[Congressional Record Volume 164, Number 105 (Friday, June 22, 2018)]
[House]
[Pages H5561-H5572]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  SUBSTANCE USE-DISORDER PREVENTION THAT PROMOTES OPIOID RECOVERY AND 
               TREATMENT FOR PATIENTS AND COMMUNITIES ACT

  The Committee resumed its sitting.


                  Amendment No. 2 Offered by Mr. Dunn

  The Acting CHAIR (Mr. Poe of Texas). It is now in order to consider 
amendment No. 2 printed in part B of House Report 115-766.
  Mr. DUNN. Mr. Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 93, strike lines 18 through 22 and insert the 
     following:
       (2) in subclause (II), by striking ``during the period 
     beginning on the date of enactment of the Comprehensive 
     Addiction and Recovery Act of 2016 and ending on October 1, 
     2021,''.
       Page 93, strike line 23 and all that follows through page 
     94, line 17.
       Page 94, line 18, strike ``(e)'' and insert ``(c)''.

  The Acting CHAIR. Pursuant to House Resolution 949, the gentleman 
from Florida (Mr. Dunn) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Florida.
  Mr. DUNN. Mr. Chair, I rise in support of my amendment to H.R. 6. I 
am grateful for the opportunity to speak about it.
  My amendment strikes language that would expand the classes of 
healthcare workers who would be authorized to dispense narcotics for 
narcotic treatment.
  Let me be clear at the outset. H.R. 6 is, in large part, a great 
bill; however, as currently written, it allows nurse specialists, nurse 
midwives, and nurse anesthetists to prescribe buprenorphine. I believe 
this is a significant and impulsive expansion of prescribing authority.
  Allowing more providers with less clinical experience to provide 
buprenorphine, a highly addictive opioid, opens up dangerous new 
potential for increased opioid abuse. The point of H.R. 6 is to 
decrease opioid abuse, but this provision increases the potential for 
abuse and vastly increases the supply of a dangerous opioid that is one 
of the major causes of opioid overdose and death in Europe.
  Mr. Chair, I appreciate the opportunity to bring these concerns to 
light in this amendment.
  Mr. Chair, I include in the Record a letter in support of my 
amendment from The OTP Consortium.

                                           The OTP Consortium,

                                                    June 19, 2018.
     Hon. Greg Walden,
     Chairman, Committee on Energy and Commerce, House of 
         Representatives, Washington, DC.
     Hon. Kevin Brady,
     Chairman, Committee on Ways and Means,
     House of Representatives, Washington, DC.
     Hon. Frank Pallone, Jr.,
     Ranking Member, Committee on Energy and Commerce, House of 
         Representatives, Washington, DC.
     Hon. Richard Neal,
     Ranking Member, Committee on Ways and Means, House of 
         Representatives, Washington, DC.
       Dear Chairmen Walden and Brady and Ranking Members Pallone 
     and Neal: On behalf of the Opioid Treatment Program (OTP) 
     Consortium we would like to offer our support for H.R. 6, the 
     Substance Use-Disorder Prevention that Promotes Opioid 
     Recovery and Treatment (SUPPORT) for Patients and Communities 
     Act. In particular, we strongly support Section 207 which 
     would provide Medicare beneficiaries with lifesaving 
     Medication-Assisted Treatment (MAT) for opioid use disorder 
     (OUD) in the highly-effective OTP setting. This policy was 
     introduced by Ranking Member Neal and Congressman George 
     Holding as part of H.R. 5776, the Medicare and Opioid Safe 
     Treatment (MOST) Act of 2018. The OTP Consortium is comprised 
     of nearly 350 OTPs across the country that provide care to 
     more than 140,000 patients daily in 37 states, including at 
     our 22 facilities in Massachusetts, 16 facilities in Texas, 
     nine facilities in Oregon, and two facilities in New Jersey.
       OTPs are highly-regulated, highly-structured, comprehensive 
     treatment programs that provide MAT--which the National 
     Institutes of Health states is the most effective solution to 
     treat OUD. OTPs are the only provider where patients are 
     guaranteed to receive MAT--including individual and group 
     counseling, random toxicology screens, medication, and other 
     supportive services such as case management, primary care, 
     mental health services, HIV and Hepatitis C testing and more.
       Medicare beneficiaries have the highest and fastest growing 
     rate of OUD, yet they do not currently have coverage for the 
     most effective form of treatment--H.R. 6 provides such 
     coverage. More than 300,000 Medicare beneficiaries have been 
     diagnosed with OUD--your legislation could end up saving 
     their lives and many more. Medicare hospitalizations due to 
     complications caused by opioid abuse or misuse increased 10% 
     every year from 1993 to 2012--your bill would help reverse 
     this alarming trend.
       We do, however, have concerns about the policies contained 
     in Section 303. While we are pleased that the 275-patient 
     threshold was not codified, we do not support expanding or 
     making permanent buprenorphine prescribing authority to non-
     physician providers before policymakers can fully analyze the 
     data resulting from the critical questions asked in 
     subsection (e). Americans need effective treatment and 
     decades of evidence and outcomes show that medication simply 
     assists the other treatment interventions. Medication should 
     never be the sole aspect of treating SUD--thus the term 
     Medication-Assisted Treatment. Office-based practices that 
     focus on medication alone run the risk of becoming the next-
     generation pill mill. We hope that Congress will revisit 
     office-based buprenorphine prescribing thresholds once this 
     quality assessment has been completed and it can be 
     determined whether or not patients are indeed truly receiving 
     MAT in these settings. Improving access to buprenorphine is 
     important, but it must be paired with the evidence-based MAT 
     services that are proven to lead to recovery.
       We support H.R. 6 and stand ready to work with you see that 
     this critical Medicare OTP benefit is signed into law, 
     without delay.
           Sincerely,
     Peter Morris,
       Division President, Acadia Healthcare.
     Alex Dodd,
       CEO, Aegis Treatment Centers, LLC.
     David White, Ph.D.,
       CEO, BayMark Health Service.
     Jay Higham,
       CEO, Behavioral Health Group.
     John Steinbrun,
       CEO, New Season.

  Mr. DUNN. Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chair, I claim time in opposition to the amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I certainly appreciate Dr. Dunn and the good 
work that he has done on many of these issues, and I also appreciate 
his willingness to withdraw his amendment.

[[Page H5562]]

  As a result of our committee process and various member conversations 
we have had, we have reached bipartisan compromise on the underlying 
bill on the issue of concern to Mr. Dunn.
  I understand that thoughtful Members can find themselves on different 
sides of an issue at different times, and I certainly respect the 
gentleman's position. That being said, we believe our underlying policy 
represents a fair middle ground, and it ensures rigorous analysis on 
the issue going forward.
  Mr. Chair, I appreciate the gentleman from Florida withdrawing the 
amendment.
  Mr. Chair, I yield 2\1/2\ minutes to the gentleman from New York (Mr. 
Tonko).
  Mr. TONKO. Mr. Chair, I thank Chairman Walden for yielding.
  Although I know my colleague plans to withdraw, I rise in opposition 
to this amendment, and I just want to articulate a bit of my reasoning.
  I think my colleagues and I both share the same goal of safely 
expanding access to addiction treatment. Where we differ is that I 
believe that the provisions in H.R. 6 expanding buprenorphine 
prescribing privileges to advanced practice nurses meet that test.
  We all know that there is a dire need for expanded treatment capacity 
to meet the demands of this current epidemic. As many as 40 percent of 
counties across the country lack even a single provider that is able to 
offer buprenorphine. Advanced practice nurses play an outsized role in 
providing care in rural America, and H.R. 6 will help expand addiction 
treatment capacity into these communities where it is most needed.
  Expanding buprenorphine prescribing privileges to APRNs is supported 
by medical groups that serve on the front lines of this epidemic, such 
as the American Society for Addiction Medicine and the American 
Congress of Obstetricians and Gynecologists.
  All advanced practice nurses who wish to prescribe medication-
assisted treatment would have to receive a special waiver from the DEA 
and would have to undergo three times as much specialized addiction 
training as their physician colleagues.
  In addition, in order to receive a waiver, practitioners are required 
to be able to provide appropriate counseling and ancillary services 
that are the hallmark of high-quality addiction treatment. All APRNs 
wishing to prescribe buprenorphine would still be subject to State laws 
regarding prescription authority, scope of practice, and collaboration 
or supervision requirements with a physician.
  While I understand that providing addiction treatment is a complex 
and nuanced area of medicine with potential complications if done 
poorly, I would point out that we don't restrict advanced practice 
registered nurses in Federal law from providing such high-risk services 
as delivering babies, administering anesthesia, or prescribing as many 
opioids as they wish. Why would we want to maintain an outdated barrier 
in Federal law that prevents these practitioners from being part of the 
solution to the opioid epidemic?
  So in closing, I appreciate that my colleagues are withdrawing this 
amendment today, and I would urge that, as we move forward toward a 
potential conference committee, we continue to recognize the role that 
advanced practice nurses can play in addressing this epidemic.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Mr. DUNN. Mr. Chair, I yield 1 minute to the gentleman from Tennessee 
(Mr. Roe), the chairman of the Veterans' Affairs Committee.
  Mr. ROE of Tennessee. Mr. Chair, I thank the gentleman for yielding.
  As a practicing physician for over 30 years, I have incredible 
respect for nurses and the work they do. I married a nurse. Some of the 
best employees I have worked with were nurses. I could not appreciate 
the job they do more, Mr. Chair, but care for patients is better 
directed with physician oversight.
  Even with my training, we need fewer doctors like me writing these 
prescriptions and more physicians trained in pain management. The 
American Society of Addiction Medicine is establishing approved 
fellowships in training in addiction medicine today.
  Expanding the scope of practice for nonphysician providers to 
dispense drugs like buprenorphine goes in the wrong direction, in my 
opinion.
  There are many factors that contribute to the explosive growth in 
opioid use, but clearly a big factor was the lack of knowledge about 
opioids' addictive qualities. I would argue that we have a similar lack 
of knowledge about buprenorphine today, and allowing providers who have 
less training and less knowledge about these substances exponentially 
increases the chances of abuse in these substances.

                              {time}  1045

  If we remove the most highly-trained specialist from administration 
of buprenorphine, I fear that all the good we are trying to do in this 
bill could be negated.
  The Acting CHAIR. The time of the gentleman has expired.
  Mr. DUNN. I yield the gentleman an additional 1 minute.
  Mr. ROE of Tennessee. There are plenty of provisions to support in 
this underlying bill. It is a good bill, but section 303 is not one of 
them.
  I encourage my colleagues to support the amendment.
  Mr. WALDEN. Mr. Chairman, I continue to reserve the balance of my 
time.
  Mr. DUNN. Mr. Chairman, I yield 1 minute to the gentleman from Kansas 
(Mr. Marshall).
  Mr. MARSHALL. Mr. Chairman, I thank Dr. Dunn for leading this 
amendment.
  I had an over three-decade experience and great working relationship 
with physician assistants, nurse practitioners, as well as nurse 
anesthetists. I believe one of the secrets to that great work that we 
did was the collaboration between us and how we worked together.
  I firmly believe that whenever narcotics are involved, there needs to 
be a very close working relationship between the supervising physician 
and these other groups and societies. As narcotic and opioid abuse has 
become a national crisis, we need to be working even more closely 
together so as not to exacerbate the problem.
  Mr. WALDEN. Mr. Chairman, I yield back the balance of my time.
  Mr. DUNN. Mr. Chair, buprenorphine was introduced in Finland in 1997, 
and now it has become the most widely-abused opioid in that country. 
Buprenorphine can kill people. It does kill people. And office-based 
practices involving merely prescribing buprenorphine run a large risk 
of harming patients, not helping them to recover.
  In closing, I want to thank you for working with me on this 
amendment, and I thank Chairman Walden for his gracious commitment to 
continue to examine.
  I yield back the balance of my time
  Mr. Chairman, I ask unanimous consent to withdraw my amendment.
  The Acting CHAIR. Is there objection to the request of the gentleman 
from Florida?
  There was no objection.
  The Acting CHAIR. The amendment is withdrawn.


                 Amendment No. 3 Offered by Mr. Barton

  The Acting CHAIR. It is now in order to consider amendment No. 3 
printed in part B of House Report 115-766.
  Mr. BARTON. Mr. Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       At the end of title III, insert the following new section:

     SEC. 304. HIGH-QUALITY, EVIDENCE-BASED OPIOID ANALGESIC 
                   PRESCRIBING GUIDELINES AND REPORT.

       (a) Guidelines.--The Commissioner of Food and Drugs shall 
     develop high-quality, evidence-based opioid analgesic 
     prescribing guidelines for the indication-specific treatment 
     of acute pain in the relevant therapeutic areas where such 
     guidelines do not exist.
       (b) Public Input.--In developing the guidelines under 
     subsection (a), the Commissioner of Food and Drugs shall--
       (1) conduct a public workshop, open to representatives of 
     State medical societies and medical boards, various medical 
     specialties including pain medicine specialty societies, 
     patient groups, pharmacists, universities, and others; and
       (2) provide a period for the submission of comments by the 
     public.
       (c) Report.--Not later than the date that is 2 years after 
     the date of enactment of this Act, the Commissioner of Food 
     and Drugs shall submit to the Committee on Energy and 
     Commerce of the House of Representatives and the Committee on 
     Health, Education, Labor, and Pensions of the Senate,

[[Page H5563]]

     and post on the public website of the Food and Drug 
     Administration, a report on how the guidelines under 
     subsection (a) will be utilized to protect the public health.
       (d) Updates.--The Commissioner of Food and Drugs shall 
     periodically--
       (1) update the guidelines under subsection (a), informed by 
     public input described in subsection (b); and
       (2) submit to the committees specified in subsection (c) 
     and post on the public website of the Food and Drug 
     Administration an updated report under subsection (c).
       (e) Statement To Accompany Guidelines and 
     Recommendations.--The Commissioner of Food and Drugs shall 
     ensure that any opioid analgesic prescribing guidelines and 
     other recommendations developed under this section are 
     accompanied by a clear statement that such guidelines or 
     recommendations, as applicable--
       (1) are intended to help inform clinical decisionmaking by 
     prescribers and patients; and
       (2) should not be used by other parties, including pharmacy 
     benefit management companies, retail or community pharmacies, 
     or public and private payors, for the purposes of 
     restricting, limiting, delaying, or denying coverage for or 
     access to a prescription issued for a legitimate medical 
     purpose by an individual practitioner acting in the usual 
     course of professional practice.
       (f) Definition.--In this section, the term ``evidence-
     based'' means informed by a robust and systemic review of 
     treatment efficacy and clinical evidence.

  The Acting CHAIR. Pursuant to House Resolution 949, the gentleman 
from Texas (Mr. Barton) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Texas.
  Mr. BARTON. Mr. Chairman, we have a great piece of legislation before 
us today. Chairman Walden and Ranking Member Pallone have been great 
leaders in shepherding dozens of opioid-related bills through the 
Energy and Commerce Committee.
  This particular bill, H.R. 6, is the crown jewel of all that 
legislation. We all know what a scourge the opioid epidemic is. Since 
2015, more Americans have died annually from opioid overdoses than from 
the AIDS epidemic at its peak.
  The amendment that is before us today is very simple. It requires the 
FDA, after consultation with all the stakeholders in open meetings and 
workshops, to develop some opioid prescription guidelines based on hard 
evidence.
  This amendment gives the FDA 2 years to develop these guidelines. It 
requires the FDA to post the guidelines on their web page and to send 
the guidelines to the Energy and Commerce Committee in the House and to 
the Education and Workforce committee over in the Senate.
  It is a bipartisan amendment. Congresswoman Annie Kuster of New 
Hampshire and Congressman Mark Meadows of North Carolina have both 
worked with myself and other members of the committee to develop this 
amendment.
  Opioids are a little bit different than some of the other drugs that 
are abused and lead to addiction in that most people are exposed to 
opioids the first time because of a prescription. They have some sort 
of acute pain that opioids can help manage and in prescribing these 
opioids the doctors are trying to help alleviate the pain. But everyone 
reacts to opioids somewhat differently, and sometimes what is 
acceptable in terms of the dosage for one individual is not acceptable 
with another individual.
  These guidelines will, again, be based on facts, be based on 
evidence. They are advisory only. We are not trying to intervene in the 
doctor/patient relationship. It will still be up to the doctor to 
determine what is best for the patient. But at least the doctor will 
have some fact-based guidelines with which to make the decision on what 
level to prescribe these opioids if, in fact, opioids are necessary.
  To quote the head of the FDA, Dr. Scott Gottlieb: ``Without evidence-
based dosing recommendations at the point of care to support and inform 
rational prescribing, we're at serious risk of both undertreating some 
patients who could benefit from opioid therapy, and overtreating a lot 
of patients who are then placed at a higher risk of addiction.''
  I will say that the amendment has drawn some concern, or at least 
interest, from the stakeholders, the chairman, the ranking member, 
myself and others are committed to working on this as it goes through 
the process. If we can fine-tune the amendment in some way, we are 
willing to at least consider that.
  But as it is constructed today, Mr. Chairman, this is a good 
amendment, and I hope that the body will adopt it.
  Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I would like to request time to speak in 
favor of the amendment.
  The Acting CHAIR. Does anyone claim time in opposition?
  Mr. WALDEN. I claim time in opposition, Mr. Chairman, although I am 
not opposed to the amendment, and I will yield to my friend from New 
Jersey in a second, but I do ask unanimous consent to claim the time in 
opposition.
  The Acting CHAIR. Is there objection to the request of the gentleman 
from Oregon?
  There was no objection.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I rise in support of this amendment, and I 
want to thank Representatives Barton and Meadows and Kuster. They have 
really worked hard on this and it is a good amendment.
  There is wide variation in the way acute, short-duration pain is 
treated with opioids, and there are concerns that patients may be over- 
or underprescribed opioid analgesics to treat that pain.
  This amendment would direct the FDA Commissioner to develop high-
quality, evidence-based opioid prescribing guidelines for the treatment 
of acute pain. By arming physicians with this type of information, we 
can give them more of the tools they need to treat patients' pain 
without overprescribing addictive medications.
  The intent behind this policy is that evidence-based guidelines would 
add to the universe of available data in a way that would empower 
providers, patients, caregivers and others to make determinations about 
treatment in a more informed manner.
  I understand that some stakeholders have raised some concerns about 
limitations on how these evidence-based guidelines can be used; so as 
we continue to work on these policies with our counterparts in the 
Senate, we are committed to working to ensure that the language 
accomplishes what the sponsors intend without having any unintended 
consequences.
  I encourage my colleagues to support adoption of the amendment.
  Mr. Chair, I yield to the gentleman from New Jersey (Mr. Pallone) 
such time as he may consume.
  Mr. PALLONE. Mr. Chairman, I rise in order to speak on the amendment 
offered by Representatives Barton, Meadows and Kuster.
  FDA Commissioner Gottlieb testified before the Energy and Commerce 
Committee about the work the agency is doing currently to analyze and 
assess opioid analgesic use in situations of acute pain, such as 
following surgical procedures. The goal of this analysis is to provide 
evidence-based recommendations for appropriate opioid doses by 
indicators ensuring that prescribing more closely aligns with clinical 
need.
  I believe this is a goal that we all support, which is why I support 
giving FDA the authority to conduct such work so as to inform policies 
that will better protect public health, and help to reduce the unneeded 
opioids from reaching individuals that are at risk for addiction.

  Since this amendment has been filed, we have heard some concerns from 
stakeholders about the amendment possibly impeding the use of the FDA's 
evidence-based guidelines in making decisions related to dispensing or 
coverage of opioid prescriptions. I believe that such decisions should 
be informed by evidence-based guidelines such as those developed by the 
FDA, and I hope that we can work with the amendment's sponsors and the 
chairman to address these concerns moving forward.
  Mr. WALDEN. Mr. Chairman, I have no further speakers on this matter. 
Again, I thank my friend, the former chairman of the full committee, 
Mr. Barton, for his good leadership on this effort, along with other 
Members on both sides of the aisle.
  I encourage our colleagues to support this amendment, and I yield 
back the balance of my time.
  Mr. BARTON. Mr. Chairman, can I inquire how much time I still have.
  The Acting CHAIR. The gentleman from Texas has 1 minute remaining.

[[Page H5564]]

  

  Mr. BARTON. Mr. Chairman, I yield 1 minute to the gentlewoman from 
New Hampshire (Ms. Kuster), who is an original cosponsor of the 
amendment and has worked very hard on it.
  Ms. KUSTER of New Hampshire. Mr. Chairman, I rise in support of the 
Barton amendment. This amendment would require the FDA to create high-
quality, evidence-based opioid prescribing guidelines for acute pain. 
These would complement prescribing guidelines for chronic pain created 
in 2015 by the Centers for Disease Control and Prevention.
  Taken together, these guidelines would finally provide providers 
evidence-based recommendations on best practices for all types of pain.
  While the opioid epidemic has many origins, it is universally agreed 
upon that the treatment of pain over the latter half of the 20th 
century is a significant contributing factor. In recent years, efforts 
by this Congress and the public to reconcile addiction and chronic pain 
has had a real and positive impact.
  One of the most impacted communities are veterans, and in just the 
last few years, the VA has reported a remarkable decline in opioid 
prescriptions.
  Yet, the focus until very recently has been on chronic pain. Acute 
pain impacts more people and is responsible for a massive share of 
opioid prescriptions. The country needs evidence-based guidance on 
treatment of acute pain.
  FDA is armed with a trove of data on acute pain prescription rates 
and patterns. They are uniquely positioned to provide this needed 
guidance.
  FDA Commissioner Scott Gottlieb told my colleagues on the Energy & 
Commerce Committee that this is something he wants to do and he 
underscored the importance of evidence-based opioid prescribing 
guidelines at the 2018 National Rx Drug Abuse & Heroin Summit.
  While these guidelines are focused on the prescriber practices and 
patients, given the nature of pain management as team-based, we intend 
these recommendations to inform better practices by providers that have 
collaborative working relationships with prescribers.
  I am committed to working with all stakeholders to improve this 
amendment as Congress continues to consider opioid legislation to 
ensure that these guidelines are considered consistent with law while 
still providing effective pain care for all Americans.
  Mr. BARTON. Mr. Chair, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Texas (Mr. Barton).
  The amendment was agreed to.


                 Amendment No. 4 Offered by Mr. Curtis

  The Acting CHAIR. It is now in order to consider amendment No. 4 
printed in part B of House Report 115-766.
  Mr. CURTIS. Mr. Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add at the end of title III the following:

     SEC. 304. REPORT ON OPIOIDS PRESCRIBING PRACTICES FOR 
                   PREGNANT WOMEN.

       (a) In General.--Not later than 180 days after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services, in coordination with the Centers for Disease 
     Control and Prevention, the National Institutes of Health, 
     and the Substance Abuse and Mental Health Services 
     Administration shall develop and submit to the Congress a 
     report--
       (1) on opioids prescribing practices for pregnant women and 
     recommendations for such practices;
       (2) that provides recommendations for identifying and 
     reducing opioids misuse during pregnancy;
       (3) on prescription opioid misuse during pregnancy in urban 
     and rural areas;
       (4) on prescription opioid use during pregnancy for the 
     purpose of medication-assisted treatment in urban and rural 
     areas;
       (5) evaluating current utilization of non-opiate pain 
     management practices in place of prescription opioids during 
     pregnancy;
       (6) providing guidelines encouraging the use of non-opioid 
     pain management practices during pregnancy when safe and 
     effective; and
       (7) that provides recommendations for increasing public 
     awareness and education of opioid use disorder in pregnancy, 
     including available treatment resources in urban and rural 
     areas.
       (b) No Additional Funds.--No additional funds are 
     authorized to be appropriated for purposes of carrying out 
     subsection (a).

  The Acting CHAIR. Pursuant to House Resolution 949, the gentleman 
from Utah (Mr. Curtis) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Utah.
  Mr. CURTIS. Mr. Chairman, I rise today to offer an amendment to 
improve research and public awareness of opioid use during pregnancy. I 
introduced the POPPY Study Act earlier this year to address this issue, 
and I am pleased that it is being considered here today in this form.
  We all know the opioid epidemic has widespread and devastating 
effects. Nearly all of us know someone who has been affected by the 
crisis, and many of us have grieved through the heartbreak of losing 
loved ones to addiction.
  Sadly, the impact this has had on Utah has been overwhelming. In my 
State, six Utahns die every week as a result of the opioid overdose, 
and we rank among the highest in the Nation for drug overdose deaths. 
Areas of my district have some of the highest rates of opioid 
prescriptions dispensed nationwide.
  Tragically, Utah also leads out in prescribing the most opioids to 
pregnant women. Across the Nation, 1 in 5 women receive an opioid 
prescription during pregnancy but, in Utah, that number is doubled.
  Of course, opioid use during pregnancy can have dramatic consequences 
for a mother and her unborn child. Neonatal abstinence syndrome 
presents itself as babies go through withdrawal, constant screaming, 
shaking, vomiting, and difficulty sleeping and eating.

                              {time}  1100

  This condition often requires long and expensive hospitalization. For 
Medicaid-covered babies, this syndrome costs more than $460 million in 
2014 alone.
  Tragically, from 2004 to 2014, the rate of infants diagnosed with 
opioid withdrawal symptoms increased more than 400 percent nationwide.
  Across the Nation, women have been disproportionately impacted by the 
opioid epidemic, and little is known about the effect this has had on 
pregnant women.
  Healthcare experts, providers, and patients agree there is simply too 
much we don't know about why pregnant women are being prescribed 
opioids and what possible alternatives might provide better healthcare 
outcomes for mothers and their unborn children.
  My amendment calls for increased research on current opioid 
prescribing practices during pregnancy, more data on prescription 
opioid misuse during pregnancy, and evaluates and encourages nonopioid 
pain management therapies that are safe and effective during pregnancy.
  I am proud of the work we have done here to curb the opioid epidemic, 
and I applaud the chairman, ranking member, and members of the 
committee for the work they have done to fight this crisis.
  Mr. Chair, I encourage my colleagues to support this vital amendment 
as well as the underlying bill that will help us better serve our 
suffering communities, and I reserve the balance of my time.
  Mr. WALDEN. Mr. Chair, although I am not opposed to the amendment, I 
ask unanimous consent to claim the time in opposition.
  The Acting CHAIR. Is there objection to the request of the gentleman 
from Oregon?
  There was no objection.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, I rise to speak in support of the amendment 
and to thank my friend from Utah, Mr. Curtis, for his hard work on this 
very thoughtful piece of legislation.
  It is important that women who take opioid pain medications are aware 
of the possible risks during pregnancy. You heard him delineate those 
tragic, tragic risks, such as premature birth and neonatal abstinence 
syndrome, or NAS.
  While there is increasing awareness and use of nonopioid approaches 
in the management of pain over all, information about their use in 
pregnant patients and unique considerations of mother and child are 
simply lacking.
  So this amendment requires the Department of Health and Human 
Services to report on the opioid prescribing practices and opioid 
misuse during pregnancy, and evaluate nonopioid alternatives to pain 
management during pregnancy.

[[Page H5565]]

  This will complement the efforts of the Protecting Our Infants Act, 
which required a report on prenatal opioid exposure and NAS, presenting 
a strategy and clinical recommendations for preventing and treating 
infants withdrawal.
  I encourage my colleagues to support this amendment.
  Mr. Chair, I yield such time as he may consume to the gentleman from 
Louisiana (Mr. Scalise), a very important Member not only of the U.S. 
House of Representatives as our whip, but a very influential and 
effective member on our Energy and Commerce Committee.
  Mr. SCALISE. Mr. Chairman, I thank the chairman for yielding me the 
time and for leading on this important issue.
  Mr. Chairman, I rise in strong support of my friend from Utah's 
amendment. As he mentioned, Mr. Chairman, you look at this crisis in 
our country, and I am so glad that Congress is taking a wide array of 
actions to address the opioid crisis in our country, because it doesn't 
affect just one community or another. Everybody might think ``mine is 
the only problem,'' and then you talk to other Members of Congress from 
around the country, and you find out they are experiencing the same 
kind of crisis. And it is widespread. It is killing people every single 
day.
  But as we are talking about on this amendment, Mr. Chairman, we are 
talking about children, children that are born to a mother that is 
addicted to opioids.
  I highlight Kemper, a young boy from my district in Slidell, 
Louisiana. He was born addicted to opioids because his mother, while 
she was pregnant, was addicted to opioids herself.
  Now, I wish that this was the only time that it had happened. 
Fortunately for all of us, Kemper is now a healthy young boy, but he 
spent his first 11 days of life in the hospital fighting to beat a drug 
addiction that was not created, of course, on his own.
  We would like to think that this might be an isolated example, but, 
Mr. Chairman, this example highlights something the Centers for Disease 
Control has noted, and that is, once every 25 minutes in America, a 
baby is born addicted to opioids--one every 25 minutes. That is how 
widespread it is just for babies that are born.
  When we talk about this entire package of bills, today, H.R. 6 is 
going to pull together 50 different bills covering many different parts 
of this problem. It is an incredibly bipartisan effort. I know, Mr. 
Chairman, so often we hear about the partisan wrangling in Congress. 
Clearly, there are divided lines on some high-profile issues, but this 
is an issue where Republicans and Democrats have come together.
  I want to thank my friends from both sides of the aisle for 
recognizing this problem and coming together in a bipartisan way to 
solve it.
  This is going to give real tools to our communities so that they can 
combat this at every different level we are seeing, including 
treatment, including law enforcement to stop these deadly drugs from 
getting on the streets so that more babies like Kemper are not born 
addicted to opioids.
  Mr. Chairman, I encourage all my colleagues to support this amendment 
and the underlying package of bills.
  Mr. WALDEN. Mr. Chairman, I urge passage, and I yield back the 
balance of my time.
  Mr. CURTIS. Mr. Chairman, I thank the gentleman from Louisiana and 
the chairman for their speaking out in support of this important bill.
  Mr. Chairman, this amendment is essential in helping us improve our 
understanding of the impact of using opioid prescription during 
pregnancy and, ultimately, preventing opioid use disorder entirely. It 
is vital that we have sound and accurate research to guide us in the 
best ways to help pregnant women suffering from addiction.
  Mr. Chairman, this is a critical amendment. I urge my colleagues to 
support it, and I yield back the balance of my time.
  The Acting CHAIR (Mr. Weber of Texas). The question is on the 
amendment offered by the gentleman from Utah (Mr. Curtis).
  The amendment was agreed to.


                 Amendment No. 5 Offered by Mr. Keating

  The Acting CHAIR. It is now in order to consider amendment No. 5 
printed in part B of House Report 115-766.
  Mr. KEATING. Mr. Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add at the end of title III the following:

     SEC. 304. GUIDELINES FOR PRESCRIBING NALOXONE.

       (a) In General.--Not later than 180 days after the date of 
     the enactment of this Act, the Secretary of Health and Human 
     Services shall issue guidelines for prescribing an opioid 
     overdose reversal drug.
       (b) Contents.--In issuing guidelines under subsection (a), 
     the Secretary shall address the following:
       (1) Co-prescribing an opioid overdose reversal drug in 
     conjunction with any prescribed opioid.
       (2) Dosage safety.
       (3) Prescribing an opioid overdose reversal drug to an 
     individual other than a patient.
       (4) Standing orders.
       (5) Other distribution, education, and safety measures as 
     determined necessary.

  The Acting CHAIR. Pursuant to House Resolution 949, the gentleman 
from Massachusetts (Mr. Keating) and a Member opposed each will control 
5 minutes.
  The Chair recognizes the gentleman from Massachusetts.
  Mr. KEATING. Mr. Chairman, I rise in support of my amendment that 
directs the Department of the Health and Human Services to issue and 
expand guidelines for medical providers for prescribing naloxone to 
reflect a major shift that has occurred in the opioid health crisis 
that we continue to work to counter today.
  Mr. Chairman, earlier this year, I sat in a room with my colleagues 
on the Bipartisan Heroin Task Force and listened to Dr. Francis Collins 
and the NIH leadership present data revealing how we have seen a shift 
in the opioid crisis.
  For the first time, we learned that opioid overdoses from 
prescriptions of opioid drugs have dropped. That is good news.
  The shocking news was that overdose rates for illicit opioids, heroin 
and fentanyl, had risen at an alarming rate.
  If we are going to save lives of people overdosing from increasingly 
prevalent and increasingly unpredictable illicit compounds, we need to 
make sure naloxone gets in the right hands.
  My amendment would provide necessary guidance to patients, providers, 
public health professionals, first responders, and loved ones on the 
ability to obtain effective doses of naloxone to combat overdoses of 
all types of opioids, prescriptions or otherwise.
  It is so crucial that people dealing with this brain disease know how 
to use naloxone in an emergency and, importantly, understand that it is 
okay to have naloxone in the home.
  I was proud that I and the gentleman from Pennsylvania (Mr. Rothfus), 
who also joins me as a cosponsor of this bipartisan amendment, were 
able to insert legislative language on prescribing guidelines into the 
Comprehensive Addiction and Recovery Act that passed Congress and 
became law last year. But giving HHS the option to issue guidelines 
didn't go far enough.
  This amendment before us is firm in its requirement, and I believe my 
amendment will more explicitly and more expansively direct and yield 
necessary change.
  Mr. Chairman, I conclude by reaffirming our commitment to ending this 
devastating epidemic that takes the lives of 115 people every day on 
average in our country.
  I share this commitment with the Members of the House, and I pledge 
to work with you all to see this amendment's passage and to effect 
necessary change that reflects the ever-shifting landscape in this 
battle.
  Mr. Chairman, I yield 2 minutes to the gentleman from Pennsylvania 
(Mr. Rothfus), the cosponsor of this amendment.
  Mr. ROTHFUS. Mr. Chairman, I thank the gentleman for yielding time to 
me.
  Mr. Chairman, I rise to urge my colleagues to support this amendment 
to H.R. 6, and I want to thank my colleague, the gentleman from 
Massachusetts (Mr. Keating), for his work on this effort. We have 
worked before on this issue of naloxone, and it is great that he is 
bringing forth this amendment. I am happy to be cosponsoring it with 
him.
  The House has been doing amazing, wide-ranging work over the last 2 
weeks to combat the opioid crisis, and

[[Page H5566]]

I am proud to have assisted with these efforts.
  The amendment that I have cojoined with Congressman Keating today is 
simple. It instructs the Secretary of Health and Human Services to give 
additional guidance to prescribing naloxone.
  Naloxone is the drug used to reverse opioid overdoses, a situation 
that far too many Americans have found themselves in across the country 
and across western Pennsylvania.
  Opioid addiction is tearing families apart. Unfortunately, an 
overdose is frequently the grim end to a long struggle.
  If we can help some of our fellow Americans come back from the brink 
with increased knowledge for our Nation's medical professionals, I see 
no reason not to do it.
  Mr. Chairman, I urge my colleagues to support this amendment. I again 
thank Congressman Keating for his leadership on this.
  Mr. WALDEN. Mr. Chairman, although I am not opposed to the amendment, 
I ask unanimous consent to claim time in opposition.
  The Acting CHAIR. Is there objection to the request of the gentleman 
from Oregon?
  There was no objection.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, I rise to speak in support of the amendment 
that requires the Department of Health and Human Services to issue 
guidelines for prescribing an opioid overdose reversal drug.
  The guidelines would cover dosage safety, standing orders and other 
education, and distribution measures.
  In April, the Surgeon General issued an advisory calling for more 
people to carry naloxone.
  Expanding the use of this lifesaving drug is a key part of the public 
health response to the opioid crisis, along with effective prevention, 
treatment, and recovery programs for substance use disorder.
  I can just tell you, Mr. Chairman, from my own district, I have had 
multiple roundtables in every corner of the district. I have, of 
course, met with families that have been affected. I have met with 
addiction treatment specialists. I have met with medical providers. But 
I have also met with law enforcement.
  In Oregon, we lead in a lot of this recovery effort, but also in 
making sure naloxone is available. This is the antidote.
  Mr. Chair, these fentanyls that are coming into our country 
illegally, if I had a little salt shaker here and put out, I don't 
know, a half a dozen, a dozen grains of salt, and you put your hand on 
it, you would likely absorb that through your skin and pass out. And 
if somebody in this Chamber didn't have naloxone, or the medical people 
who are nearby didn't get to you in time, you would be one of those 115 
people who will die in the next 24 hours, or one of the thousand that 
will show up in our emergency rooms.

  So moving forward with guidelines for prescribing an opioid overdose 
reversal drug really makes sense. Moving forward with naloxone really 
makes sense.
  We will save lives with this amendment, and I commend my colleagues 
from Massachusetts and Pennsylvania for their good work on this. We are 
happy to accept it as part of H.R. 6, and I yield back the balance of 
my time.
  Mr. KEATING. Mr. Chairman, in Cape Cod, the islands, and South Shore 
and south coast of Massachusetts, the real cause of death in overdoses 
now is fentanyl. It is being mixed with cocaine. It is being mixed with 
marijuana. And this is very important.
  This bipartisan amendment will save lives. I want to thank Chairman 
Walden. I want to thank Chairman Brady. I want to thank my cosponsor 
Mr. Rothfus. I want to thank Ranking Member Pallone and Ranking Member 
Neal for their work on an amendment that will truly save lives.
  Mr. WALDEN. Will the gentleman yield?
  Mr. KEATING. Mr. Chairman, I yield to the gentleman from Oregon.
  Mr. WALDEN. Mr. Chairman, because the gentleman raised the issue of 
these synthetics on other--we have talked a lot about fentanyl being 
cut into heroin over the course of this debate over 2 weeks.
  We haven't talked as much about these synthetics being sprayed on 
marijuana or other things that you go: Oh, that is natural, mom. I can 
smoke that.
  And what these evil people are doing is taking these deadly 
synthetics and literally creating a liquid or a spray and then spraying 
it.
  And I talked to a father the other day whose daughter died of a 
heroin overdose, but when they did the autopsy, they discovered it was 
100 percent fentanyl. So I thank the gentleman for his good work on 
this amendment.
  Mr. KEATING. Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Massachusetts (Mr. Keating).
  The amendment was agreed to.
  The Acting CHAIR. It is now in order to consider amendment No. 6 
printed in part B of House Report 115-766.


       Amendment No. 7 Offered by Ms. Maxine Waters of California

  The Acting CHAIR. It is now in order to consider amendment No. 7 
printed in part B of House Report 115-766.
  Ms. MAXINE WATERS of California. Mr. Chairman, I have an amendment at 
the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add at the end of title III the following new section:

     SEC. ___. REQUIRING A SURVEY OF SUBSTANCE USE DISORDER 
                   TREATMENT PROVIDERS RECEIVING FEDERAL FUNDING.

       (a) In General.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary'') shall 
     conduct a survey of all entities that receive Federal funding 
     for the purpose of providing substance use disorder treatment 
     services. The survey shall direct such entities to provide 
     the following information:
       (1) The length of time the entity has provided substance 
     use disorder treatment services.
       (2) A detailed description of the patient population served 
     by the entity, including but not limited to the number of 
     patients, type of addictions, geographic area served, as well 
     as gender, racial, ethnic and socioeconomic demographics of 
     such patients.
       (3) A detailed description of the types of addiction for 
     which the entity has the experience, capability, and capacity 
     to provide such services.
       (4) An explanation of how the entity handles patients 
     requiring treatment for a substance use disorder that the 
     organization is not able to treat.
       (5) A description of what is needed, in the opinion of the 
     entity, in order to improve the entity's ability to meet the 
     addiction treatment needs of the communities served by that 
     entity.
       (6) Based on the identified needs of the communities 
     served, a description of unmet needs and inadequate services 
     and how such needs and services could be better addressed 
     through additional Federal, State, or local government 
     resources or funding to treat addiction to methamphetamine, 
     crack cocaine, other types of cocaine, heroin, opioids, and 
     other commonly abused drugs.
       (b) Report.--Not later than 1 year after the date of the 
     enactment of this Act, the Secretary shall develop and submit 
     to Congress a plan to direct appropriate resources to 
     entities that provide substance use disorder treatment 
     services in order to address inadequacies in services or 
     funding identified through the survey described in subsection 
     (a).

  The Acting CHAIR. Pursuant to House Resolution 949, the gentlewoman 
from California (Ms. Maxine Waters) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentlewoman from California.

                              {time}  1115

  Ms. MAXINE WATERS of California. Mr. Chairman, first I would like to 
say that I appreciate the bipartisan work of the bill's sponsor, 
Chairman  Greg Walden, and, of course, Chairman Kevin Brady and our 
cosponsor Frank Pallone and cosponsor Richard Neal on this bill, H.R. 
6, the SUPPORT for Patients and Communities Act.


 =========================== NOTE =========================== 

  
  June 22, 2018, on page H5566, the following appeared: Ms. MAXINE 
WATERS of California. Mr. Chairman, first I would like to say that 
I appreciate the bipartisan work of the bill's sponsor, Chairman 
GREG WALDEN, and, of course, Chairman Ken Brady and our cosponsor 
FRANK PALLONE and cosponsor RICHARD NEAL on this bill, H.R. 6, the 
SUPPORT for Patients and Communities Act.
  
  The online version has been corrected to read: Ms. MAXINE WATERS 
of California. Mr. Chairman, first I would like to say that I 
appreciate the bipartisan work of the bill's sponsor, Chairman 
GREG WALDEN, and, of course, Chairman KEVIN BRADY and our 
cosponsor FRANK PALLONE and cosponsor RICHARD NEAL on this bill, 
H.R. 6, the SUPPORT for Patients and Communities Act.


 ========================= END NOTE ========================= 

  The bill, as drafted, includes many positive provisions and extends 
well-intended legislative efforts to address the opioid crisis in this 
country. That said, as we all know, in the United States, people suffer 
from a wide range of substance use disorders, including alcoholism and 
the abuse of illegal drugs like heroin, methamphetamine, crack, and 
other forms of cocaine. Likewise, there are a range of entities that 
provide different types of substance abuse treatment services.

[[Page H5567]]

  The purpose of my amendment is to ensure that we have a clear 
understanding of the substance abuse treatment services available, the 
communities and the populations that are being served, the types of 
substance use disorders being addressed, and any other unmet needs or 
inadequacies in the way we are addressing substance abuse issues.
  My amendment would direct that the Department of Health and Human 
Services conduct a nationwide survey of entities that provide substance 
use disorder treatment services. Based on the results of that survey, 
my amendment directs HHS to develop and submit to Congress a plan to 
direct appropriate resources in order to address inadequacies in 
services or funding identified through the survey.
  The survey called for by my amendment is intended to complement 
existing efforts by the Substance Abuse and Mental Health Services 
Administration, SAMHSA, to examine substance use treatment services in 
order to develop a concrete plan to address unmet needs.
  Mr. Chairman, let me just say that I appreciate the information that 
was shared by the majority whip, Mr. Scalise, when he talked about the 
baby who was born addicted, and we are going to have a lot of that.
  I have one regret, having worked on the issue of crack cocaine, that 
we did not do something to do the research that was necessary on these 
babies that are born addicted, to find out what happens to them later 
on in life and whether or not these children are handicapped and 
disabled in some ways, have learning disabilities, and on and on and 
on. So I would like to work with Mr. Scalise to do the follow-up for 
the research that is so necessary.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, although I am not opposed to the amendment, 
I ask unanimous consent to claim the time in opposition.
  The Acting CHAIR. Is there objection to the request of the gentleman 
from Oregon?
  There was no objection.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I rise to speak in support of this amendment 
and to thank my friend, Ms. Waters, for her work on this initiative.
  Before I go through that, I just want to say we are more than happy 
to team up with the gentlewoman on this issue of crack cocaine and its 
effects, and I am sure that Mr. Scalise, although I can't officially 
speak for him, I am sure that he would work in partnership with the 
gentlewoman.
  The gentlewoman has raised an issue that we have dealt with in other 
parts of this legislation but not in the part that the gentlewoman has 
brought to us. There will be more going forward, I assure you, and we 
would be happy to work with the gentlewoman on that.
  Mr. Rush brought an amendment on the IMD issue to make sure that 
those suffering from cocaine and crack cocaine addiction also could get 
treatment under expansion in the IMD, so we would be happy to work with 
the gentlewoman on that.
  This amendment directs the Secretary of Health and Human Services to 
conduct a survey of organizations that provide substance abuse 
treatment services and then develop a plan to direct resources to 
address any identified gaps in services for specific types of substance 
use disorders. This information will help us better understand how our 
Federal dollars are invested in interdiction treatment at the local 
level and what more can be done with Federal resources to yield even 
better returns in reducing drug-related crimes, accidents, overdoses, 
and deaths.
  So I certainly appreciate the gentlewoman's work on this effort. It 
is important work that will help save lives and bring about the kind of 
treatment we need in our communities.
  I encourage adoption of the amendment, and I yield back the balance 
of my time.
  Ms. MAXINE WATERS of California. Mr. Chairman, I yield back the 
balance of my time
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from California (Ms. Maxine Waters).
  The amendment was agreed to.
  The Acting CHAIR (Mrs. Walorski). The Chair understands that 
amendment No. 8 will not be offered.
  There being no further amendments, under the rule, the Committee 
rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Weber of Texas) having assumed the chair, Mrs. Walorski, Acting Chair 
of the Committee of the Whole House on the state of the Union, reported 
that that Committee, having had under consideration the bill (H.R. 6) 
to provide for opioid use disorder prevention, recovery, and treatment, 
and for other purposes, and, pursuant to House Resolution 949, she 
reported the bill, as amended by that resolution, back to the House 
with sundry further amendments adopted in the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  Is a separate vote demanded on any further amendment reported from 
the Committee of the Whole? If not, the Chair will put them en gros.
  The amendments were agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


                           Motion to Recommit

  Mr. TONKO. Mr. Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. TONKO. I am opposed in its current form.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Tonko moves to recommit the bill H.R. 6 to the 
     Committee on Energy and Commerce and the Committee on Ways 
     and Means with instructions to report the same back to the 
     House forthwith with the following amendment:
       Page 84, after line 14, insert the following:

     SEC. 208. DISTRIBUTION OF ADDITIONAL RESIDENCY POSITIONS TO 
                   HELP COMBAT OPIOID CRISIS.

       (a) In General.--Section 1886(h) of the Social Security Act 
     (42 U.S.C. 1395ww(h)) is amended--
       (1) in paragraph (4)(F)(i), by striking ``paragraphs (7) 
     and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
       (2) in paragraph (4)(H)(i), by striking ``paragraphs (7) 
     and (8)'' and inserting ``paragraphs (7), (8), and (9)'';
       (3) in paragraph (7)(E), by inserting ``paragraph (9),'' 
     after ``paragraph (8),''; and
       (4) by adding at the end the following new paragraph:
       ``(9) Distribution of additional residency positions to 
     help combat opioid crisis.--
       ``(A) Additional residency positions.--For each of fiscal 
     years 2021 through 2025 (and succeeding fiscal years if the 
     Secretary determines that there are additional residency 
     positions available to distribute under subparagraph (D)), 
     the Secretary shall increase the otherwise applicable 
     resident limit for each qualifying hospital that submits a 
     timely application under this subparagraph by such number as 
     the Secretary may approve for portions of cost reporting 
     periods occurring on or after July 1 of the fiscal year of 
     the increase. Except as provided in subparagraph (B)(iv) or 
     (D), the aggregate number of increases in the otherwise 
     applicable resident limit under this subparagraph shall be 
     equal to 500 over the period of fiscal years 2021 through 
     2025, distributed in accordance with the succeeding 
     subparagraphs of this paragraph.
       ``(B) Distribution for fiscal year 2021.--
       ``(i) In general.--For fiscal year 2021, the positions 
     available for distribution with respect to the fiscal year as 
     described in subparagraph (A) shall be distributed to 
     hospitals that have existing established approved programs in 
     addiction medicine, addiction psychiatry, or pain medicine as 
     determined by the Secretary. The Secretary shall establish 
     standards and a process for ensuring additional residency 
     positions under this subparagraph are used to increase the 
     number of residents studying in the fields specified in the 
     previous sentence.
       ``(ii) Number of positions hospital eligible to receive.--
     Subject to clauses (iii) and (iv), the aggregate number of 
     positions a hospital may receive under this subparagraph with 
     respect to fiscal year 2021 is equal to the sum of the 
     following:

       ``(I) The number of full-time-equivalent residents that 
     will be training in addiction medicine, addiction psychiatry, 
     or pain medicine as determined by the Secretary with respect 
     to the fiscal year.
       ``(II) The associated number, as defined by the Secretary, 
     of residents training in a pre-requisite program, such as 
     internal medicine, necessary for the number of full-time 
     residents for the programs described in subclause (I).

       ``(iii) Additional positions for expansion of existing 
     program.--If a hospital demonstrates to the Secretary that 
     the hospital is planning to increase the number of full-

[[Page H5568]]

     time-equivalent residents in existing programs described in 
     clause (i), the Secretary may increase the number of 
     positions a hospital is eligible to receive under clause (ii) 
     in order to accommodate that expansion, as determined by the 
     Secretary.
       ``(iv) Considerations in distribution.--The Secretary shall 
     distribute additional residency positions under this 
     subparagraph based on--

       ``(I) in the case of positions made available under clause 
     (ii), the demonstrated likelihood, as defined by the 
     Secretary, of the hospital filling such positions by July 1, 
     2021; and
       ``(II) in the case of positions made available under clause 
     (iii), the demonstrated likelihood, as so defined, of the 
     hospital filling such positions within the first three cost 
     reporting periods beginning on or after July 1, 2021.

       ``(v) Limitation.--Notwithstanding clauses (ii) and (iv), 
     an individual hospital may not receive more than 25 full-
     time-equivalent residency positions under this paragraph.
       ``(vi) Positions not distributed during the fiscal year.--
     If the number of resident full-time-equivalent positions 
     distributed under this subparagraph is less than the 
     aggregate number of positions available for distribution in 
     the fiscal year (as described in subparagraph (A)), the 
     difference between such number distributed and such number 
     available for distribution shall be added to the aggregate 
     number of positions available for distribution under 
     subparagraph (C).
       ``(C) Distribution for fiscal years 2022 through 2025.--
       ``(i) In general.--For the period of fiscal years 2022 
     through 2025, the positions available for distribution with 
     respect to such period (as described in subparagraph (A), 
     including after application of subparagraph (B)(vi)) shall be 
     distributed to hospitals which demonstrate to the Secretary 
     that the hospital--

       ``(I) will establish an approved program in addiction 
     medicine, addiction psychiatry, or pain medicine; and
       ``(II) will use all of the additional positions made 
     available under this subparagraph in such program or a 
     prerequisite residency program for such program within the 
     first four cost reporting periods after the increase would be 
     effective.

       ``(ii) Requirements.--Subject to clause (iii), a hospital 
     that receives an increase in the otherwise applicable 
     resident limit under this subparagraph shall ensure, during 
     the 10-year period beginning after the date of such increase, 
     that the hospital uses the positions received under clauses 
     (i)(I) and (i)(II) for the programs for which the positions 
     were distributed, or similar programs (as determined by the 
     Secretary). The Secretary may determine whether a hospital 
     has met the requirements under this clause during such 10-
     year period in such manner and at such time as the Secretary 
     determines appropriate, including at the end of such 10-year 
     period.
       ``(iii) Redistribution of positions if hospital no longer 
     meets certain requirements.--In the case where the Secretary 
     determines that a hospital described in clause (ii) does not 
     meet the requirements of such clause, the Secretary shall--

       ``(I) reduce the otherwise applicable resident limit of the 
     hospital by the amount by which such limit was increased 
     under this subparagraph; and
       ``(II) provide for the distribution of positions 
     attributable to such reduction in accordance with the 
     requirements of this paragraph.

       ``(D) Distribution of remaining positions.--If the 
     aggregate number of positions distributed under subparagraphs 
     (B) and (C) during the period of fiscal years 2021 through 
     2025 is less than 500, the Secretary shall distribute the 
     remaining residency positions in succeeding fiscal years 
     according to criteria consistent with this paragraph until 
     such time as the aggregate amount of positions distributed 
     under this paragraph is equal to 500.
       ``(E) Notification.--The Secretary shall notify hospitals 
     of the number of positions distributed to the hospital under 
     this paragraph as a result on an increase in the otherwise 
     applicable resident limit by January 1 of the fiscal year of 
     the increase. Such increase shall be effective for portions 
     of cost reporting periods beginning on or after July 1 of 
     that fiscal year.
       ``(F) Application of per resident amounts for primary care 
     and nonprimary care.--With respect to additional residency 
     positions in a hospital attributable to the increase provided 
     under this paragraph, the approved FTE per resident amounts 
     are deemed to be equal to the hospital per resident amounts 
     for primary care and nonprimary care computed under paragraph 
     (2)(D) for that hospital.
       ``(G) Permitting facilities to apply aggregation rules.--
     The Secretary shall permit hospitals receiving additional 
     residency positions attributable to the increase provided 
     under this paragraph to, beginning in the fifth year after 
     the effective date of such increase, apply such positions to 
     the limitation amount under paragraph (4)(F) that may be 
     aggregated pursuant to paragraph (4)(H) among members of the 
     same affiliated group.
       ``(H) Definitions.--In this paragraph:
       ``(i) Otherwise applicable resident limit.--The term 
     `otherwise applicable resident limit' means, with respect to 
     a hospital, the limit otherwise applicable under 
     subparagraphs (F)(i) and (H) of paragraph (4) on the resident 
     level for the hospital determined without regard to this 
     paragraph but taking into account paragraphs (7)(A), (7)(B), 
     (8)(A), and (8)(B).
       ``(ii) Resident level.--The term `resident level' has the 
     meaning given such term in paragraph (7)(C)(i).''.
       (b) IME.--
       (1) In general.--Section 1886(d)(5)(B)(v) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(5)(B)(v)), in the third 
     sentence, is amended by striking ``and (h)(8)'' and inserting 
     ``(h)(8), and (h)(9)''.
       (2) Conforming provision.--Section 1886(d)(5)(B) of the 
     Social Security Act (42 U.S.C. 1395ww(d)(5)(B)) is amended--
       (A) by redesignating clause (x), as added by section 
     5505(b) of the Patient Protection and Affordable Care Act 
     (Public Law 111-148), as clause (xi) and moving such clause 4 
     ems to the left; and
       (B) by adding after clause (xi), as redesignated by 
     subparagraph (A), the following new clause:
       ``(xii) For discharges occurring on or after July 1, 2021, 
     insofar as an additional payment amount under this 
     subparagraph is attributable to resident positions 
     distributed to a hospital under subsection (h)(9), the 
     indirect teaching adjustment factor shall be computed in the 
     same manner as provided under clause (ii) with respect to 
     such resident positions.''.
       Page 95, after line 21, insert the following:

     SEC. 304. ACTIONS FOR DELAYS OF GENERIC DRUGS AND BIOSIMILAR 
                   BIOLOGICAL PRODUCTS.

       (a) Definitions.--In this section--
       (1) the term ``commercially reasonable, market-based 
     terms'' means--
       (A) a non-discriminatory price for the sale of the covered 
     product at or below, but not greater than, the most recent 
     wholesale acquisition cost for the drug, as defined in 
     section 1847A(c)(6)(B) of the Social Security Act (42 U.S.C. 
     1395w-3a(c)(6)(B));
       (B) a schedule for delivery that results in the transfer of 
     the covered product to the eligible product developer 
     consistent with the timing under subsection (b)(2)(A)(iv); 
     and
       (C) no additional conditions are imposed on the sale of the 
     covered product;
       (2) the term ``covered product''--
       (A) means--
       (i) any drug approved under subsection (b) or (j) of 
     section 505 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355) or biological product licensed under subsection 
     (a) or (k) of section 351 of the Public Health Service Act 
     (42 U.S.C. 262);
       (ii) any combination of a drug or biological product 
     described in clause (i); or
       (iii) when reasonably necessary to support approval of an 
     application under section 505 of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355), or section 351 of the Public 
     Health Service Act (42 U.S.C. 262), as applicable, or 
     otherwise meet the requirements for approval under either 
     such section, any product, including any device, that is 
     marketed or intended for use with such a drug or biological 
     product; and
       (B) does not include any drug or biological product that 
     the Secretary has determined to be currently in shortage and 
     that appears on the drug shortage list in effect under 
     section 506E of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 356e), unless the shortage will not be promptly 
     resolved--
       (i) as demonstrated by the fact that the drug or biological 
     product has been in shortage for more than 6 months; or
       (ii) as otherwise determined by the Secretary;
       (3) the term ``device'' has the meaning given the term in 
     section 201 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 321);
       (4) the term ``eligible product developer'' means a person 
     that seeks to develop a product for approval pursuant to an 
     application for approval under subsection (b)(2) or (j) of 
     section 505 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355) or for licensing pursuant to an application under 
     section 351(k) of the Public Health Service Act (42 U.S.C. 
     262(k));
       (5) the term ``license holder'' means the holder of an 
     application approved under subsection (c) or (j) of section 
     505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     355) or the holder of a license under subsection (a) or (k) 
     of section 351 of the Public Health Service Act (42 U.S.C. 
     262) for a covered product;
       (6) the term ``REMS'' means a risk evaluation and 
     mitigation strategy under section 505-1 of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355-1);
       (7) the term ``REMS with ETASU'' means a REMS that contains 
     elements to assure safe use under section 505-1 of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1);
       (8) the term ``Secretary'' means the Secretary of Health 
     and Human Services;
       (9) the term ``single, shared system of elements to assure 
     safe use'' means a single, shared system of elements to 
     assure safe use under section 505-1 of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355-1); and
       (10) the term ``sufficient quantities'' means an amount of 
     a covered product that allows the eligible product developer 
     to--
       (A) conduct testing to support an application--
       (i) for approval under subsection (b)(2) or (j) of section 
     505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     355); or
       (ii) for licensing under section 351(k) of the Public 
     Health Service Act (42 U.S.C. 262(k)); and

[[Page H5569]]

       (B) fulfill any regulatory requirements relating to such an 
     application for approval or licensing.
       (b) Civil Action for Failure to Provide Sufficient 
     Quantities of a Covered Product.--
       (1) In general.--An eligible product developer may bring a 
     civil action against the license holder for a covered product 
     seeking relief under this subsection in an appropriate 
     district court of the United States alleging that the license 
     holder has declined to provide sufficient quantities of the 
     covered product to the eligible product developer on 
     commercially reasonable, market-based terms.
       (2) Elements.--
       (A) In general.--To prevail in a civil action brought under 
     paragraph (1), an eligible product developer shall prove, by 
     a preponderance of the evidence--
       (i) that--

       (I) the covered product is not subject to a REMS with 
     ETASU; or
       (II) if the covered product is subject to a REMS with 
     ETASU--

       (aa) the eligible product developer has obtained a covered 
     product authorization from the Secretary in accordance with 
     subparagraph (B); and
       (bb) the eligible product developer has provided a copy of 
     the covered product authorization to the license holder;
       (ii) that, as of the date on which the civil action is 
     filed, the product developer has not obtained sufficient 
     quantities of the covered product on commercially reasonable, 
     market-based terms;
       (iii) that the eligible product developer has requested to 
     purchase sufficient quantities of the covered product from 
     the license holder; and
       (iv) that the license holder has not delivered to the 
     eligible product developer sufficient quantities of the 
     covered product on commercially reasonable, market-based 
     terms--

       (I) for a covered product that is not subject to a REMS 
     with ETASU, by the date that is 31 days after the date on 
     which the license holder received the request for the covered 
     product; and
       (II) for a covered product that is subject to a REMS with 
     ETASU, by 31 days after the later of--

       (aa) the date on which the license holder received the 
     request for the covered product; or
       (bb) the date on which the license holder received a copy 
     of the covered product authorization issued by the Secretary 
     in accordance with subparagraph (B).
       (B) Authorization for covered product subject to a rems 
     with etasu.--
       (i) Request.--An eligible product developer may submit to 
     the Secretary a written request for the eligible product 
     developer to be authorized to obtain sufficient quantities of 
     an individual covered product subject to a REMS with ETASU.
       (ii) Authorization.--Not later than 120 days after the date 
     on which a request under clause (i) is received, the 
     Secretary shall, by written notice, authorize the eligible 
     product developer to obtain sufficient quantities of an 
     individual covered product subject to a REMS with ETASU for 
     purposes of--

       (I) development and testing that does not involve human 
     clinical trials, if the eligible product developer has agreed 
     to comply with any conditions the Secretary determines 
     necessary; or
       (II) development and testing that involves human clinical 
     trials, if the eligible product developer has--

       (aa)(AA) submitted protocols, informed consent documents, 
     and informational materials for testing that include 
     protections that provide safety protections comparable to 
     those provided by the REMS for the covered product; or
       (BB) otherwise satisfied the Secretary that such 
     protections will be provided; and
       (bb) met any other requirements the Secretary may 
     establish.
       (iii) Notice.--A covered product authorization issued under 
     this subparagraph shall state that the provision of the 
     covered product by the license holder under the terms of the 
     authorization will not be a violation of the REMS for the 
     covered product.
       (3) Affirmative defense.--In a civil action brought under 
     paragraph (1), it shall be an affirmative defense, on which 
     the defendant has the burden of persuasion by a preponderance 
     of the evidence--
       (A) that, on the date on which the eligible product 
     developer requested to purchase sufficient quantities of the 
     covered product from the license holder--
       (i) neither the license holder nor any of its agents, 
     wholesalers, or distributors was engaged in the manufacturing 
     or commercial marketing of the covered product; and
       (ii) neither the license holder nor any of its agents, 
     wholesalers, or distributors otherwise had access to 
     inventory of the covered product to supply to the eligible 
     product developer on commercially reasonable, market-based 
     terms; or
       (B) that--
       (i) the license holder sells the covered product through 
     agents, distributors, or wholesalers;
       (ii) the license holder has placed no restrictions, 
     explicit or implicit, on its agents, distributors, or 
     wholesalers to sell covered products to eligible product 
     developers; and
       (iii) the covered product can be purchased by the eligible 
     product developer in sufficient quantities on commercially 
     reasonable, market-based terms from the agents, distributors, 
     or wholesalers of the license holder.
       (4) Remedies.--
       (A) In general.--If an eligible product developer prevails 
     in a civil action brought under paragraph (1), the court 
     shall--
       (i) order the license holder to provide to the eligible 
     product developer without delay sufficient quantities of the 
     covered product on commercially reasonable, market-based 
     terms;
       (ii) award to the eligible product developer reasonable 
     attorney fees and costs of the civil action; and
       (iii) award to the eligible product developer a monetary 
     amount sufficient to deter the license holder from failing to 
     provide other eligible product developers with sufficient 
     quantities of a covered product on commercially reasonable, 
     market-based terms, if the court finds, by a preponderance of 
     the evidence--

       (I) that the license holder delayed providing sufficient 
     quantities of the covered product to the eligible product 
     developer without a legitimate business justification; or
       (II) that the license holder failed to comply with an order 
     issued under clause (i).

       (B) Maximum monetary amount.--A monetary amount awarded 
     under subparagraph (A)(iii) shall not be greater than the 
     revenue that the license holder earned on the covered product 
     during the period--
       (i) beginning on--

       (I) for a covered product that is not subject to a REMS 
     with ETASU, the date that is 31 days after the date on which 
     the license holder received the request; or
       (II) for a covered product that is subject to a REMS with 
     ETASU, the date that is 31 days after the later of--

       (aa) the date on which the license holder received the 
     request; or
       (bb) the date on which the license holder received a copy 
     of the covered product authorization issued by the Secretary 
     in accordance with paragraph (2)(B); and
       (ii) ending on the date on which the eligible product 
     developer received sufficient quantities of the covered 
     product.
       (C) Avoidance of delay.--The court may issue an order under 
     subparagraph (A)(i) before conducting further proceedings 
     that may be necessary to determine whether the eligible 
     product developer is entitled to an award under clause (ii) 
     or (iii) of subparagraph (A), or the amount of any such 
     award.
       (c) Limitation of Liability.--A license holder for a 
     covered product shall not be liable for any claim under 
     Federal, State, or local law arising out of the failure of an 
     eligible product developer to follow adequate safeguards to 
     assure safe use of the covered product during development or 
     testing activities described in this section, including 
     transportation, handling, use, or disposal of the covered 
     product by the eligible product developer.
       (d) No Violation of REMS.--The provision of samples of a 
     drug pursuant to an authorization under subsection (b)(2)(B) 
     shall not be considered a violation of the requirements of 
     any risk evaluation and mitigation strategy that may be in 
     place under section 505-1 of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355-1) for such drug.
       (e) Rule of Construction.--
       (1) Definition.--In this subsection, the term ``antitrust 
     laws''--
       (A) has the meaning given the term in subsection (a) of the 
     first section of the Clayton Act (15 U.S.C. 12); and
       (B) includes section 5 of the Federal Trade Commission Act 
     (15 U.S.C. 45) to the extent that such section applies to 
     unfair methods of competition.
       (2) Antitrust laws.--Nothing in this section shall be 
     construed to limit the operation of any provision of the 
     antitrust laws.

     SEC. 305. REMS APPROVAL PROCESS FOR SUBSEQUENT FILERS.

       Section 505-1 of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355-1) is amended--
       (1) in subsection (g)(4)(B)--
       (A) in clause (i) by striking ``or'' after the semicolon;
       (B) in clause (ii) by striking the period at the end and 
     inserting ``; or''; and
       (C) by adding at the end the following:
       ``(iii) accommodate different, comparable approved risk 
     evaluation and mitigation strategies for a drug that is the 
     subject of an abbreviated new drug application, and its 
     reference drug product.'';
       (2) in subsection (i)(1), by striking subparagraph (B) and 
     inserting the following:
       ``(B) Elements to assure safe use, if required under 
     subsection (f) for the listed drug.
       ``(i) Subject to clause (ii), a drug that is the subject of 
     an abbreviated new drug application may use--

       ``(I) a single, shared system with the listed drug under 
     subsection (f); or
       ``(II) a different, comparable aspect of the elements to 
     assure safe use under subsection (f).

       ``(ii) The Secretary may require a drug that is the subject 
     of an abbreviated new drug application and the listed drug to 
     use a single, shared system under subsection (f), if the 
     Secretary determines that no different, comparable aspect of 
     the elements to assure safe use could satisfy the 
     requirements of subsection (f).''; and
       (3) by adding at the end the following:
       ``(l) Separate REMS.--When used in this section, the terms 
     ``different, comparable aspect of the elements to assure safe 
     use'' or ``different, comparable approved risk evaluation and 
     mitigation strategies'' means a risk

[[Page H5570]]

     evaluation and mitigation strategy for a drug that is the 
     subject of an application under section 505(j) that uses 
     different methods or operational means than the strategy 
     required under subsection (a) for the applicable reference 
     drug, or other application under section 505(j) with the same 
     such reference listed drug, but achieves the same level of 
     safety as such strategy.''.

     SEC. 306. FUNDING FOR OPIOID GRANT PROGRAM FOR STATE RESPONSE 
                   TO OPIOID ABUSE CRISIS.

       Section 1003(c) of the 21st Century Cures Act (42 U.S.C. 
     290ee-3 note) is amended by adding at the end the following 
     new paragraph:
       ``(3) For purposes of carrying out this subsection, there 
     is appropriated, out of any funds in the Treasury not 
     otherwise appropriated, $995,000,000 for each of fiscal years 
     2019 through 2021.''.
       Page 98, strike line 20 and all that follows through page 
     99, line 9.

  Mr. TONKO (during the reading). Mr. Speaker, I ask unanimous consent 
to dispense with the reading.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New York?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
York is recognized for 5 minutes in support of his motion.
  Mr. TONKO. Mr. Speaker, this is the final amendment to the bill, 
which will not kill the bill or send it back to committee. If adopted, 
the bill will immediately proceed to final passage, as amended.
  For more than a year and a half, Republicans in the House have been 
engaged in an all-out ideological assault to weaken healthcare for 
Americans by working to repeal the Affordable Care Act and gutting 
protections for preexisting conditions. Republicans have repeatedly 
voted to strip Medicaid coverage for millions struggling with 
addiction. Thanks to Republican policies, we are seeing this uninsured 
rate rise sharply for the first time in years.
  This attack on our healthcare has had serious consequences for our 
ability to adequately address the needs of those struggling with the 
opioid epidemic. I remind my friends that we can't have it both ways: 
We either are for fighting this epidemic every way we can, or we are 
not.
  I have seen the carnage this epidemic can produce in my own backyard, 
where my hometown of Amsterdam, New York, with a population of a little 
over 18,000 people, saw four overdose deaths and a dozen close calls 
within a single month.
  We know that, as of today, less than 20 percent of Americans who need 
substance abuse treatment are able to receive it. We need to move 
toward a system of treatment on demand so that, when an individual has 
that moment of clarity, we are ready with a helping hand to pull them 
away from the deadly grip of addiction.
  While I am pleased that the bill before us will make some incremental 
progress in our fight against the opioid epidemic and is the product of 
a significant amount of bipartisan work, every single Member of this 
Chamber knows that we can and we should be doing more. This motion to 
recommit is our chance to do just that and to make additional progress 
in this fight.
  First, the motion would invest in our addiction workforce by 
incorporating a proposal advanced by Representatives Crowley and 
Costello to add 500 new resident physician slots to hospitals that have 
developed or are developing training programs in addiction medicine, 
addiction psychiatry, or pain medicine. We all have seen firsthand the 
need for more addiction specialists out there, and we have a chance to 
take action on that right now.
  Secondly, this motion would allot an additional $1 billion annually 
to States through 2021 so that we can continue to invest in locally 
designed prevention, treatment, and recovery solutions. It is clearly 
going to take more than 2 years to battle the epidemic, and we need to 
let providers in States know that we are making sustained, meaningful 
investments in this area.
  Finally, our motion to recommit includes a commonsense prescription 
drug policy which will reduce prescription drug prices for all 
Americans by reducing gaming by drug manufacturers to prevent generics 
from coming to market.
  The CREATES Act, introduced by Representatives Marino and Cicilline, 
is estimated to save the Federal Government some $3.8 billion and 
patients far more. This legislation has been passed by the Senate 
Judiciary Committee on a bipartisan basis, but we have been denied a 
vote on the House floor to consider this practical, positive policy to 
halt pharma gaming and mischief.
  Each of the policies contained in this package is bipartisan, fully 
paid for, and would bolster our ability to respond to the crisis. We 
have the opportunity to provide a more robust response for the American 
people and to save the lives of countless of our friends and neighbors 
all across this country who could be the next to fall victim to this 
deadly disease of addiction.
  Every day, every week, every month, every year that passes, the 
challenge rests in our collective laps: Will we do more?
  We need to do more. Let's do it for those families living with the 
pain and loss. Let's do it for those individuals who struggle with the 
illness of addiction. Let's be the light, the candle that brightens 
their darkness. Let's go forward with the recovery that is inspired by 
this legislation.
  Mr. Speaker, I urge all of my colleagues on both sides of the aisle 
to support this motion to recommit, and I yield back the balance of my 
time.
  Mr. WALDEN. Mr. Speaker, I claim the time in opposition to the 
motion.
  The SPEAKER pro tempore. The gentleman from Oregon is recognized for 
5 minutes.
  Mr. WALDEN. Mr. Speaker, like a lot of our work here that has been 
bipartisan, we would hope, going forward, this, too, could become 
bipartisan, because we believe that getting prescription drug prices 
down is essential. The Trump administration believes that as well and 
is doing some things administratively. We are going to be working on 
this in the committee.
  We also agree that this unmet workforce need is important as well. 
Over the course of five hearings, a full markup in subcommittee, two 
full markups in the full committee, this issue was never fully brought 
and vetted. There is more work to be done here, and we are committed to 
doing work on both the CREATES Act and on the Opioid Workforce Act.
  As the gentleman from New York, my friend, knows, we have worked out 
our differences on many, many issues on this and other topics, and we 
intend to move forward. It is just that the agreement we have today, 
Mr. Speaker, is about all of us coming together with bills that were 
ready for prime time that would not somehow cause problems with the 
underlying document.
  This proposal, while well-intended and, frankly, on the big scope of 
things makes a lot of sense, it is just not ready and agreed to yet. 
The gentleman knows that. We know that. We appreciate his passion on 
this issue. We share it. But I have to reluctantly oppose the motion to 
recommit because we have agreement that only issues we all agree on are 
going into this bill--that is, Republicans and Democrats at the top of 
both committees.
  So I take the signal that he remains committed to this effort to fill 
the gap. We will work with him and others going forward because we have 
a lot more work to do, Mr. Speaker. This one is just not ready for 
prime time.
  Mr. Speaker, I urge opposition to the motion to recommit, and I yield 
back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. TONKO. Mr. Speaker, on that, I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule 
XX, this 15-minute vote on the motion to recommit will be followed by 
5-minute votes on passage of the bill, if ordered, and agreeing to the 
Speaker's approval of the Journal, if ordered.
  The vote was taken by electronic device, and there were--yeas 185, 
nays 226, not voting 16, as follows:

                             [Roll No. 287]

                               YEAS--185

     Adams
     Aguilar
     Barragan
     Bass
     Beatty
     Bera

[[Page H5571]]


     Beyer
     Bishop (GA)
     Blum
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brady (PA)
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Capuano
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Crist
     Cuellar
     Cummings
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     DeLauro
     DelBene
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Engel
     Eshoo
     Espaillat
     Esty (CT)
     Evans
     Foster
     Frankel (FL)
     Fudge
     Gabbard
     Gallego
     Garamendi
     Gomez
     Gonzalez (TX)
     Gottheimer
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hastings
     Heck
     Higgins (NY)
     Himes
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     Krishnamoorthi
     Kuster (NH)
     Lamb
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     Maloney, Carolyn B.
     Maloney, Sean
     Matsui
     McCollum
     McEachin
     McGovern
     McNerney
     Meeks
     Moore
     Moulton
     Murphy (FL)
     Nadler
     Napolitano
     Neal
     Nolan
     Norcross
     O'Halleran
     O'Rourke
     Pallone
     Panetta
     Pascrell
     Pelosi
     Perlmutter
     Peters
     Peterson
     Pingree
     Pocan
     Polis
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Rosen
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez
     Sarbanes
     Schakowsky
     Schiff
     Schneider
     Schrader
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Sinema
     Sires
     Smith (WA)
     Soto
     Speier
     Suozzi
     Swalwell (CA)
     Takano
     Thompson (CA)
     Thompson (MS)
     Tonko
     Torres
     Tsongas
     Vargas
     Vela
     Velazquez
     Visclosky
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Welch
     Wilson (FL)
     Yarmuth

                               NAYS--226

     Abraham
     Aderholt
     Allen
     Amash
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barton
     Bergman
     Biggs
     Bilirakis
     Bishop (MI)
     Bishop (UT)
     Blackburn
     Bost
     Brady (TX)
     Brat
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Coffman
     Cole
     Collins (NY)
     Comer
     Comstock
     Conaway
     Cook
     Costello (PA)
     Cramer
     Crawford
     Culberson
     Curbelo (FL)
     Curtis
     Davidson
     Davis, Rodney
     Denham
     DeSantis
     DesJarlais
     Diaz-Balart
     Donovan
     Duffy
     Duncan (SC)
     Duncan (TN)
     Dunn
     Emmer
     Estes (KS)
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx
     Frelinghuysen
     Gaetz
     Gallagher
     Garrett
     Gianforte
     Gibbs
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Griffith
     Grothman
     Guthrie
     Handel
     Harper
     Harris
     Hartzler
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Hill
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jenkins (KS)
     Jenkins (WV)
     Johnson (LA)
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Joyce (OH)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Kustoff (TN)
     Labrador
     LaHood
     LaMalfa
     Lamborn
     Lance
     Latta
     Lesko
     Lewis (MN)
     LoBiondo
     Long
     Loudermilk
     Love
     Lucas
     Luetkemeyer
     MacArthur
     Marino
     Marshall
     Massie
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     McMorris Rodgers
     McSally
     Meadows
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Newhouse
     Norman
     Nunes
     Olson
     Palazzo
     Palmer
     Paulsen
     Pearce
     Perry
     Pittenger
     Poe (TX)
     Poliquin
     Posey
     Ratcliffe
     Reichert
     Renacci
     Rice (SC)
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rooney, Francis
     Ros-Lehtinen
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Russell
     Rutherford
     Sanford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smucker
     Stefanik
     Stewart
     Stivers
     Taylor
     Tenney
     Thompson (PA)
     Thornberry
     Tipton
     Trott
     Turner
     Upton
     Valadao
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yoder
     Yoho
     Young (AK)
     Young (IA)
     Zeldin

                             NOT VOTING--16

     Black
     Collins (GA)
     Crowley
     Delaney
     Ellison
     Hanabusa
     Marchant
     Meng
     Noem
     Payne
     Reed
     Rokita
     Rooney, Thomas J.
     Titus
     Veasey
     Walz

                              {time}  1152

  Messrs. DAVIDSON, RUTHERFORD, ROYCE of California, YOUNG of Iowa, 
BISHOP of Michigan, McHENRY, BISHOP of Utah, HOLLINGSWORTH, and COLE 
changed their vote from ``yea'' to ``nay.''
  Ms. SANCHEZ changed her vote from ``nay'' to ``yea.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. WALDEN. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.
  The vote was taken by electronic device, and there were--yeas 396, 
nays 14, not voting 17, as follows:

                             [Roll No. 288]

                               YEAS--396

     Abraham
     Adams
     Aderholt
     Aguilar
     Allen
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barragan
     Barton
     Bass
     Beatty
     Bera
     Bergman
     Beyer
     Bilirakis
     Bishop (GA)
     Bishop (MI)
     Bishop (UT)
     Blackburn
     Blum
     Blumenauer
     Blunt Rochester
     Bonamici
     Bost
     Boyle, Brendan F.
     Brady (PA)
     Brady (TX)
     Brat
     Brooks (IN)
     Brown (MD)
     Brownley (CA)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Bustos
     Butterfield
     Byrne
     Calvert
     Capuano
     Carbajal
     Cardenas
     Carson (IN)
     Carter (GA)
     Carter (TX)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chabot
     Cheney
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Coffman
     Cohen
     Cole
     Collins (NY)
     Comer
     Comstock
     Conaway
     Connolly
     Cook
     Cooper
     Correa
     Costa
     Costello (PA)
     Courtney
     Cramer
     Crawford
     Crist
     Cuellar
     Culberson
     Cummings
     Curbelo (FL)
     Curtis
     Davidson
     Davis (CA)
     Davis, Danny
     Davis, Rodney
     DeFazio
     DeGette
     DeLauro
     DelBene
     Demings
     Denham
     DeSantis
     DeSaulnier
     DesJarlais
     Deutch
     Diaz-Balart
     Dingell
     Doggett
     Donovan
     Doyle, Michael F.
     Duffy
     Duncan (SC)
     Duncan (TN)
     Dunn
     Emmer
     Engel
     Eshoo
     Espaillat
     Estes (KS)
     Esty (CT)
     Evans
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foster
     Foxx
     Frankel (FL)
     Frelinghuysen
     Fudge
     Gabbard
     Gallagher
     Gallego
     Garamendi
     Gianforte
     Gibbs
     Gomez
     Goodlatte
     Gottheimer
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Green, Al
     Green, Gene
     Griffith
     Grijalva
     Grothman
     Guthrie
     Gutierrez
     Handel
     Harper
     Harris
     Hartzler
     Hastings
     Heck
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Higgins (NY)
     Hill
     Himes
     Holding
     Hollingsworth
     Hoyer
     Hudson
     Huffman
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jackson Lee
     Jayapal
     Jeffries
     Jenkins (KS)
     Jenkins (WV)
     Johnson (GA)
     Johnson (LA)
     Johnson (OH)
     Johnson, E. B.
     Johnson, Sam
     Jordan
     Joyce (OH)
     Kaptur
     Katko
     Keating
     Kelly (IL)
     Kelly (MS)
     Kelly (PA)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Krishnamoorthi
     Kuster (NH)
     Kustoff (TN)
     LaHood
     LaMalfa
     Lamb
     Lamborn
     Lance
     Langevin
     Larsen (WA)
     Larson (CT)
     Latta
     Lawrence
     Lawson (FL)
     Lee
     Lesko
     Levin
     Lewis (GA)
     Lewis (MN)
     Lieu, Ted
     Lipinski
     LoBiondo
     Loebsack
     Lofgren
     Long
     Love
     Lowenthal
     Lowey
     Lucas
     Luetkemeyer
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     MacArthur
     Maloney, Carolyn B.
     Maloney, Sean
     Marino
     Marshall
     Mast
     Matsui
     McCarthy
     McCaul
     McCollum
     McEachin
     McGovern
     McHenry
     McKinley
     McMorris Rodgers
     McNerney
     McSally
     Meadows
     Meeks
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Moore
     Moulton
     Mullin
     Murphy (FL)
     Nadler
     Napolitano
     Neal
     Newhouse
     Nolan
     Norcross
     Norman
     Nunes
     O'Halleran
     Olson
     Palazzo
     Pallone
     Palmer
     Panetta
     Pascrell
     Paulsen
     Pearce
     Pelosi
     Perlmutter
     Perry
     Peters
     Peterson
     Pingree
     Pittenger
     Pocan
     Poe (TX)
     Poliquin
     Polis
     Posey
     Price (NC)
     Quigley
     Raskin
     Ratcliffe
     Reichert
     Renacci
     Rice (NY)
     Rice (SC)
     Richmond
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rooney, Francis
     Ros-Lehtinen
     Rosen
     Roskam
     Ross
     Rothfus
     Rouzer
     Roybal-Allard
     Royce (CA)
     Ruiz
     Ruppersberger
     Rush
     Russell
     Rutherford
     Ryan (OH)
     Sanchez
     Sarbanes
     Scalise
     Schakowsky
     Schiff
     Schneider
     Schrader
     Schweikert
     Scott (VA)
     Scott, Austin
     Scott, David
     Sensenbrenner

[[Page H5572]]


     Serrano
     Sessions
     Sewell (AL)
     Shea-Porter
     Sherman
     Shimkus
     Shuster
     Simpson
     Sinema
     Sires
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smith (WA)
     Smucker
     Soto
     Speier
     Stefanik
     Stewart
     Stivers
     Suozzi
     Swalwell (CA)
     Takano
     Taylor
     Tenney
     Thompson (CA)
     Thompson (MS)
     Thompson (PA)
     Thornberry
     Tipton
     Tonko
     Torres
     Trott
     Tsongas
     Turner
     Upton
     Valadao
     Vargas
     Vela
     Velazquez
     Visclosky
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Weber (TX)
     Webster (FL)
     Welch
     Wenstrup
     Westerman
     Williams
     Wilson (FL)
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yarmuth
     Yoder
     Yoho
     Young (AK)
     Young (IA)
     Zeldin

                                NAYS--14

     Amash
     Biggs
     Brooks (AL)
     Gaetz
     Garrett
     Gohmert
     Gonzalez (TX)
     Gosar
     Jones
     Labrador
     Loudermilk
     Massie
     McClintock
     Sanford

                             NOT VOTING--17

     Black
     Collins (GA)
     Crowley
     Delaney
     Ellison
     Hanabusa
     Marchant
     Meng
     Noem
     O'Rourke
     Payne
     Reed
     Rokita
     Rooney, Thomas J.
     Titus
     Veasey
     Walz

                              {time}  1201

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________