substances Act (21 U.S.C. 823(g)), 
     or any other entity that the Secretary deems appropriate.
       (4) Prescribing.--For purposes of this section and section 
     3, the term ``prescribing'' means, with respect to an opioid 
     overdose reversal drug, such as naloxone, the practice of 
     prescribing such drug--
       (A) in conjunction with an opioid prescription for patients 
     at an elevated risk of overdose;
       (B) in conjunction with an opioid agonist approved under 
     section 505 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355) for the treatment of opioid abuse disorder;
       (C) to the caregiver or a close relative of patients at an 
     elevated risk of overdose from opioids; or
       (D) in other circumstances, as identified by the Secretary, 
     in which a provider identifies a patient is at an elevated 
     risk for an intentional or unintentional drug overdose from 
     heroin or prescription opioid therapies.
       (b) Application.--To be eligible to receive a grant under 
     this section, an eligible entity shall submit to the 
     Secretary of Health and Human Services, in such form and 
     manner as specified by the Secretary, an application that 
     describes--
       (1) the extent to which the area to which the entity will 
     furnish services through use of the grant is experiencing 
     significant morbidity and mortality caused by opioid abuse;
       (2) the criteria that will be used to identify eligible 
     patients to participate in such program; and
       (3) how such program will work to try to identify State, 
     local, or private funding to continue the program after 
     expiration of the grant.
       (c) Use of Funds.--An eligible entity receiving a grant 
     under this section may use the grant for any of the following 
     activities, but may use not more than 20 percent of the grant 
     funds for activities described in paragraphs (4) and (5):
       (1) To establish a program for prescribing opioid overdose 
     reversal drugs, such as naloxone.
       (2) To train and provide resources for health care 
     providers and pharmacists on the prescribing of opioid 
     overdose reversal drugs, such as naloxone.
       (3) To establish mechanisms and processes for tracking 
     patients participating in the program described in paragraph 
     (1) and the health outcomes of such patients.
       (4) To purchase opioid overdose reversal drugs, such as 
     naloxone, for distribution under the program described in 
     paragraph (1).
       (5) To offset the co-pays and other cost sharing associated 
     with opioid overdose reversal drugs, such as naloxone, to 
     ensure that cost is not a limiting factor for eligible 
     patients.
       (6) To conduct community outreach, in conjunction with 
     community-based organizations, designed to raise awareness of 
     prescribing practices, and the availability of opioid 
     overdose reversal drugs, such as naloxone.
       (7) To establish protocols to connect patients who have 
     experienced a drug overdose with appropriate treatment, 
     including medication assisted treatment and appropriate 
     counseling and behavioral therapies.
       (d) Evaluations by Recipients.--As a condition of receipt 
     of a grant under this section, an eligible entity shall, for 
     each year for which the grant is received, submit to the 
     Secretary of Health and Human Services information on 
     appropriate outcome measures specified by the Secretary to 
     assess the outcomes of the program funded by the grant, 
     including--
       (1) the number of prescribers trained;
       (2) the number of prescribers who have co-prescribed an 
     opioid overdose reversal drug, such as naloxone, to at least 
     one patient;
       (3) the total number of prescriptions written for opioid 
     overdose reversal drugs, such as naloxone;
       (4) the percentage of patients at elevated risk who 
     received a prescription for an opioid overdose reversal drug, 
     such as naloxone;
       (5) the number of patients reporting use of an opioid 
     overdose reversal drug, such as naloxone; and
       (6) any other outcome measures that the Secretary deems 
     appropriate.
       (e) Reports by Secretary.--For each year of the grant 
     program under this section, the Secretary of Health and Human 
     Services shall submit to the appropriate committees of the 
     House of Representatives and of the Senate a report 
     aggregating the information received from the grant 
     recipients for such year under subsection (d) and evaluating 
     the outcomes achieved by the programs funded by grants made 
     under this section.

     SEC. 3. PROVIDING INFORMATION TO PRESCRIBERS IN CERTAIN 
                   FEDERAL HEALTH CARE AND MEDICAL FACILITIES ON 
                   BEST PRACTICES FOR PRESCRIBING OPIOID OVERDOSE 
                   REVERSAL DRUGS.

       (a) In General.--Not later than 180 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary'') 
     may, as appropriate, provide information to prescribers 
     within Federally qualified health centers (as defined in 
     paragraph (4) of section 1861(aa) of the Social Security Act 
     (42 U.S.C. 1395x(aa))), and the health care facilities of the 
     Indian Health Service, on best practices for prescribing 
     opioid overdose reversal drugs, such as naloxone, for 
     patients receiving chronic opioid therapy, patients being 
     treated for opioid use disorders, and other patients that a 
     provider identifies as having an elevated risk of overdose 
     from heroin or prescription opioid therapies.
       (b) Not Establishing a Medical Standard of Care.--The 
     information on best practices provided under this section 
     shall not be construed as constituting or establishing a 
     medical standard of care for prescribing opioid overdose 
     reversal drugs, such as naloxone, for patients described in 
     subsection (a).
       (c) Elevated Risk of Overdose Defined.--In this section, 
     the term ``elevated risk of overdose'' has the meaning given 
     such term by the Secretary, which--
       (1) may be based on the criteria provided in the Opioid 
     Overdose Toolkit published by the Substance Abuse and Mental 
     Health Services Administration (SAMHSA); and
       (2) may include patients on a first course opioid 
     treatment, patients using extended-release and long-acting 
     opioid analgesics, and patients with a respiratory disease or 
     other co-morbidities.

     SEC. 4. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated to carry out this 
     Act $5,000,000 for the period of fiscal years 2017 through 
     2021.

     SEC. 5. CUT-GO COMPLIANCE.

       Subsection (f) of section 319D of the Public Health Service 
     Act (42 U.S.C. 247d-4) is amended by inserting before the 
     period at the end the following: ``(except such dollar amount 
     shall be reduced by $5,000,000 for fiscal year 2018)''.

  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 
may 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 such time as I may consume.
  Mr. Speaker, I rise today in support of H.R. 3680, the Co-Prescribing 
to Reduce Overdoses Act of 2016, introduced by my colleague on the 
Energy and Commerce Committee, Mr. Sarbanes of Maryland.
  In 1999, there were 6.1 overdose deaths per 100,000 Americans 
involving opioid analgesics and heroin. By 2014, that number doubled to 
14.7 overdose deaths. The rate of overdose for individuals aged 24 to 
34 nearly tripled, going from 8.1 overdose deaths per 100,000 to 23.1 
overdose deaths.
  Naloxone is an opioid antagonist that can prevent opioid overdose 
deaths by binding to the opioid receptors in the body and preventing 
the overdose. The World Health Organization estimated that, if naloxone 
was more widely available in the United States, more than 20,000 
overdose deaths could be prevented annually.
  H.R. 3680 is a step in promoting wider access of naloxone or other 
opioid-overdose reversal drugs that may come to market. It directs the 
Secretary of Health and Human Services to carry out a grant program for 
coprescribing opioid reversal drugs and helps develop best practices 
for doing so.
  Mr. Speaker, I urge my colleagues to support this legislation.
  I reserve the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I rise to voice my support for H.R. 3680, the Co-
Prescribing to Reduce Overdoses Act. We must do more to prevent opioid 
addiction and ensure those currently suffering have access to 
potentially lifesaving treatments.
  Naloxone has been proven effective in reversing opioid overdoses, and 
it is a cost-effective public health intervention. Naloxone blocks and 
reverses the effects of opioid medication and is used to treat narcotic 
overdose in emergency situations.

[[Page H2258]]

  In addition to recent efforts to improve access to naloxone through 
first responders and community-based health organizations, providing 
naloxone to at-risk patients in a healthcare setting may reduce 
overdoses and encourage patients to use prescription drugs more safely.

                              {time}  1645

  The Co-Prescribing to Reduce Overdoses Act would create a 
demonstration grant program to facilitate coprescribing of naloxone 
when appropriate.
  Coprescribing refers to the practice of prescribing that naloxone 
alongside an opioid prescription to patients with heightened risk of 
overdose. This could include patients who take significant doses of 
opioids for long-term chronic pain management, patients with a history 
of substance abuse, or patients who have been discharged from emergency 
care following poisoning or intoxication from an opiate.
  The bill would further authorize funding to train healthcare 
providers and pharmacists on coprescribing, establish mechanisms for 
tracking patients and their health outcomes, and other efforts to 
expand access to naloxone.
  We must act swiftly in order to save lives and stem the growing 
prescription drug epidemic in our country. The Co-Prescribing to Reduce 
Overdoses Act is an important step toward preventing overdose deaths, 
which is a critical part of the fight against our devastating drug 
crisis.
  I want to thank the bill's sponsor, the gentleman from Maryland, 
Representative John Sarbanes, who is a member of our Subcommittee on 
Health, for his leadership in introducing this bill.
  I urge my colleagues to support the Co-Prescribing to Reduce 
Overdoses Act.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GUTHRIE. Mr. Speaker, I yield 3 minutes to the gentleman from 
Pennsylvania (Mr. Shuster), the distinguished chairman of the Committee 
on Transportation and Infrastructure.
  Mr. SHUSTER. I thank the gentleman for yielding.
  Mr. Speaker, I rise today in support of H.R. 3680, which is one of 
several initiatives being taken up by the House this week to combat the 
devastating opioid epidemic our Nation is facing.
  Every person in my district knows someone who has been impacted by 
this crisis, and each day that we wait is another day we go without 
taking action to save the lives of the people feeling the terrible 
effects of this addiction.
  Each day without action is another day that our communities are 
ravaged by these drugs.
  We can combat this crisis and repair our communities. This is a 
needed step that both Republicans and Democrats are working together to 
achieve.
  I strongly support this legislation because it will provide funding 
to our health centers to coprescribe naloxone, a lifesaving drug.
  My entire district has been plagued by the scourge of this crisis. 
The alarming rise in overdose deaths show the urgent need for naloxone 
to be readily available to both healthcare professionals and those with 
increased risk of overdose.
  These efforts are one part of a broader solution that will 
undoubtedly save lives. I applaud my colleagues on both sides of the 
aisle for taking these steps, and I look forward to continuing to work 
to make our communities a safer place by ridding them of this epidemic.
  I urge all my colleagues to support H.R. 3680.
  Mr. GENE GREEN of Texas. Mr. Speaker, I am happy to yield 3 minutes 
to the gentleman from Maryland (Mr. Sarbanes), my colleague on the 
committee.
  Mr. SARBANES. I thank the gentleman for yielding.
  Mr. Speaker, I first want to thank Ranking Members Pallone and Green, 
as well as Chairmen Upton and Pitts, for working diligently with me to 
bring this bill to the floor today.
  This bipartisan bill, the Co-Prescribing to Reduce Overdoses Act, 
would create a demonstration project to encourage prescribing opioid 
overdose reversal drugs like naloxone to patients at an elevated risk 
of overdose, as well as to a close relative of such a patient.
  Why is this bill needed, Mr. Speaker?
  More than 100 Americans are dying every single day of preventable 
drug overdose, and overdose fatality is now the leading cause of 
accidental death in the Nation.
  In 2014, in my home State of Maryland, there were 887 opioid-related 
deaths. In Baltimore, 192 people died from heroin overdoses. In Anne 
Arundel County in 2014, there were 360 opioid overdoses, fatal and 
nonfatal; 49 of those were fatal.
  The problem is getting worse. From 2001 to 2013, there was a fivefold 
increase in the total number of deaths from heroin. This is an 
epidemic, but it is an epidemic that we can begin to stem if we take 
action.
  Naloxone is a drug that safely and effectively reverses both opioid 
and heroin-induced overdoses, if administered in time. It has been used 
by nonmedical personnel with only minimal training for over 15 years, 
and has been proven to lower overdose mortality by almost 50 percent.
  More people need access to this lifesaving medication. One part of 
that proactive approach is the idea of coprescribing naloxone to 
patients, or their caregivers, who are taking opioids and are at high 
risk of overdose.
  The Co-Prescribing to Reduce Overdoses Act would create a 
demonstration project for federally qualified health centers, opioid 
treatment centers, and other providers, to encourage coprescribing of 
naloxone and other opioid reversal drugs.
  This bill has been endorsed by the AMA, the American Society of 
Addiction Medicine; the American Academy of Family Physicians; and the 
Harm Reduction Coalition.
  There are five Republican cosponsors, I am pleased to say, proving 
that this is a bipartisan issue affecting virtually every part of the 
country.
  I am pleased as well to note that the bill received unanimous support 
in the Committee on Energy and Commerce.
  I urge support of this bill today because I know that it will save 
lives and help begin to stem the tide of this terrible epidemic.
  I also support the other bills being debated this evening, and 
believe that these are all important initiatives to address the opioid 
crisis.
  However, it is just as critical that we provide adequate resources 
for all aspects of this epidemic to prevent addiction, to provide 
effective treatment, and to increase access to lifesaving opioid 
reversal drugs in order to truly bring an end to this epidemic.
  Mr. Speaker, I urge support of this important legislation.
  Mr. GUTHRIE. Mr. Speaker, one of the great privileges of the people's 
House, people come here from all walks of life with all different 
expertise.
  I yield such time as he may consume to the gentleman from Georgia 
(Mr. Carter), the only registered pharmacist that serves in the House 
of Representatives, who is here to speak on this and several of the 
bills today.
  Mr. CARTER of Georgia. I thank the gentleman for yielding.
  Mr. Speaker, I rise today in support of H.R. 3680, the Co-Prescribing 
to Reduce Overdoses Act, which gives patients the tools they need to 
protect themselves from opioid overdoses.
  H.R. 3680 calls for the Department of Health and Human Services to 
create a grant program that will increase the ability for healthcare 
providers to coprescribe opioid reversal medication like naloxone when 
those providers prescribe opioid-based medications for patients.
  This new direction by HHS will work to decrease the risk of fatally 
overdosing on opioids while also allowing healthcare providers to learn 
more about the opioid reversal medication benefits.
  In addition, with the grant money, providers will be able to track 
patient outcomes to make sure that the reversal medication has the 
desired effect.
  As a lifelong pharmacist, I consider it my duty to always care for my 
patients and give them every tool I can to protect and serve them the 
best way I can, and I have carried this duty to the United States House 
of Representatives.
  The Co-Prescribing to Reduce Overdoses Act does just this and is a 
major step in the right direction to ending the opioid addiction deaths 
in America.

[[Page H2259]]

  I encourage all of my colleagues to support this bill.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield back the balance of my 
time.
  Mr. GUTHRIE. Mr. Speaker, I appreciate the gentleman from Maryland 
(Mr. Sarbanes) bringing this forward and all the bipartisan work that 
was put into it. I urge my colleagues to support this legislation.
  I yield back the balance of my time.
  Ms. JACKSON LEE. Mr. Speaker, I rise in support of H.R. 3680 the 
``Co-Prescribing To Reduce Overdoses Act of 2015.''
  This bill requires the Department of Health and Human Services (HHS) 
to establish a grant program to support prescribing opioid overdose 
reversal drugs, such as naloxone, for patients at an elevated risk of 
overdose, including patients prescribed an opioid.
  Opioids are drugs with effects similar to opium, such as heroin and 
certain pain medications.
  The Centers for Disease Control and Prevention reports that nearly 
259 million opioid prescriptions were written in 2012, more than enough 
for every adult in the United States.
  In 2013 nearly 4.5 million people in the United States without a 
valid medical need were using prescription painkillers.
  Both states and the federal government have begun responding to this 
growing public health crisis.
  The Obama administration has awarded $94 million to community health 
centers to improve and expand the delivery of substance abuse services.
  H.R. 3680 would encourage and train health care providers to 
prescribe lifesaving overdose reversal drugs.
  Enacting this legislation will help reduce drug overdoses across the 
country by giving at-risk patients better access to lifesaving overdose 
reversal drugs.
  The plague of opioid overdose deaths across the nation is disturbing, 
but there are ways to combat this trend.
  H.R. 3680 is supported by the American Medical Association, the 
American Society of Addiction Medicine and the Harm Reduction 
Coalition.
  A party, or organization receiving a grant under this legislation 
will use the grant for the following reasons:
  1. To establish a program for co-prescribing opioid overdose reversal 
drugs.
  2. To train and provide resources for health care providers and 
pharmacists on the co-prescribing of opioid reversal drugs.
  3. To establish mechanisms and processes for tracking patients 
participating in the program.
  4. To purchase opioid overdose reversal drugs for distribution.
  5. To offset the copays and other cost sharing associated with opioid 
overdose reversal drugs to ensure that cost is not a limiting factor 
for eligible patients.
  6. To conduct community outreach, in conduction with community based 
organizations, designed to raise awareness of co-prescribing practices 
and the availability of opioid overdose reversal drugs.
  7. To establish protocols to connect patients who have experienced a 
drug overdose with appropriate treatment, including medications 
assisted treatment and appropriate counseling and behavioral therapies.
  Mr. Speaker, the mounting number of people adversely affected and the 
over 25,000 lives lost expressly demonstrates the need for this type of 
legislation.
  H.R. 3680 is a positive step in the right direction and I urge all 
members to support this important 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. 3680, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________