[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.

                          ____________________