[Congressional Record Volume 164, Number 97 (Tuesday, June 12, 2018)]
[House]
[Pages H5067-H5069]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ALTERNATIVES TO OPIOIDS IN THE EMERGENCY DEPARTMENT ACT
Mr. WALDEN. Mr. Speaker, I move to suspend the rules and pass the
bill (H.R. 5197) to direct the Secretary of Health and Human Services
to conduct a demonstration program to test alternative pain management
protocols to limit the use of opioids in emergency departments, as
amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 5197
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 ``Alternatives to Opioids in
the Emergency Department Act'' or the ``ALTO Act''.
SEC. 2. EMERGENCY DEPARTMENT ALTERNATIVES TO OPIOIDS
DEMONSTRATION PROGRAM.
(a) Demonstration Program Grants.--The Secretary of Health
and Human Services (in this section referred to as the
``Secretary'') shall carry out a demonstration program under
which the Secretary shall award grants to hospitals and
emergency departments, including freestanding emergency
departments, to develop, implement, enhance, or study
alternative pain management protocols and treatments that
limit the use and prescription of opioids in emergency
departments.
(b) Eligibility.--To be eligible to receive a grant under
subsection (a), a hospital or emergency department shall
submit an application to the Secretary at such time, in such
manner, and containing such information as the Secretary may
require.
(c) Geographic Diversity.--In awarding grants under this
section, the Secretary shall seek to ensure geographical
diversity among grant recipients.
(d) Use of Funds.--Grants under subsection (a) shall be
used to--
(1) target common painful conditions, such as renal colic,
sciatica, headaches, musculoskeletal pain, and extremity
fractures;
(2) train providers and other hospital personnel on
protocols and the use of treatments that limit the use and
prescription of opioids in the emergency department; and
(3) provide alternatives to opioids to patients with
painful conditions, not including patients who present with
pain related to cancer, end-of-life symptom palliation, or
complex multisystem trauma.
(e) Consultation.--The Secretary shall implement a process
for recipients of grants under subsection (a) to consult (in
a manner that allows for sharing of evidence-based best
practices) with each other and with persons having robust
knowledge, including emergency departments and physicians
that have successfully deployed alternative pain management
protocols, such as non-drug approaches studied through the
National Center for Complimentary and Integrative Health
including acupuncture that limit the use of opioids. The
Secretary shall offer to each recipient of a grant under
subsection (a) technical support as necessary.
(f) Report to the Secretary.--Each recipient of a grant
under this section shall submit to the Secretary (during the
period of such grant) annual reports on the progress of the
program funded through the grant. These reports shall
include, in accordance with State and Federal statutes and
regulations regarding disclosure of patient information--
(1) a description of and specific information about the
alternative pain management protocols employed;
(2) data on the alternative pain management protocols and
treatments employed, including--
(A) during a baseline period before the program began, as
defined by the Secretary;
(B) at various stages of the program, as determined by the
Secretary; and
(C) the conditions for which the alternative pain
management protocols and treatments were employed;
(3) the success of each specific alternative pain
management protocol;
(4) data on the opioid prescriptions written, including--
(A) during a baseline period before the program began, as
defined by the Secretary;
(B) at various stages of the program, as determined by the
Secretary; and
(C) the conditions for which the opioids were prescribed;
[[Page H5068]]
(5) the demographic characteristics of patients who were
treated with an alternative pain management protocol,
including age, sex, race, ethnicity, and insurance status and
type;
(6) data on patients who were eventually prescribed opioids
after alternative pain management protocols and treatments
were employed; and
(7) any other information the Secretary deems necessary.
(g) Report to Congress.--Not later than one year after
completion of the demonstration program under this section,
the Secretary shall submit a report to the Congress on the
results of the demonstration program and include in the
report--
(1) the number of applications received and the number
funded;
(2) a summary of the reports described in subsection (f),
including standardized data; and
(3) recommendations for broader implementation of pain
management protocols that limit the use and prescription of
opioids in emergency departments or other areas of the health
care delivery system.
(h) Authorization of Appropriations.--To carry out this
section, there is authorized to be appropriated $10,000,000
for each of fiscal years 2019 through 2021.
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Oregon (Mr. Walden) and the gentleman from New Jersey (Mr. Pallone)
each will control 20 minutes.
The Chair recognizes the gentleman from Oregon.
General Leave
Mr. WALDEN. 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 material in the Record on the bill.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Oregon?
There was no objection.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today to express my strong support of H.R. 5197,
the Alternatives to Opioids in the Emergency Department Act.
Emergency rooms are uniquely positioned to prevent addiction before
it starts through the conservative and judicious prescribing of
opioids. By establishing a demonstration program to test alternative
pain management protocols to limit the use of opioids in hospital
emergency departments, H.R. 5197 places emergency rooms on the front
lines of defense against this opioid crisis.
Mr. Speaker, I thank Representative Pascrell and Representative
McKinley, along with Representative DeGette and Representative Tipton
for leading this important initiative.
Throughout my district in Oregon, I met with victims, families,
treatment advocates, medical providers, and law enforcement officers on
the front lines of this fight in our communities. That includes Mike
Pelfrey of Grants Pass.
The first time I met Mike was at a roundtable in Medford, I think, in
southern Oregon. Mike didn't really know anybody in the room. I had
invited these folks to come around the table. They were addiction
specialists, they were in the treatment programs, and they were law
enforcement. I noticed he was there. He had heard the news about our
meeting to discuss opioid abuse.
When we had finished going around the table, I said: So what brings
you here, sir? And then he told me his family's story.
His son was injured in a school sporting accident and became addicted
to the prescription painkillers provided by his medical provider to aid
in his recovery.
Eventually, Mike's son made the all-too-familiar transition to a
cheaper source. You would know it as heroin. And to this day, his son
struggles with his addiction that began with opioid abuse.
Then he went on to talk about his sister, who also suffered from
addiction. She was a nurse. His sister found herself with, frankly, a
way to get easier access to pills than most. When coworkers and others
caught on, she moved and continued her addiction and her ability to
procure pills. He said that she died as a result of her addiction.
Mike came to the meeting in hopes that sharing the stories of his son
and of his sister could help ensure such tragedies don't happen to
other families.
At a more recent meeting I held in southern Oregon, Mike was present
once more. During the meeting, Mike urged everyone to make combating
the opioid crisis a top priority, saying, ``The only way we are going
to do it is address it, do something about it, and make this an
everyday part of our thought.''
Well, Mike, this Congress, we have made addressing this scourge an
everyday part of our thoughts and efforts, and we will continue to do
so no matter how long it takes to rip this terrible menace out of our
communities.
{time} 1745
We have an extraordinary opportunity to make important progress in
this fight with the legislation before us, all of which reflects the
feedback we have heard from people like you and from others at
roundtables and meetings in our home districts.
Mr. Speaker, I want to say to Mike: You have been heard. We are
acting. We are acting on your behalf and on the behalf of so many other
Americans and American families who are dealing with this tragedy.
Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise in support of H.R. 5197, the Alternatives to
Opioids in the Emergency Department Act, introduced by my colleague
from New Jersey, Representative Pascrell.
This legislation would create a demonstration program to support
emergency departments in developing, implementing, enhancing, or
studying alternative pain management protocols and treatments that
limit the use of prescription opioids in emergency departments.
Supporting the development of additional protocols for alternatives
to opioid medications as proposed by this bill can help reduce the
number of those put at risk of addiction and lead to fewer fatal and
nonfatal overdoses.
Mr. Speaker, I encourage my colleagues to support this legislation.
Mr. Speaker, I yield such time as he may consume to the gentleman
from New Jersey (Mr. Pascrell), the sponsor of this bill.
Mr. PASCRELL. Mr. Speaker, I rise today in support of H.R. 5197, the
Alternatives to Opioids, ALTO, in the Emergency Department Act.
I would like to thank Chairman Walden and Ranking Member Pallone for
their work, not only today, but leading up to today. This is moving
quickly on us. They have reviewed the legislation very carefully and
have offered very, very good advice on all of these pieces of
legislation. The leadership here is outstanding.
Mr. Speaker, I want to give a special thank you to my colleague,
David McKinley, who sponsored this legislation with me and has been an
essential partner.
I am glad to see this body come together in a bipartisan manner to
address a problem that is ravaging every corner of our districts.
I believe the bills being considered today should be seen as only a
small part of an ongoing discussion and, more importantly, resources
needed to reverse the unyielding trend of this epidemic.
Opioids are contributing to 115 people dying a day. If you go back to
the HIV epidemic at the end of the 1980s and early 1990s, you will see
similar numbers. Until we educated ourselves and people, we still were
in the 19th century with that disease. In the 1990s, we had no idea how
to solve that epidemic, and we finally did.
Today, we do know how to prevent, how to halt, and how to reverse the
horrific trend of substance use disorder, which continues to be on the
rise.
We need to make sure the front lines have the resources to address
it. I believe a major piece of the equation is prevention. That is why
I introduced this Alternatives to Opioids legislation, which enjoys
strong bipartisan support.
The ALTO program was pioneered at St. Joseph's Medical Center in the
city I have lived in all my life, Paterson, New Jersey. They started in
the emergency room, Mr. Speaker, and now they are moving to other
departments to use alternatives that are legitimate.
The president of that hospital, Kevin Slavin, and the head of
Emergency Medicine, Dr. Mark Rosenberg, implemented innovative
protocols to use
[[Page H5069]]
nonopioid treatments to address some of the most common painful
conditions, like acute backache and headaches.
In its first 2 years, St. Joe's ALTO model has already led to an 82
percent reduction in opioid prescriptions. I think that is a big deal.
St. Joseph's has been replicating this model, as I said, beyond the
emergency department to other departments. They are also teaching ALTO
to other States and other hospitals that are now seeing similar
success.
While ending the opioid epidemic will require a multifaceted
approach, the initial success of this program and others like it are
worthy of broader study and implementation. I recommend that, Mr.
Speaker.
This bill establishes a demonstration program to test alternative
pain management. Those protocols should be limited to the use of
opioids in emergency departments. The Secretary of Health and Human
Services will then report on the results of the program and make
recommendations for broader implementation.
This bill will empower healthcare providers to prevent unnecessary
opioids from getting into patients' hands and ultimately stop countless
overdoses.
My motto for dealing with a zero tolerance, which I taught in the
classroom, is the fact that we need to prevent these things from
happening: No market, no sale. That is the center of everything I do in
terms of drug prevention, because we are not going to pass enough
legislation until the culture itself rids our inner sanctums of having
to deal with our devils and have to deal with those things that get us
off track every day, whether you are a student or an adult.
Mr. Speaker, I thank the gentlemen for their cooperation.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
I want to commend the gentleman for bringing this to our attention
with his colleagues. That was part of what we did back on Member Day. I
think it was in October. We had 50 Members. I don't recall specifically
whether Mr. Pascrell brought it to us there or some other time, but we
are taking these real-life experiences from our districts, the things
that work, and saying: This works. We know it works. It works in our
hospital. It works in our town, and we are saying it can work
nationwide.
We are taking ideas, like my friend from New Jersey has brought, Mr.
Speaker, to our committee and now to this House floor. We are saying,
let's apply this nationwide.
Together, we can overcome this epidemic. We must overcome this
epidemic. It is in our ability to do this.
Mr. Speaker, I just say to the gentleman and my friend that we are
not done, just as we weren't done 2 years ago when we modernized
America's mental health laws. At that point, Mr. Murphy of Pennsylvania
was here and gave us great counsel about how to do that. We put money
in to deal with opioids then, that and 21st Century Cures that Mr.
Upton and Ms. DeGette helped lead the effort on.
I know at NIH they are working day and night, as they are in other
institutions, to find a nonaddictive pain management medicine. We wish
them Godspeed in that effort, Mr. Speaker.
Mr. Speaker, I again thank my friend from New Jersey for bringing
this to us. This is the kind of legislation that will save lives,
prevent tragedy. We are going to get it passed here in a bipartisan,
unanimous way, I do believe, in a matter of seconds.
Mr. Speaker, I urge my Members to support this bill, and I yield back
the balance of my time.
Mr. PALLONE. Mr. Speaker, I urge support, urge my colleagues to
support this bill, and I yield back the balance of my time.
Ms. JACKSON LEE. Mr. Speaker, I rise in strong support of H.R. 5197,
the Alternatives to Opioids in the Emergency Department Act, or the
ALTO Act.
Mr. Speaker, our nation faces an opioid crisis.
H.R. 5197, the ALTO Act, directs the Secretary of Health and Human
Services to conduct a demonstration program to test alternative pain
management protocols to limit the use of opioids in hospitals and
emergency departments.
Opioids contributed to the deaths of more than 42,000 people in 2016,
more than any year on official record.
Forty percent of all opioid overdose deaths involve a prescription
opioid.
The economic burden of prescription opioid misuse in the United
States is estimated to be $78.5 billion dollars per year.
This figure includes costs stemming from health care, including
addiction treatment, lost productivity, and criminal justice
involvement.
Over 200 million opioid prescriptions are written in the United
States each year, and 2 million Americans have the symptoms of
substance use disorder.
Approximately 21 to 29 percent of patients prescribed opioids for
chronic pain misuse them.
In Texas, 4 percent of the population reports using pain relievers
for non-medical purposes.
Harris County, which contains my home district, has a pain medication
misuse rate of 3.91 percent.
The time for action is now.
H.R. 5197, the ALTO Act, directs Health and Human Services to carry
out a 3-year demonstration program which awards grants to hospitals and
emergency departments to develop, implement, enhance, or study
alternative pain management protocols and treatments that promote the
appropriate limited use of opioids.
Emergency departments in several States, including in New Jersey and
Colorado, have developed innovative programs to more widely utilize
non-opioid pain treatments to reduce the use of opioids.
We must learn from these attempts and initiate a national program to
limit the overuse of opioids in emergency settings.
However, it is important to realize that some groups, such as African
Americans, are under-prescribed pain management medications.
We must balance these new programs that work to reduce over-
prescription with our continued efforts to ensure that medically
necessary treatment be provided to people in need.
H.R. 5197, the ALTO Act, is especially important for my district and
the greater Houston area.
Houston is home to many world-renowned trauma centers including Ben
Taub and Memorial Hermann.
These centers have extensive emergency medical services and they,
along with hospitals around the state and the nation, will benefit
greatly from the support this bill provides.
Mr. Speaker, it is time for Congress to intervene before opioids
claim the lives of more Americans.
The Alternatives to Opioids in the Emergency Department Act, or the
ALTO Act is a necessary step towards stopping this opioid crisis.
I urge my colleagues to join me in supporting H.R. 5197, the ALTO
Act, to prevent opioid addiction at the source and ensure that this
crisis is stopped.
The SPEAKER pro tempore. The question is on the motion offered by the
gentleman from Oregon (Mr. Walden) that the House suspend the rules and
pass the bill, H.R. 5197, 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.
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