[Congressional Record (Bound Edition), Volume 162 (2016), Part 4]
[House]
[Pages 5672-5686]
[From the U.S. Government Publishing Office, www.gpo.gov]




  ESTABLISHING PAIN MANAGEMENT BEST PRACTICES INTER-AGENCY TASK FORCE


                             General Leave

  Mrs. BROOKS of Indiana. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days to revise and extend their remarks 
and to include extraneous material on the bill, H.R. 4641.
  The SPEAKER pro tempore (Mr. Rodney Davis of Illinois). Is there 
objection to the request of the gentlewoman from Indiana?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to House Resolution 720 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the consideration of the bill, H.R. 4641.
  The Chair appoints the gentleman from Texas (Mr. Poe) to preside over 
the Committee of the Whole.

[[Page 5673]]



                              {time}  1340


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the consideration of the bill 
(H.R. 4641) to provide for the establishment of an inter-agency task 
force to review, modify, and update best practices for pain management 
and prescribing pain medication, and for other purposes, with Mr. Poe 
of Texas in the chair.
  The Clerk read the title of the bill.
  The CHAIR. Pursuant to the rule, the bill is considered read the 
first time.
  The gentlewoman from Indiana (Mrs. Brooks) and the gentleman from New 
Jersey (Mr. Pallone) each will control 30 minutes.
  The Chair recognizes the gentlewoman from Indiana.
  Mrs. BROOKS of Indiana. Mr. Chairman, I yield myself such time as I 
may consume.
  Mr. Chairman, this week we have and will continue to hear harrowing 
and personal stories on the House floor about how opioid addiction is 
devastating local communities and families across the country. Just 
last night, my colleagues shared some of their stories. The gentleman 
from Pennsylvania (Mr. Meehan) shared a story about a promising 
collegiate athlete whose star was extinguished when a minor injury led 
to an addiction and his eventual overdose and death. Ms. Kuster from 
New Hampshire told of a constituent named Amber who tragically died of 
an overdose after a treatment bed was unavailable for her after leaving 
incarceration.
  We are going to hear many more stories today about this epidemic that 
has touched every community in every State of our country, an epidemic 
that has exploded in recent years to the point where every 12 minutes 
someone is dying of a drug overdose in this country. By the end of this 
debate, there may be over five people who have died of an overdose.
  The Energy and Commerce Committee has meticulously investigated this 
epidemic over the past year with multiple hearings and expert 
witnesses. The result is a thoughtful package of solutions focused on 
prevention and treatment that will help those facing addictions and 
their families deal with this opioid and, subsequently, heroin crisis. 
The statistics couldn't be more stark.
  The United States only represents 5 percent of the world's 
population, yet we consume 80 percent of the world's pain medication. 
Yet 80 percent of heroin users started with a prescription to legal 
pain medication. Nearly 260 million opioid prescriptions were written 
in the United States in 2012, outpacing the number of American adults 
by 20 million.
  As we debate this crisis, this is not just about statistics, because 
we are actually talking about husbands, wives, brothers, sisters, 
parents, and, sadly, our children. A parent who has inspired me is a 
woman named Justin Phillips from Indianapolis, a Hoosier mom who lost 
her son, Aaron, to a heroin overdose at the age of 20.
  Out of her heartbreak, she found a calling to keep local and national 
attention on the issue of heroin and opioid abuse, she said, ``until 
the dying stops.'' She became a leading voice for families facing 
addiction in Indiana, and she founded Overdose Lifeline, a nonprofit 
organization devoted to purchasing those lifesaving drugs, those 
reversal drugs, for Hoosier first responders. But she didn't stop 
there.
  She helped pass a bill at our statehouse, called Aaron's Law, to 
provide access to overdose reversal drugs for others beyond first 
responders. Justin is just like so many other moms and dads. She needs 
our help to prevent more kids like Aaron from being lost to heroin and 
opioid abuse.
  Her story made me realize that solving this public health crisis, 
this epidemic, must be a top priority for Congress and for the Federal 
Government, and inspired me to work with my colleague from across the 
aisle, Congressman Kennedy of Massachusetts, to lead these efforts in 
the House to combat the heroin opioid crisis.
  This week we are taking up a series of bills that are going to make a 
real difference--we hope. They must make a real difference in turning 
back this scourge.

                              {time}  1345

  Now, I have cited the number of opioid prescriptions written in 2012, 
which outpaces the number of American adults. But the fact is that our 
prescribers--our doctors, our nurse practitioners, our dentists, and 
others--are often unaware that, in many cases, their efforts to 
properly treat their patients' pain can inadvertently create longer 
term addiction issues.
  While there are certainly legitimate medical needs for pain 
medication opioids, many prescribers are unaware that, in many cases, 
their efforts to properly treat their patients' pain can inadvertently 
create these long-term addiction issues.
  In an effort to address this, the CDC recently developed guidelines 
for prescribing opioids for chronic pain. In order to improve the way 
opioids are prescribed to patients with severe and chronic pain, these 
guidelines seek to reduce their overuse and their abuse.
  H.R. 4641, which I introduced with Representative Kennedy, would 
ensure that the CDC's opioid prescribing guidelines are reviewed, 
modified, and updated where needed by an interagency task force and 
expert stakeholders from the prescriber community, the patient 
community, the addiction community, and the recovery community to 
reflect best practices going forward.
  The task force will be comprised of representatives from the Federal 
relevant agencies as well as those who deal with this problem day in 
and day out: physicians, dentists, pharmacists, hospitals, overdose 
reversal specialists, and pain and addiction researchers.
  This task force will also include representatives from State medical 
boards, pain advocacy groups, medical professional associations, mental 
health and addiction treatment communities.
  The scope and breadth of this group will ensure that the practices 
are thoughtfully reviewed, modified, and updated. They will take into 
account the different types of opioids, opioids within and between 
different classes, the availability of deterrent technology as well as 
nonpharmacological and medical device alternatives to opioids. It is 
important that the task force consider the broadest scope of pain 
management options.
  It is also important that this isn't just going to be another 
bureaucratic report that is compiled and sits on a shelf that is 
reviewed by congressional researchers and congressional staff. They 
must report out to Congress, lay out best practices, and provide a 
strategy for disseminating these best practices for pain management and 
recommendations at medical facilities.
  We have to do more in this country. Failure to address a major part 
of this epidemic from the outset will perpetuate the cycle of addiction 
in our communities. This is but one important step. There are many, 
many bills that the House is considering.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
  I rise in support of H.R. 4641, a bill to create an interagency task 
force on pain management. This legislation passed the committee with 
unanimous support.
  In 2014, pharmacies in the United States dispensed approximately 245 
million prescriptions for opioids. This is enough to provide a script 
to every adult in our entire Nation.
  At the same time, we know that over 5 million Americans use 
prescription pain relievers either recreationally or to satisfy an 
opioid addiction.
  This combination has produced tragic results. 2014 produced the 
highest number of drug overdose deaths than any previous year on 
record, with opioids and heroin driving the recent surge.
  Unfortunately, our Nation's doctors and healthcare providers have not 
been provided the tools and education necessary to safely prescribe 
these medications in the midst of an opioid epidemic.
  Recently, an article in the New England Journal of Medicine examined 
this

[[Page 5674]]

topic and found that ``many physicians admit that they are not 
confident about how to prescribe opioids safely, how to detect abuse or 
emerging addiction, or even how to discuss these issues with their 
patients.''
  As a result, we have created a patchwork of prescribing practices 
with tremendous variation both geographically as well as even within 
the same field.
  This bill would create an interagency task force on pain management 
to review, modify, and update best practices on management and 
development of a strategy to disseminate those best practices to 
prescribers, pharmacists, and other stakeholders.
  Those best practices will increase the tools available to providers 
who prescribe opioids more safely and be able to detect and intervene 
earlier in instances of substance use disorders.
  I urge my colleagues to support this important legislation, which is 
part of the opioid epidemic package that we are moving on the floor 
today on suspension.
  Mr. Chairman, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I yield 3 minutes to the 
gentleman from Michigan (Mr. Upton), our chairman.
  Mr. UPTON. Mr. Chairman, every 12 minutes someone in the U.S. dies of 
a drug overdose. Abuse of prescription painkillers and heroin has 
impacted every single community. It is an epidemic. It doesn't have 
boundaries and doesn't discriminate.
  We have lost a lot of good kids and a lot of good people in my State 
and every State. As I travel back and forth to Michigan virtually every 
week, I meet a family member who has lost somebody with this very 
tragic story.
  This last week it was a mother and a wife of a fellow who had 
committed suicide in Mattawan, Michigan. It breaks your heart.
  Yes, we know the numbers. They are staggering. The CDC reports that 
nearly 260 million opioid prescriptions were written in 2012. That is 
one for every single U.S. adult, as my friend Mr. Pallone said, with 
another 20 million to spare.
  A recent study from the Kaiser Family Foundation found that one in 
five Americans say they have a family member who has been addicted to 
prescription painkillers.
  The epidemic is unique to the U.S., as Americans consume 80 percent 
of the world's opioid prescriptions. It is not unique. It is a 
frightening reality, but we have to face the epidemic head-on. That is 
why today is an important step.
  In the Energy and Commerce Committee, we have held a number of 
hearings over the last year with testimony from so many experts on the 
front lines. What we learned is eye-opening.
  Federal policies toward opioid addiction in the past year have often 
overemphasized a one-size-fits-all law enforcement approach. It is 
clear through our listening sessions that it is a public health crisis 
and that our strategy should reflect the complex dynamic between public 
health and criminal activity. We know that we cannot simply incarcerate 
our way out of this epidemic.
  The bills that we are considering today touch on a spectrum of issues 
driving the opioid crisis. While there is no one solution, these bills 
represent good steps in addressing a problem that has rapidly grown.
  I want to thank all of my colleagues on the Energy and Commerce 
Committee and off for working to adhere in a bipartisan way these 
important bills that will really make a difference in every one of our 
communities.
  The House leadership deserves recognition on both sides for their 
swift consideration of these bills. I want to thank, in particular, my 
good friend, Mr. Pallone, for working with us to get these bills across 
the finish line, through the committee process, and now on the floor.
  Our work is going to continue. We owe this effort to the past, 
present, and, sadly, future victims of this epidemic: our neighbors, 
friends, and families across every part of the country, every 
demographic group. We owe it to the families and we owe it to the 
communities who are suffering from this addiction.
  Mr. PALLONE. Mr. Chairman, I yield such time as he may consume to the 
gentleman from Massachusetts (Mr. Kennedy), who is the Democratic 
sponsor of this bill and has worked a lot on the opioid epidemic 
problem.
  Mr. KENNEDY. Mr. Chairman, I want to thank Mr. Pallone for yielding, 
for his leadership on this issue throughout his time on Energy and 
Commerce, particularly over the last several months since I have been 
on the committee trying to galvanize support from all of our colleagues 
to recognize the impact that this is having every single day.
  Mr. Chairman, I want to thank you for including H.R. 4641 in this 
package of bipartisan opioid-related bills.
  None of our districts has been spared the heartbreaking headlines 
about lives lost to the opioid crisis. We have heard from each of our 
constituents who have attended funerals for friends, neighbors, 
classmates, colleagues, and family members. The bills we are 
considering this week are a promising step forward as we find ways to 
respond to this crisis.
  To my colleague, Congresswoman Brooks, thank you for your partnership 
on this issue and on so many others. We have both seen firsthand how 
lack of access to treatment can lead those suffering from addiction to 
our courts. With this bill, we are trying to change the course of their 
path to stop addiction before it even begins.
  Mr. Chairman, last week the Boston Globe wrote a series of articles 
about the opioid crisis in my home State of Massachusetts. The 
statistics are devastating. Nationally, heroin overdose rates have 
tripled in the last 5 years. At home, our State faces a heroin overdose 
rate that is twice the national average.
  Last year alone, nearly 1,400 Massachusetts families lost loved ones 
to opioid overdoses. Between 2013 and 2014, prescription opioid 
overdoses nearly doubled. During that same time, the number of people 
in Massachusetts who overdosed on a combination of heroin and 
prescription opioids rose by almost 500 percent.
  The Globe also noted that there has been a noticeable shift from 
opioids to heroin with one exception, Bristol County, where many of my 
constituents live. In trying to explain that exception, the reporter 
included a haunting line that has stayed with me ever since.
  He wrote that, in Bristol County, ``prescription opioids remain a 
dominant killer, though it's not clear whether that's because this area 
is somehow less susceptible to heroin or if it's merely a matter of 
time.''
  Mr. Chairman, we cannot accept a reality with a rise in heroin 
overdoses as ``merely a matter of time.'' We have all said it over 100 
times. When it comes to a Federal response, there is no silver bullet.
  But H.R. 4641 tries to focus on what I believe offers us one of the 
very best opportunities for combating this problem: stopping addiction 
before it ever starts.
  The bill will create a new task force dedicated to the job of 
reviewing, modifying, and updating best practices for the management of 
pain and the prescription of pain medication.
  Voices from HHS, the VA, FDA, DEA, NIH, and other agencies will join 
prescribers, substance use disorder professionals, patients suffering 
from chronic pain, and patients who have lived through the 
heartbreaking reality of becoming addicted to prescription pills.
  These advocates and experts are on the front lines of this fight 
every single day. Under their guidance, this task force will ensure we 
implement the policies that balance responsible pain management with 
the urgency that our opioid crisis requires.
  Again, I am encouraged by the bipartisan progress we are making on 
this issue; yet, our work is just beginning.
  I urge my colleagues to support this bill and look forward to working 
with each of them to build on this momentum.
  Mrs. BROOKS of Indiana. Mr. Chairman, I yield 3 minutes to the 
gentleman from Oregon (Mr. Walden).
  Mr. WALDEN. Mr. Chairman, I think, as you can see, Members on both 
sides of the aisle know of people in our districts, our States, and 
across our

[[Page 5675]]

country that have been tragically affected by opioid abuse and 
overdose.
  I want to thank my colleagues on both sides of the aisle for their 
work on this legislation, especially my friend from Indiana, Mrs. 
Brooks.
  I rise in strong support of H.R. 4641. This is a very important 
bipartisan step forward to combat opioid abuse. This issue hits close 
to home, all of our homes.
  The State of Oregon ranked near the top or at the top for nonmedical 
use of prescription pain relievers in the Nation. With opioid 
prescriptions serving as a gateway to heroin, it is no surprise that 
deaths from drug overdoses have surpassed those of car accidents in my 
State.
  Last week, in Medford, Bend, and Hermiston, I hosted roundtables with 
community leaders and affected families to talk about what they are 
seeing on the front lines.
  Physicians, first responders, members of law enforcement, and 
families all were there sharing their stories, talking about how 
important the work we are doing here today is to them and our 
communities. All of them are on the ground combating this problem every 
day. We had excellent discussions.
  H.R. 4641, in addition to the 17 other bipartisan bills we are voting 
on this week, will help combat this epidemic. This bill will help 
prevent lawful prescription use from spiraling into abuse by developing 
best practices for the treatment of pain.
  In Medford, I heard from a father who had seen the impacts of 
addiction on his own family. His sister, who was a nurse, died of an 
overdose after years of suffering from addiction and bouncing between 
pharmacies, passing off forged prescriptions.

                              {time}  1400

  He spoke about how better tracking and treatment could have helped 
catch his sister's problem earlier and, perhaps, made counseling more 
effective. As it was, she was only caught because two pharmacies in a 
small town happened to check with each other. You see, by then, it was 
too late.
  Today, this man is working to help his son with an addiction that 
started with a prescription for a high school sports injury that 
drifted into a heroin addiction. He spoke to the importance of 
counseling, support, and trying to avoid addiction through better 
prescribing practices.
  Echoing those sentiments, a therapist I spoke to in Hermiston 
experienced 10 years of addiction of opioids after she was prescribed 
painkillers for a broken foot. Then when she tried to overcome this 
addiction, she could not find any help. So she traveled more than 5 
hours, from Milton-Freewater, Oregon, to Marysville, Washington, 
because she could not find a physician in her region to prescribe 
Suboxone, an important medicine to help people break free from opioids.
  Addiction is an equal opportunities destroyer. It crosses all 
segments and regions of our country, and often the disease shows no 
symptoms.
  One emergency room physician relayed a story about a recent patient 
he had no reason to believe had an addiction problem until he saw in 
the database that the patient just received 60 pills the week before.
  Opioids are highly effective at providing relief and improving the 
quality of life for those in debilitating pain. But if we don't know 
how to appropriately prescribe them, it's no wonder we got to this 
place. We need to increase access to counseling, medication-assisted 
therapy and treatment for those battling addiction. Echoing what I 
heard from health practitioners across my district, opioid addiction is 
a biopsychosocial disease--it's as complicated as diabetes and requires 
a multi-pronged approach.
  That's why it is so important that we pass H.R. 4641 and all of these 
bills this week to give health providers, first responders, law 
enforcement, and those battling addiction the tools they need to 
overcome the epidemic of opioid abuse.
  Mr. PALLONE. Mr. Chairman, I yield 3 minutes to the gentlewoman from 
New Mexico (Ms. Michelle Lujan Grisham).
  Ms. MICHELLE LUJAN GRISHAM of New Mexico. I thank my colleague for 
yielding time.
  Mr. Chairman, opioid abuse has become, as we have heard today, a 
critical national issue as 78 Americans are killed by heroin and 
prescription drug overdoses each day, and drug overdoses are now the 
leading cause of injury-related deaths in the United States.
  The number of unintentional overdose deaths from prescription 
painkillers almost quadrupled between 1999 and 2013; but as bad as the 
opioid epidemic is across the country, it is much more severe in my 
home State of New Mexico, which has had one of the highest rates of 
overdose deaths in the country for several years. Unfortunately, it is 
getting worse. From 2013 to 2014, the death rate from drug overdoses in 
New Mexico increased 21 percent. Rio Arriba County, New Mexico, has the 
highest overdose death rate in the Nation--one in 500 people dies from 
overdose--which is about six times the national average.
  The over-prescription of opioids for pain management is part of the 
problem, and an increasing number of patients is becoming dependent on 
these powerfully addictive medications. In fact, 259 million opioid 
prescriptions were written in 2012--more than one for every adult in 
the United States. Once addicted to these prescription opioids, many 
then turn to heroin and to synthetic opioids due to their increased 
availability, lower prices, and higher purity.
  We must act to respond to this public health crisis, but we need to 
do it in a balanced way. We need to be mindful of the millions of 
Americans who suffer from chronic pain. We need to ensure that patients 
and providers continue to have access to the best, most medically 
appropriate course of treatment while cutting off access to those who 
abuse the system.
  This is why I strongly support H.R. 4641, which would establish an 
interagency task force to review and update medical best practices for 
pain management and prescribing pain medication; but we can't stop 
here. We have to do more than just study the problem, because only 11 
percent of Americans who need treatment for substance abuse are 
receiving it. Many of those who remain find themselves in our criminal 
justice system. Our prisons have become de facto treatment centers. 
More than 65 percent of our prison population has a substance abuse 
problem.
  We have to provide the funds necessary to fully invest in opioid 
prevention, rehabilitation, and treatment programs. We have to support 
the placement of substance abuse treatment providers in the communities 
that are most in need, like Rio Arriba County. We have to improve 
access to the overdose reversal drug, naloxone, which can help save 
countless lives every year.
  I urge my colleagues to support this legislation, which will address 
this disease that has destroyed the lives of so many.
  Mrs. BROOKS of Indiana. Mr. Chairman, I yield 1 minute to the 
gentleman from Florida (Mr. Bilirakis).
  Mr. BILIRAKIS. Mr. Chairman, I rise in support of H.R. 4641.
  Prescription drug abuse, particularly with opioids, has become a 
national epidemic. It affects all of our communities. The bill before 
us today will authorize an important task force to determine and 
disseminate best practices for pain management.
  The need for best practice guidelines was highlighted last week 
during a substance abuse panel I hosted in my district with Office of 
National Drug Control Policy Director Botticelli. One woman shared her 
story of addiction and struggle to receive help following a surgery she 
had had as a 15-year-old gymnast. We must give people like her the 
tools they need for prevention and treatment in order to stop the 
spread of this epidemic.
  I thank the gentlewoman for sponsoring this bill. Please support this 
great bill.
  Mr. PALLONE. Mr. Chairman, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I yield 2 minutes to the 
gentleman from North Dakota (Mr. Cramer).
  Mr. CRAMER. I thank Mrs. Brooks for her leadership on this--Mr. 
Kennedy's as well--and for bringing this

[[Page 5676]]

important legislation to our committee and to the floor.
  Mr. Chairman, I rise to support H.R. 4641.
  With heroin addiction now being three times greater than it was a 
decade ago, we know it doesn't matter where you come from. Whether you 
are on an Indian reservation, on a farm, in the middle of a city, in a 
suburb, in a small town, or whether you are in a Fargo high school, at 
the University of North Dakota in Grand Forks, or at Bismarck State 
College, it doesn't matter what your lot is in life. It doesn't matter 
what your income level is. It doesn't matter what your social status 
is. This opioid abuse crisis affects people from all walks of life, and 
it is about time we acknowledged it and tried to deal with it at this 
level.
  This bill is pretty basic, but is pretty profound as well because it 
takes advantage of the collective opportunity of the collective 
talents, experiences, and backgrounds of the people on the ground who 
are dealing with it every day. It brings it all together and 
facilitates it at every level of government in every community and in 
every State whether it is North Dakota or Indiana or Massachusetts. It 
is the beginning, I believe, of a profound solution.
  Just as much as anything, I applaud the efforts of the leadership who 
brought this to us, and I grieve with so many parents as we have heard 
their stories. This year, in the Fargo, North Dakota, area alone, there 
have been a minimum of 10 fatal overdoses because of this crisis.
  I will stand shoulder to shoulder with anybody and everybody in this 
Chamber, as well as in the Chamber on the other side of the Capitol, to 
help solve this problem.
  Mr. PALLONE. Mr. Chairman, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I yield 2 minutes to the 
gentleman from Georgia (Mr. Carter).
  Mr. CARTER of Georgia. Mr. Chairman, I rise in support of H.R. 4641 
so we can continue to involve the practices of pain management and the 
prescribing of pain medication to fight the opioid abuse epidemic in 
this country.
  As a lifelong pharmacist, I have provided prescription medications to 
Americans for over 30 years. In that time, I have personally witnessed 
the struggles that both medical professionals and patients face with 
prescription drug abuse.
  There are many steps that must be taken to address this epidemic. One 
priority should be to involve practices related to pain management and 
the prescribing of pain medication. This bill does just that. This bill 
creates an interagency task force to continually review, modify, and 
update best practices for pain management and prescribing pain 
medication. Through the new task force, experts in fields related to 
prescription drug abuse and pain management will be able to involve 
best industry practices that will give clarity to our fight against 
this epidemic.
  I commend Representative Brooks and the Committee on Energy and 
Commerce for their work on this bill, and I encourage all of my 
colleagues to support this measure.
  Mr. PALLONE. Mr. Chairman, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I yield myself the balance of 
my time.
  I thank all of my colleagues. I thank particularly the leadership of 
the Committee on Energy and Commerce. There have also been other 
committees--the Judiciary Committee, the Committee on Education and the 
Workforce--that have been working on bills. This is not something that 
any one Member of this body has truly been a leader on. So many 
different Members have been leading on this because it has affected our 
communities, our families, our neighborhoods.
  I urge my colleagues to vote ``yes'' on this important bill because, 
as the gentleman from North Dakota said, the Federal Government has not 
done enough yet. This will be an opportunity for us to bring together 
all of the Federal agencies that are involved in this problem, which 
have been part of the problem, and try to change the way our 
prescribers throughout the country work on the pain management issues 
the country faces, which, hopefully, will yield a much lower overdose 
rate--a rate which now exceeds the motor traffic fatalities in this 
country and which is the leading cause of calls to our poison centers. 
More importantly, it has devastated so many parents and friends who 
have found their friends who have overdosed from either heroin or 
opioids.
  I am so pleased that we are finally beginning to recognize that we 
cannot arrest our way out of this problem. It is a disease. It is 
something that so many people cannot stop on their own. They need help. 
With all of these experts coming together on this task force to provide 
the best practices for the country, I hope we can turn the tide and 
save many lives.
  I urge the bill's passage by my colleagues.
  Mr. Chairman, I yield back the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
  I ask all of my colleagues to support this bill. As I said, this 
interagency task force is an important part of this larger opioid 
package that we produced in the Committee on Energy and Commerce on a 
bipartisan basis. I know the rest of those bills are going to come up 
on suspension--or most of them--this afternoon. I can't emphasize 
enough the importance of this package, as well as this bill, as being 
part of it.
  I yield back the balance of my time.
  The CHAIR. All time for general debate has expired.
  Pursuant to the rule, the bill shall be considered for amendment 
under the 5-minute rule.
  It shall be in order to consider as an original bill for the purpose 
of amendment under the 5-minute rule the amendment in the nature of a 
substitute, recommended by the Committee on Energy and Commerce, 
printed in the bill. The committee amendment in the nature of a 
substitute shall be considered as read.
  The text of the committee amendment in the nature of a substitute is 
as follows:

                               H.R. 4641

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. DEVELOPMENT OF BEST PRACTICES FOR THE USE OF 
                   PRESCRIPTION OPIOIDS.

       (a) Definitions.--In this section--
       (1) the term ``Secretary'' means the Secretary of Health 
     and Human Services; and
       (2) the term ``task force'' means the Pain Management Best 
     Practices Inter-Agency Task Force convened under subsection 
     (b).
       (b) Inter-Agency Task Force.--Not later than December 14, 
     2018, the Secretary, in cooperation with the Secretary of 
     Veterans Affairs, the Secretary of Defense, and the 
     Administrator of the Drug Enforcement Administration, shall 
     convene a Pain Management Best Practices Inter-Agency Task 
     Force to review, modify, and update, as appropriate, best 
     practices for pain management (including chronic and acute 
     pain) and prescribing pain medication.
       (c) Membership.--The task force shall be comprised of--
       (1) representatives of--
       (A) the Department of Health and Human Services;
       (B) the Department of Veterans Affairs;
       (C) the Food and Drug Administration;
       (D) the Department of Defense;
       (E) the Drug Enforcement Administration;
       (F) the Centers for Disease Control and Prevention;
       (G) the Health Resources and Services Administration;
       (H) the Indian Health Service;
       (I) the National Academy of Medicine;
       (J) the National Institutes of Health;
       (K) the Office of National Drug Control Policy; and
       (L) the Substance Abuse and Mental Health Services 
     Administration;
       (2) State medical boards;
       (3) physicians, dentists, and nonphysician prescribers;
       (4) hospitals;
       (5) pharmacists and pharmacies;
       (6) experts in the fields of pain research and addiction 
     research;
       (7) representatives of--
       (A) pain management professional organizations;
       (B) the mental health treatment community;
       (C) the addiction treatment and recovery community;
       (D) pain advocacy groups; and
       (E) groups with expertise on overdose reversal;
       (8) a person in recovery from addiction to medication for 
     chronic pain;
       (9) a person with chronic pain; and
       (10) other stakeholders, as the Secretary determines 
     appropriate.

[[Page 5677]]

       (d) Duties.--The task force shall--
       (1) not later than 180 days after the date on which the 
     task force is convened under subsection (b), review, modify, 
     and update, as appropriate, best practices for pain 
     management (including chronic and acute pain) and prescribing 
     pain medication, taking into consideration--
       (A) existing pain management research;
       (B) recommendations from relevant conferences and existing 
     relevant evidence-based guidelines;
       (C) ongoing efforts at the State and local levels and by 
     medical professional organizations to develop improved pain 
     management strategies, including consideration of differences 
     within and between classes of opioids, the availability of 
     opioids with abuse deterrent technology, and pharmacological, 
     nonpharmacological, and medical device alternatives to 
     opioids to reduce opioid monotherapy in appropriate cases;
       (D) the management of high-risk populations, other than 
     populations who suffer pain, who--
       (i) may use or be prescribed benzodiazepines, alcohol, and 
     diverted opioids; or
       (ii) receive opioids in the course of medical care; and
       (E) the 2016 Guideline for Prescribing Opioids for Chronic 
     Pain issued by the Centers for Disease Control and 
     Prevention;
       (2) solicit and take into consideration public comment on 
     the practices developed under paragraph (1), amending such 
     best practices if appropriate; and
       (3) develop a strategy for disseminating information about 
     the best practices developed under paragraphs (1) and (2) to 
     prescribers, pharmacists, State medical boards, educational 
     institutions that educate prescribers and pharmacists, and 
     other parties, as the Secretary determines appropriate.
       (e) Limitation.--The task force shall not have rulemaking 
     authority.
       (f) Report.--Not later than 270 days after the date on 
     which the task force is convened under subsection (b), the 
     task force shall submit to Congress a report that includes--
       (1) the strategy for disseminating best practices for pain 
     management (including chronic and acute pain) and prescribing 
     pain medication, as developed under subsection (d);
       (2) the results of a feasibility study on linking the best 
     practices described in paragraph (1) to receiving and 
     renewing registrations under section 303(f) of the Controlled 
     Substances Act (21 U.S.C. 823(f)); and
       (3) recommendations for effectively applying the best 
     practices described in paragraph (1) to improve prescribing 
     practices at medical facilities, including medical facilities 
     of the Veterans Health Administration and Indian Health 
     Service.

  The CHAIR. No amendment to the committee amendment in the nature of a 
substitute shall be in order except those printed in part A of House 
Report 114-551. Each such amendment may be offered only in the order 
printed in the report, by a Member designated in the report, shall be 
considered read, shall be debatable for the time specified in the 
report, equally divided and controlled by the proponent and an 
opponent, shall not be subject to amendment, and shall not be subject 
to a demand for division of the question.


         Amendment No. 1 Offered by Ms. Brownley of California

  The CHAIR. It is now in order to consider amendment No. 1 printed in 
part A of House Report 114-551.
  Ms. BROWNLEY of California. Mr. Chairman, I have an amendment at the 
desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 4, line 11, strike ``and''.
       Page 4, line 13, insert ``and'' after the semicolon.
       Page 4, after line 13, insert the following:
       (M) the Office of Women's Health;

  The CHAIR. Pursuant to House Resolution 720, the gentlewoman from 
California (Ms. Brownley) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from California.
  Ms. BROWNLEY of California. Mr. Chairman, I rise to offer a very 
straightforward amendment to H.R. 4641.
  The amendment would include the Office of Women's Health in the 
interagency task force created under the bill.
  As we all know, the underlying bill includes a list of Federal agency 
representatives to be included in the interagency task force, which 
will review, modify, and update best practices for pain management and 
prescribing pain medication.
  However, the bill does not currently include the Office of Women's 
Health. The Office of Women's Health, within the U.S. Department of 
Health and Human Services, was established in 1991 to improve the 
health of women by advancing and coordinating a comprehensive women's 
health agenda to address healthcare prevention and service delivery.
  The Office of Women's Health works with numerous government agencies, 
nonprofit organizations, consumer groups, and associations of 
healthcare professionals to coordinate and advance policies and 
programs that best meet the unique healthcare needs of women.
  


                              {time}  1415

  As a national leader in the health of women and girls, the Office of 
Women's Health has critical specialized expertise that will help the 
interagency pain management task force address the unique pain 
management needs of women who may be pregnant or who may be nursing.
  This expertise is desperately needed because opioid abuse among women 
has increased substantially in recent years. In fact, according to the 
Centers for Disease Control and Prevention, the number of women who 
fall victim to an opioid-related fatality increased an alarming 400 
percent from 1999 to 2010, totalling 48,000 women who have died during 
that span of time.
  During this decade, opioid abuse among women increased more than 
abuse of any other drug, including cocaine and heroin. Shockingly, the 
CDC reports that in 2010, 18 women per day died of a prescription 
painkiller overdose, accounting for nearly 7,000 women in total.
  It is critically important that we include experts on women's health 
in the opioid task force. Women who are pregnant or who may be nursing 
have specialized healthcare needs, and the Office of Women's Health is 
uniquely qualified to ensure that the interagency task force takes the 
needs of women and girls into account as it examines best practices for 
pain management in prescribing pain medication.
  I urge my colleagues to support this commonsense amendment.
  I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I claim the time in opposition, 
but I support the amendment.
  The CHAIR. Without objection, the gentlewoman from Indiana is 
recognized for 5 minutes.
  There was no objection.
  Mrs. BROOKS of Indiana. At this time, I thank the gentlewoman from 
California for the amendment. I think it strengthens the bill. I think 
it is very important that the Office of Women's Health is added to the 
task force. So many of us have had the opportunity to visit NICUs in 
hospitals and have seen drug-addicted babies. So I do believe that 
having the perspective of the Office of Women's Health would be 
critically important.
  So often women's health has not been given the proper attention that 
it deserves, and I would ask for support of the amendment.
  I yield back the balance of my time.
  Ms. BROWNLEY of California. Mr. Chairman, I yield 1 minute to the 
gentleman from New Jersey (Mr. Pallone).
  Mr. PALLONE. Mr. Chairman, I want to urge all my colleagues on this 
side of the aisle to support the bill as well.
  Ms. BROWNLEY of California. Mr. Chairman, I thank the gentleman from 
New Jersey and the gentlewoman from Indiana. I think we all realize the 
importance of ensuring that this interagency task force is effective 
and works, and I think the eyes on specific healthcare needs of women 
and girls is most important.
  I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the 
gentlewoman from California (Ms. Brownley).
  The amendment was agreed to.


           Amendment No. 2 Offered by Mrs. Brooks of Indiana

  The CHAIR. It is now in order to consider amendment No. 2 printed in 
part A of House Report 114-551.
  Mrs. BROOKS of Indiana. Mr. Chairman, as the designee of the 
gentleman from Georgia (Mr. Carter), I offer amendment No. 2.
  The CHAIR. The Clerk will designate the amendment.

[[Page 5678]]

  The text of the amendment is as follows:

       Page 4, line 15, strike ``physicians'' and insert ``subject 
     to subsection (d), physicians''.
       Page 4, line 18, strike ``pharmacists'' and insert 
     ``subject to subsection (d), pharmacists''.
       Page 5, after line 10, insert the following:
       (d) Condition on Participation on Task Force.--An 
     individual representing a profession or entity described in 
     paragraph (3) or (5) of subsection (c) may not serve as a 
     member of the task force unless such individual--
       (1) is currently licensed in a State in which such 
     individual is practicing (as defined by such State) such 
     profession (or, in the case of an individual representing an 
     entity, a State in which the entity is engaged in business); 
     and
       (2) is currently practicing (as defined by such State) such 
     profession (or, in the case of an individual representing an 
     entity, the entity is in operation).
       Page 5, line 11, strike ``(d)'' and insert ``(e)''.
       Page 7, line 1, strike ``(e)'' and insert ``(f)''.
       Page 7, line 3, strike ``(f)'' and insert ``(g)''.

  The CHAIR. Pursuant to House Resolution 720, the gentlewoman from 
Indiana (Mrs. Brooks) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentlewoman from Indiana.
  Mrs. BROOKS of Indiana. Mr. Chairman, this amendment simply would 
require that any of the individuals who are appointed to the task force 
under H.R. 4641, whether they be a physician, a dentist, a nonphysician 
prescriber, or pharmacist who is eventually appointed by the lead of 
Health and Human Services, that that individual shall be a licensed 
prescriber and practicing in their appropriate State or that they, at a 
minimum, should have an active license and that they should be a 
practicing prescriber in that State.
  I urge my colleagues to adopt this amendment.
  I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I claim the time in opposition, but I 
support the amendment.
  The CHAIR. Without objection, the gentleman from New Jersey is 
recognized for 5 minutes.
  There was no objection.
  Mr. PALLONE. Mr. Chairman, I urge my colleagues to support the 
amendment.
  I yield back the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I yield back the balance of my 
time.
  The CHAIR. The question is on the amendment offered by the 
gentlewoman from Indiana (Mrs. Brooks).
  The amendment was agreed to.


                 Amendment No. 3 Offered by Mr. Grayson

  The CHAIR. It is now in order to consider amendment No. 3 printed in 
part A of House Report 114-551.
  Mr. GRAYSON. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 4, after line 18, insert the following (and 
     redesignate the subsequent paragraphs accordingly):
       (6) first responders;

  The CHAIR. Pursuant to House Resolution 720, the gentleman from 
Florida (Mr. Grayson) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Florida.
  Mr. GRAYSON. Mr. Chairman, my amendment would ensure that first 
responders are included for membership on the Pain Management Best 
Practices Interagency Task Force. This is a commonsense amendment.
  First responders, like police officers and other emergency room 
staff, are the first on the scene when a person overdoses. And they are 
the first to administer emergency treatments and resuscitation 
programs. These are the people who have the first contact with victims 
of opioid overdose.
  It would make sense that if we are putting together a task force to 
address the terrible opioid problem--and specifically pain management 
best practices--we should include the views and opinions of those who 
are first on the scene and in the best position to save lives.
  Being first on the scene to overdose emergencies, first responders 
often interact with patients in pain. Yet, most first responders, 
especially EMS responders, have no pain management standards as part of 
their accreditation.
  The Commission on Accreditation of Ambulance Services does not 
include a pain management standard as part of its clinical assessment, 
nor is pain management a major part of EMS education. As a result, 
first responder attitudes vary. According to a 2012 Yale study, there 
is a widespread reluctance within the EMS community to administer 
opioids to those who legitimately need it out of a fear--perhaps 
unfounded--that patients could be addicts seeking drugs.
  First responders certainly do encounter people who are not 
prescription painkiller dependent. However, it is often not possible 
for paramedics to know with certainty if a patient is an addict or even 
whether the addict is also experiencing legitimate pain.
  This level of uncertainty and varying degrees of attitudes within the 
first responder community, along with the unique experience and insight 
into the opioid epidemic, warrants the inclusion of first responders to 
the Pain Management Best Practices Interagency Task Force membership.
  Mr. Chairman, this is very simple, we are putting together a Pain 
Management Best Practices Interagency Task Force. We should include 
police officers. We should include paramedics. We should include people 
who are on the front lines of fighting this battle every day that is a 
battle of life and death.
  I urge the support of my amendment.
  I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I claim the time in opposition.
  The CHAIR. The gentlewoman from Indiana is recognized for 5 minutes.
  Mrs. BROOKS of Indiana. Mr. Chairman, for the record, I support the 
amendment.
  I yield back the balance of my time.
  Mr. GRAYSON. Mr. Chairman, I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from Florida (Mr. Grayson).
  The amendment was agreed to.


         Amendment No. 4 Offered by Ms. Clark of Massachusetts

  The CHAIR. It is now in order to consider amendment No. 4 printed in 
part A of House Report 114-551.
  Ms. CLARK of Massachusetts. Mr. Chairman, I have an amendment at the 
desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 4, after line 20, insert the following:
       (7) experts in the fields of adolescent and young adult 
     addiction research;
       Page 4, line 21, strike ``(7)'' and insert ``(8)''.
       Page 5, line 6, strike ``(8)'' and insert ``(9)''.
       Page 5, after line 7, insert the following:
       (10) a person in recovery from addiction to medication for 
     chronic pain, whose addiction began in adolescence or young 
     adulthood;
       Page 5, line 8, strike ``(9)'' and insert ``(11)''.
       Page 5, line 9, strike ``(10)'' and insert ``(12)''.
       Page 6, line 13, strike ``and''.
       Page 6, after line 13, insert the following:
       (E) the distinct needs of adolescents and young adults with 
     respect to pain management, pain medication, substance use 
     disorder, and medication-assisted treatment; and
       Page 6, line 14, strike ``(e)'' and insert ``(f)''.

  The CHAIR. Pursuant to House Resolution 720, the gentlewoman from 
Massachusetts (Ms. Clark) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Massachusetts.
  Ms. CLARK of Massachusetts. Mr. Chairman, a special thanks to 
Congresswoman Brooks, Congressman Kennedy, and Congressman Pallone for 
introducing this important bipartisan bill to address a devastating 
public health crisis.
  The opioid epidemic is a scourge on this country. In my district 
alone, 400 people have died in the last 4 years as a direct result. As 
we all know, there is no silver bullet to fix this problem. But what we 
can do and what we must do is find every possible way to help those 
people already affected and stop it from reaching more victims.
  When substance use disorder starts in adolescence, it affects key 
development and societal changes in young people's lives. It can 
interfere with the brain's ability to mature properly and have 
potentially lifelong consequences.

[[Page 5679]]

  We know that a large majority of adults in substance abuse treatment 
start using prior to the age of 18, and we need to make sure that the 
voices of adolescents and young adults are heard in this conversation.
  The underlying bill establishes a pain management task force that 
will include many different stakeholders and experts. This amendment 
would add an expert in adolescent and young adult addiction and a 
person in recovery from addiction to medication for chronic pain that 
began in adolescence or young adulthood to the bill's list of experts.
  This amendment would also call on the task force to consider the 
distinct needs of adolescents and young adults as it develops best 
practices for pain management and medication.
  Mr. Chairman, this is a commonsense amendment to help our young 
people dealing with this epidemic. I urge its passage.
  I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I claim the time in opposition, 
but I do support the amendment.
  The CHAIR. Without objection, the gentlewoman from Indiana is 
recognized for 5 minutes.
  There was no objection.
  Mrs. BROOKS of Indiana. Mr. Chairman, I very much want to thank the 
gentlewoman from Massachusetts (Ms. Clark). I believe that this does 
strengthen the task force. I appreciate and welcome the attention and 
focus on adolescents.
  We had the opportunity to travel to the NIH and to learn so much 
about the research that is being done there. I believe in having an 
expert in adolescent and young adult addiction because we do know that 
that is where it so very often begins. So I appreciate and thank the 
gentlewoman for strengthening the bill.
  I yield back the balance of my time.
  Ms. CLARK of Massachusetts. Mr. Chairman, I yield back the balance of 
my time.
  The CHAIR. The question is on the amendment offered by the 
gentlewoman from Massachusetts (Ms. Clark).
  The amendment was agreed to.


                 Amendment No. 5 Offered by Mr. Pallone

  The CHAIR. It is now in order to consider amendment No. 5 printed in 
part A of House Report 114-551.
  Mr. PALLONE. Mr. Chairman, I rise as the designee of the gentleman 
from Massachusetts (Mr. Moulton) to offer amendment No. 5.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 5, line 3, strike ``and''.
       Page 5, after line 3, insert the following:
       (E) veteran service organizations; and
       Page 5, line 4, strike ``(e)'' and insert ``(f)''.

  The CHAIR. Pursuant to House Resolution 720, the gentleman from New 
Jersey (Mr. Pallone) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from New Jersey.

                              {time}  1430

  Mr. PALLONE. Mr. Chairman, this amendment by the gentleman from 
Massachusetts (Mr. Moulton) would basically add representatives of 
veterans service organizations to the Pain Management Best Practices 
Inter-Agency Task Force that we have discussed and that we support on a 
bipartisan basis. I urge support for Mr. Moulton's amendment.
  Mr. Chairman, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I claim the time in opposition, 
but I support this amendment.
  The CHAIR. Without objection, the gentlewoman from Indiana is 
recognized for 5 minutes.
  There was no objection.
  Mrs. BROOKS of Indiana. Mr. Chairman, while the task force was 
designed with the Veterans Administration as a key member of the task 
force, I do believe that this bill would strengthen the task force in 
that representatives from veterans service organizations often speak on 
behalf of and are the first line of defense and advocates for veterans.
  Obviously, as we know, veterans seek their medical treatment often 
from VA hospitals and VA facilities. We know that there has been a 
significant problem with overprescribing at some of our VA facilities. 
I believe that this amendment will strengthen the task force and the 
bill. I urge passage or adoption of the amendment.
  I yield back the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield such time as he may consume to the 
gentleman from Massachusetts (Mr. Moulton), the sponsor of the 
amendment.
  Mr. MOULTON. Mr. Chairman, the addiction epidemic has touched every 
community and demographic in America, but our veterans have been hit 
particularly hard. Veterans suffer from chronic pain at a higher rate 
than the civilian population, often due to injuries they sustained 
during their service. This puts our veterans at high risk of developing 
addiction and presents unique challenges as they search for ways to 
cope with the pain caused by the wounds of war.
  The results of veteran addiction are tragic. Approximately 68,000 
veterans struggle with opioid use. Veterans are also almost twice as 
likely to die from accidental opioid overdoses than nonveterans.
  We need to do more to ensure that we are not losing veterans to the 
disease of addiction, while also ensuring that they get the absolute 
best care possible when they return home. That is why it is imperative 
that the veteran community has a seat at the table as we begin the 
process of reviewing and updating our pain management best practices.
  By adding a representative of a veterans service organization to the 
interagency task force created by this bill, my amendment will ensure 
that the unique challenges our veterans face are part of the 
conversation.
  In closing, I would like to thank my colleagues, the gentleman from 
New York (Mr. Zeldin) and the gentleman from Minnesota (Mr. Walz), for 
their bipartisan cosponsorship and the Iraq and Afghanistan Veterans of 
America, Vietnam Veterans of America, American Legion, Paralyzed 
Veterans of America, and Boston Scientific for their support of this 
amendment.
  I urge my colleagues to support this amendment.
  Mr. PALLONE. Mr. Chairman, I urge support for the amendment.
  I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from New Jersey (Mr. Pallone).
  The amendment was agreed to.


                  Amendment No. 6 Offered by Mr. Nolan

  The CHAIR. It is now in order to consider amendment No. 6 printed in 
part A of House Report 114-551.
  Mr. NOLAN. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 5, line 8, strike ``and''.
       Page 5, after line 8, insert the following:
       (10) an expert on active duty military, armed forces 
     personnel, and veteran health and prescription opioid 
     addiction;
       Page 5, line 9, strike ``(10)'' and insert ``(11)''.

  The CHAIR. Pursuant to House Resolution 720, the gentleman from 
Minnesota (Mr. Nolan) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Minnesota.
  Mr. NOLAN. Mr. Chairman, Members of the House, my amendment simply 
would ensure that the concerns and the interests of Active-Duty members 
of our Armed Forces and veterans have their interests and concerns 
taken into consideration by the interagency task force.
  The simple truth is that there is a greater need and use of opioids 
among Active Duty and veterans of our Armed Forces simply because of 
the many serious accidents and injuries that they incur in combat and 
in training.
  Over half of the Iraq and Afghanistan veterans have had to use 
opioids as painkillers from the accidents and the injuries that they 
have suffered. That is well over half a million of our finest and 
bravest citizens here in this country, and an 80 percent increase in 
its use over the last decade.
  I would be remiss if I didn't point out as well that overdose from 
opioids is twice the rate among our Active-Duty

[[Page 5680]]

servicemembers and veterans of that of the general population. Also, I 
would be remiss if I didn't point out that, because of problems that we 
have been seeing in the Veterans Administration with veterans having a 
difficult time sometimes getting appointments to get their 
prescriptions filled, they have been tragically forced to go to 
alternative street measures, including heroin, with disastrous 
consequences for our soldiers and our veterans. Our veterans, our men 
and women of the Armed Forces, deserve better.
  This is a growing problem, a growing concern, and my amendment would 
simply require that they be represented on this interagency task force 
so that their interests, their concerns can be properly reflected and 
reported in the findings and results of this interagency task force.
  Mr. Chairman, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I claim the time in opposition, 
but I support the amendment as well.
  The CHAIR. Without objection, the gentlewoman from Indiana is 
recognized for 5 minutes.
  There was no objection.
  Mrs. BROOKS of Indiana. Mr. Chairman, I want to thank the gentleman 
from Minnesota, again, for strengthening the representation on the task 
force. While I do feel that the VSOs are a strong voice for veterans 
and will continue to be, I believe the addition specifically of Active-
Duty military is something that would be a very strong voice. While DOD 
is represented on the task force, I think actually having specific 
Active-Duty military personnel and those who are currently serving and 
are currently dealing with their pain as a result of their service 
would be an important addition.
  I thank the gentleman, and I urge passage of the amendment.
  Mr. Chairman, I yield back the balance of my time.
  Mr. NOLAN. Mr. Chairman, I want to thank the gentlewoman from Indiana 
(Mrs. Brooks) for her leadership on this important issue and her 
support for this important amendment, most importantly the great work 
she is doing here on behalf of our veterans and our men and women in 
the Armed Forces.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from Minnesota (Mr. Nolan).
  The amendment was agreed to.


             Amendment No. 7 Offered by Mrs. Watson Coleman

  The CHAIR. It is now in order to consider amendment No. 7 printed in 
part A of House Report 114-551.
  Mrs. WATSON COLEMAN. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 5, line 8, strike ``and''.
       Page 5, after line 8, insert the following:
       (10) an expert in the field of minority health; and
       Page 5, line 9, strike ``(10)'' and insert ``(11)''.

  The CHAIR. Pursuant to House Resolution 720, the gentlewoman from New 
Jersey (Mrs. Watson Coleman) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from New Jersey.
  Mrs. WATSON COLEMAN. Mr. Chairman, this amendment would simply ensure 
that, as we address what has rightly been called an epidemic, we 
consider the unique impacts and issues of drug addiction for minority 
communities by adding an expert on minority health to the task force 
that is created by this bill.
  The dangers of opiate addiction are apparent across the board. Abuse 
of prescription opioids has contributed to a flood of cheap heroin to 
all communities.
  Over the past 4 years, we have seen a 269 percent increase in heroin 
overdose deaths in White communities, but also a 213 percent increase 
in Black communities, 137 percent increase in Latino communities, and 
236 percent in Native American communities.
  With that in mind, it is important to remember that the opiate 
epidemic--both heroin and its prescription painkiller counterparts--
looks very different from the perspective of communities of color. The 
compassion and clemency that we are showing now and the evidence-based 
solutions we are embracing were needed long ago, way before abuse by 
predominantly White and suburban communities.
  As we craft the tools to solve this crisis, we must ensure the 
policies we create will help everyone affected. Adding an expert in 
minority health to this task force helps to make sure that the diverse 
needs of all Americans are represented at the table. We still live in a 
world of significant biases.
  Just last month, the University of Virginia released a study that 
found that White medical students and residents genuinely believed that 
Black patients were less sensitive to pain and had less sensitive nerve 
endings than White patients, bearing out at least one reason for the 
consistently documented lack of pain management provided to Black 
patients.
  As we give this task force the vital task of improving how we 
prescribe some of the most powerful and still-critical medication for 
pain management, let's do our part to eliminate as much bias as 
possible. This amendment takes an important step toward reaching that 
goal. I hope my colleagues will support it.
  Mr. Chairman, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I claim the time in opposition, 
but I support the amendment.
  The CHAIR. Without objection, the gentlewoman from Indiana is 
recognized for 5 minutes.
  There was no objection.
  Mrs. BROOKS of Indiana. Mr. Chairman, I thank the gentlewoman from 
New Jersey for this important addition to the task force. I think that 
she has brought forth some interesting points and some statistics with 
respect to the opioid abuse and addiction problems facing the minority 
community. A minority health expert that is very focused on this would 
add tremendous expertise to the depth of this task force. I support the 
amendment.
  Mr. Chairman, I yield back the balance of my time.
  Mrs. WATSON COLEMAN. Mr. Chairman, I thank the gentlewoman from 
Indiana for her leadership and for her support of this initiative.
  Let me close by adding this. We are considering a number of bills 
this week aimed at curing the opioid and heroin epidemics ravaging so 
many American families. As we do so, we need to consider two things:
  First is that communities of color have unique needs that deserve 
just as much consideration. That is why I have offered this amendment, 
and it is a theme I hope to see continued in other legislation we will 
debate.
  The second is that, when we head back to our districts on Friday 
after completing consideration of these bills, we should not wash our 
hands and walk away from this issue. We need to fund the programs we 
have authorized. We need to look back with a critical eye at the ways 
we criminalized addictions in the past and offer those whom we failed 
solutions that will allow them to reenter society. Our work cannot stop 
there. I urge my colleagues to support this amendment.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the 
gentlewoman from New Jersey (Mrs. Watson Coleman).
  The amendment was agreed to.


                 Amendment No. 8 Offered by Ms. Kuster

  The CHAIR. It is now in order to consider amendment No. 8 printed in 
part A of House Report 114-551.
  Ms. KUSTER. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 5, after line 18, insert the following:
       (B) research on trends in areas and communities in which 
     the prescription opioid abuse rate and fatality rate exceed 
     the national average prescription opioid abuse rate and 
     fatality rate;
       Page 5, line 19, strike ``(b)'' and insert ``(c)''.
       Page 5, line 22, strike ``(c)'' and insert ``(d)''.

[[Page 5681]]

       Page 6, line 6, strike ``(d)'' and insert ``(e)''.
       Page 6, line 14, strike ``(e)'' and insert ``(f)''.

  The CHAIR. Pursuant to House Resolution 720, the gentlewoman from New 
Hampshire (Ms. Kuster) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from New Hampshire.
  Ms. KUSTER. Mr. Chairman, the underlying bill before us authorizes 
the creation of an interagency task force to combat the opiate 
epidemic. I want to commend the gentlewoman from Indiana (Mrs. Brooks) 
and the gentleman from Massachusetts (Mr. Kennedy) for their hard work 
on this issue.
  This important legislation will make it easier to tackle this crisis 
in a holistic way that addresses all angles of the crisis, including 
law enforcement, education and prevention, and, most importantly, 
treatment and lifelong recovery.
  I thank Congresswoman Brooks and Congressman Kennedy for their great 
work on this bill, as well as the leadership of the chair and the 
ranking member.

                              {time}  1445

  In fact, a similar provision to this legislation was included in the 
STOP ABUSE Act that I introduced with my colleague, Mr. Guinta, last 
year. Today he has joined me in introducing this important bipartisan 
amendment that will further improve the scope of the task force's 
effort.
  In New Hampshire and across the country, four out of every five 
heroin users started out misusing prescription opioid medication. Last 
year more than 25,000 people died across this country from overdoses on 
prescription drugs.
  There are complex reasons for why we have seen such a dramatic rise 
in prescription drug misuse, but one of the causes that we must examine 
more closely is prescribing practices and overprescribing.
  I recently joined my colleague, Congressman Mooney of West Virginia, 
in introducing legislation that would address this problem. This 
amendment with Mr. Guinta would help to shine more light on 
prescription drug misuse by requiring the task force to research 
addiction trends in communities with high rates of prescription drug 
misuse and overdoses.
  This research will be invaluable in the effort to identify why this 
crisis is hitting certain regions of our country particularly hard and 
in identifying further potential corrections to prescribing practices 
that can be made.
  I thank my colleagues for taking up such important legislation this 
week, and I urge support for this amendment.
  I yield 2 minutes to the gentleman from New Hampshire (Mr. Guinta).
  Mr. GUINTA. Mr. Chairman, I rise today in support of the amendment 
offered by my colleague, Congresswoman Kuster, and myself, originally 
part of the STOP ABUSE Act that we authored earlier this year, as 
previously mentioned.
  This amendment would simply require the task force to research 
addiction trends in communities with high rates of prescription drug 
abuse.
  In our home State of New Hampshire, much of the heroin abuse we have 
seen today can be traced back to the overprescribing of narcotic drugs. 
This trend, which began in the 1990s, paved the way for the rampant 
heroin abuse that we are seeing today.
  Last year, as you know, 430 people in our State died of an opioid 
overdose. This year that number is expected to be exceeded. So this 
amendment would research these trends so we can work to resolve the 
problem before the epidemic continues and expands. I would urge my 
colleagues to support this important amendment.
  Again, I want to thank the gentlewoman from New Hampshire for her 
tireless work not just here, but on the Bipartisan Task Force to Combat 
Heroin Epidemic. We are clearly providing options and solutions to help 
those families in need.
  Ms. KUSTER. Mr. Chairman, I will just close by thanking Mrs. Brooks 
of Indiana for her leadership, Mr. Kennedy for his leadership in 
offering this legislation, and thank Mr. Guinta for this amendment.
  I urge our colleagues to support this bipartisan amendment that will 
allow us to understand the underlying increase in the use of opioid 
medication and prescription drugs that are leading people into 
substance use disorder and, ultimately, sadly, into the use of heroin 
and fentanyl that is killing so many people in our homes and 
communities.
  I yield back the balance of my time.
  The Acting CHAIR (Mr. Byrne). The question is on the amendment 
offered by the gentlewoman from New Hampshire (Ms. Kuster).
  The amendment was agreed to.


                 Amendment No. 9 Offered by Mr. Schiff

  The Acting CHAIR. It is now in order to consider amendment No. 9 
printed in part A of House Report 114-551.
  Mr. SCHIFF. 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:

       Page 6, line 3, strike ``and''.
       Page 6, line 5, before the semicolon insert ``and the 
     coordination of information collected from State prescription 
     drug monitoring programs for the purpose of preventing the 
     diversion of pain medication''.

  The Acting CHAIR. Pursuant to House Resolution 720, the gentleman 
from California (Mr. Schiff) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from California.
  Mr. SCHIFF. Mr. Chairman, I rise today to offer an amendment to H.R. 
4641 that will require the interagency task force created by this 
legislation to study and report on the coordination of information 
collected from state prescription drug monitoring programs, or PDMPs, 
as part of its effort to update best practices for pain management 
strategies.
  State PDMPs play a critical role in preventing the diversion of pain 
medication as well as other controlled substances. Chief among their 
benefits, access to a State PDMP provides an invaluable resource to 
prescribing physicians by allowing them to review a patient's history 
of prescription drugs and to spot signs of opioid abuse so that they 
may proactively refer a patient to substance abuse treatment, if 
appropriate. They allow medical professionals to intervene before an 
addiction spirals out of control.
  Now active in 49 States, PDMPs can also inform prescribing physicians 
if a patient has recently accessed pain medication elsewhere and help 
to detect potential doctor-shopping activities by individuals with no 
legitimate medical need. Further, PDMPs also play an important role in 
identifying forged or stolen prescriptions.
  While information sharing between some adjacent State PDMPs currently 
exists to prevent illicit doctor-shopping activities from occurring 
across State lines, I believe it is time that we boost efforts to 
strengthen the sharing of information across all State PDMPs.
  I recently met with physicians from my district who described from 
their experience how prevalent the issue of doctor shopping is, 
particularly in the State of California, and how it is becoming more 
and more common for individuals with histories of opioid abuse to 
attempt to receive illicit prescriptions in nearby States.
  With passage of this amendment, I urge the task force to explore the 
benefits of potentially establishing a national PDMP that will vastly 
approve our ability to prevent and disincentivize doctor shopping in 
all regions of the country, and I look forward to working with other 
concerned Members on this important topic.
  By requiring that the interagency task force include State PDMP 
information as it formulates its expert input and improves prescribing 
guidelines, we will be able to better understand what is and isn't 
working and how we may be able to harness the power of State PDMPs to 
develop an effective national response to the opioid crisis that has 
devastated communities across the country.
  It is beyond doubt that prescription drug monitoring programs serve 
an invaluable purpose, and any effort to address overprescription must 
include

[[Page 5682]]

consideration of important data that is gleaned across State PDMPs.
  While I hope that this Congress will ultimately provide the necessary 
resources to assure we are able to develop and implement a 
comprehensive plan to prevent opioid addiction and increase access to 
treatment, the recommendations developed by the task force created 
under this bill are an important initial step that must come to pass 
before achieving that goal.
  I urge support for this amendment and for the bill.
  Mr. Chairman, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I claim the time in opposition, 
but I am in support of the amendment.
  The Acting CHAIR. Without objection, the gentlewoman from Indiana is 
recognized for 5 minutes.
  There was no objection.
  Mrs. BROOKS of Indiana. Mr. Chairman, I would like to thank the 
gentleman from California for offering this amendment.
  We know from talking to a lot of physicians and medical educators as 
well that the use of these PDMPs is a critically important tool in 
their tool chest to combat against those patients who might be doctor 
shopping.
  We know, though, that not all States use it. Not all prescribers 
actually check that PDMP system like they should. So I appreciate the 
Congressman's concept of a feasibility study as to whether or not there 
should be a national PDMP system, and I urge its passage.
  I yield back the balance of my time.
  Mr. SCHIFF. Mr. Chairman, I thank the gentlewoman for her support as 
well as all of her good work in trying to address the opioid crisis in 
the United States.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from California (Mr. Schiff).
  The amendment was agreed to.


         Amendment No. 10 Offered by Ms. Clark of Massachusetts

  The Acting CHAIR. It is now in order to consider amendment No. 10 
printed in part A of House Report 114-551.
  Ms. CLARK of Massachusetts. 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:

       Page 6, after line 5, insert the following:
       (D) ongoing efforts at the Federal, State, and local levels 
     to examine the potential benefits of electronic prescribing 
     of opioids, including any public comments collected in the 
     course of those efforts;
       Page 6, line 6, strike ``(d)'' and insert ``(e)''.
       Page 6, line 14, strike ``(e)'' and insert ``(f)''.

  The Acting CHAIR. Pursuant to House Resolution 720, the gentlewoman 
from Massachusetts (Ms. Clark) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Massachusetts.
  Ms. CLARK of Massachusetts. Mr. Chairman, my amendment is simple. It 
directs the task force to consider any potential benefits from 
increasing the electronic prescribing of opioids.
  We know that, with the increasing sophistication of health 
information technology, we have an opportunity to use that information 
for the benefit of our public health. We also know that paper 
prescriptions are subject to being stolen, copied, and misused.
  While that is a fact, 67 percent of prescriptions nationally are 
ordered electronically, but the rate for controlled substances is less 
than 1 percent.
  Electronic prescribing of opioids has the potential to provide data 
to help us identify problems, whether from a user or a prescriber, and 
focus our interventions on saving lives and preventing addiction.
  Back home in my district, Cambridge Health Alliance has adopted 
electronic prescriptions for controlled substances and have found it 
reduces fraud and allows administrators to track prescription patterns 
and detect overprescribing. Electronic prescriptions can be a key tool 
in fighting this epidemic. I urge my colleagues to support this 
commonsense amendment.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Massachusetts (Ms. Clark).
  The amendment was agreed to.


                Amendment No. 11 Offered by Mr. Rothfus

  The Acting CHAIR. It is now in order to consider amendment No. 11 
printed in part A of House Report 114-551.
  Mr. ROTHFUS. 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:

       Page 6, line 13, strike ``and''.
       Page 6, after line 16, insert ``and'' after the semicolon.
       Page 6, after line 16, insert the following:
       (F) the practice of co-prescribing naloxone for both pain 
     patients receiving chronic opioid therapy and patients being 
     treated for opioid use disorders;

  The Acting CHAIR. Pursuant to House Resolution 720, the gentleman 
from Pennsylvania (Mr. Rothfus) and a Member opposed each will control 
5 minutes.
  The Chair recognizes the gentleman from Pennsylvania.
  Mr. ROTHFUS. Mr. Chairman, I want to thank my good friend from 
Indiana for her leadership on this very important piece of legislation 
as well as the chairman and ranking member of the committee for working 
together to bring it to the floor today.
  The United States is being ravaged by skyrocketing levels of 
prescription opioid and heroin abuse. This brutal epidemic has 
accounted for more than 28,000 American deaths in 2014, destroying 
families and devastating local communities alike.
  My constituents in western Pennsylvania have been particularly hard 
hit. In the past two decades, there has been a 470 percent increase in 
drug overdose deaths. The vast majority of these have been heroin and 
opioid related.
  Two weeks ago, at a local hospital in my district, five overdoses 
were treated in 1 day alone. In February, the same facility treated 20 
overdoses in just 2 days.
  We need meaningful and evidence-based solutions to combat this 
scourge. I have worked to help develop those solutions as part of the 
Bipartisan Task Force to Combat the Heroin Epidemic and by holding 
roundtables with stakeholders in my district.
  I strongly believe that the legislation we are considering today is 
another step forward in that process by creating an interagency task 
force to review and update best practices for pain management and 
prescribing pain medication.
  As part of its work, the task force will consider various types of 
data and practices. For example, it must consider the existence and 
availability of different classes of opioids, including those with 
safety measures such as abuse deterrent technology. It must also 
consider how high-risk populations are managed by medical 
professionals.
  The legislation has been entirely silent on the issue of naloxone, 
however. Thus, the amendment that I offered with my friend from 
Massachusetts (Mr. Keating) simply seeks to have the task force take 
into consideration the practice of coprescribing this lifesaving drug 
as part of its work.
  Naloxone has the ability to revive a victim who has suffered an 
overdoes within minutes. It is both safe and effective and has been 
used successfully to counteract more than 26,000 overdoses between 1996 
and 2014. First responders who have seen what naloxone can do have 
referred to it as the miracle drug.
  The American Medical Association and many community, State, and 
national groups have supported coprescribing naloxone to patients who 
are taking opioids as a critical part of the solution to the rising 
epidemic of opioid overdose-related deaths.
  Considering the practice of coprescribing naloxone, particularly for 
high-risk populations or when other avenues of treatment have been 
tried and failed, it is an essential part of addressing the opioid and 
heroin epidemic.
  By reviewing and updating best practices with respect to 
coprescribing naloxone, the interagency task force can ensure that 
health professionals at

[[Page 5683]]

all levels, both inside and outside of government, are fully informed 
when prescribing and treating patients.
  Simply put, Americans who are struggling with opioid and heroin 
addiction cannot be treated if they lose their lives to drug overdose. 
It is essential that we get naloxone into the hands that need it the 
most in a safe and effective manner. My amendment would ensure that the 
task force takes a close look at this.
  Mr. Chairman, I reserve the balance of my time.

                              {time}  1500

  Mr. KEATING. Mr. Chairman, I rise in support of Mr. Rothfus' 
amendment to H.R. 4641.
  The Acting CHAIR. Without objection, the gentleman from Massachusetts 
is recognized for 5 minutes.
  There was no objection.
  Mr. KEATING. Mr. Chairman, I would like to thank my colleague from 
Pennsylvania (Mr. Rothfus).
  I rise today in support of this amendment, our amendment. It is an 
amendment that I believe will move the task force to consider the 
practice of coprescribing of overdose reversal drugs such as naloxone 
as part of the review of its best practices for pain management and for 
prescribing pain medication.
  Importantly, the medical community now realizes the need for having 
these important guidelines in place and having them being addressed, as 
over 80 percent of the AMA members have indicated they see the need for 
these guidelines now and the importance in terms of saving lives.
  As a former district attorney, I took a public health approach a 
decade and a half ago, starting an Anti-Heroin Task Force. At the time, 
in our State, two people, on average, were dying every day from these 
overdoses. In just the last 6 years, that number has increased to 
almost four people a day.
  As a Congressman, this hits really close to home to me because our 
latest stats in 2014 indicate that a quarter of the overdose deaths in 
Massachusetts occurred in counties in my district. Over 60 percent 
occurred in the cities of Fall River and New Bedford alone.
  In fact, nearly twice the statewide average in Cape Cod, where the 
highest percentage of per capita rate of opioid-related overdoses 
occurs, represents a significant part of the epidemic in our 
Commonwealth.
  Going forward, Mr. Rothfus and I introduced Co-Prescribing Saves 
Lives Act legislation to require Federal health agencies, including 
HHS, the Department of Defense, and the VA, to create guidelines for 
coprescribing naloxone alongside opioid prescriptions and making 
naloxone more widely available.
  Our legislation creates a grant program as well, so the States will 
have the resources to do the same.
  As our partnership shows, in an often divided Congress, we are coming 
together. We are coming together to confront a uniquely American 
epidemic.
  Mr. Chairman, I yield back the balance of my time.
  Mr. ROTHFUS. Mr. Chairman, to close, increased access to naloxone, 
particularly for patients who are at high risk, has been identified as 
one of the most powerful tools for reducing the number of opioid and 
heroin-related overdose deaths.
  Let's ensure that our health professionals are fully informed of this 
option when prescribing and treating patients.
  I urge my colleagues to support this commonsense, bipartisan 
amendment.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Pennsylvania (Mr. Rothfus).
  The amendment was agreed to.


         Amendment No. 12 Offered by Ms. Clark of Massachusetts

  The Acting CHAIR. It is now in order to consider amendment No. 12 
printed in part A of House Report 114-551.
  Ms. CLARK of Massachusetts. 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:

       Page 6, line 13, strike ``and''.
       Page 6, after line 16, insert the following:
       (F) research that has been, or is being, conducted or 
     supported by the Federal Government on prevention of, 
     treatment for, and recovery from substance use by and 
     substance use disorders among adolescents and young adults 
     relative to any unique circumstances (including social and 
     biological circumstances) of adolescents and young adults 
     that may make adolescent-specific and young adult-specific 
     treatment protocols necessary, including any effects that 
     substance use and substance use disorders may have on brain 
     development and the implications for treatment and recovery;
       (G) Federal non-research programs and activities that 
     address prevention of, treatment for, and recovery from 
     substance use by and substance use disorders among 
     adolescents and young adults, including an assessment of the 
     effectiveness of such programs and activities in--
       (i) preventing substance use by and substance use disorders 
     among adolescents and young adults;
       (ii) treating such adolescents and young adults in a way 
     that accounts for any unique circumstances faced by 
     adolescents and young adults; and
       (iii) supporting long-term recovery among adolescents and 
     young adults; and
       (H) gaps that have been identified by Federal officials and 
     experts in Federal efforts relating to prevention of, 
     treatment for, and recovery from substance use by and 
     substance use disorders among adolescents and young adults, 
     including gaps in research, data collection, and measures to 
     evaluate the effectiveness of Federal efforts, and the 
     reasons for such gaps;

  The Acting CHAIR. Pursuant to House Resolution 720, the gentlewoman 
from Massachusetts (Ms. Clark) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Massachusetts.
  Ms. CLARK of Massachusetts. Mr. Chairman, my amendment would direct 
the task force to consider the programs and research relative to 
adolescents and young adults.
  We know that addiction and recovery often start early, and we need to 
focus research on how to address the unique needs of our adolescents 
and young adults.
  We need to understand how years of opioid abuse can affect the 
development of the brain, how it affects the development of coping 
skills, and how we can best support our kids in long-term recovery.
  Most importantly, there are many gaps in research on this subject, 
and we need to know the status of the current research and where we 
need to focus our resources.
  Recently, I met a constituent named Ryan. In seventh grade, he 
started taking drugs. When he did, he told me he felt like he finally 
fit in, like he had found the answers to the problems he felt and the 
pain he felt.
  By the time he was 13, he started drinking, taking pills, and 
stealing money from his family. His mother was panicked. The minute he 
walked out of the house he had to get high. He also felt powerless.
  At 15, he became convinced he was a bad person. He felt ashamed that 
he couldn't change, not even for his mother.
  The last time he relapsed, his mom told him he couldn't see friends 
anymore, and he threw a piece of glass at her.
  She looked him in the eyes and said: I don't know who you are 
anymore.
  He went into treatment for three additional months, and that 
treatment is what changed his life. He said that it saved him. One day 
at the sober house he remembers sincerely laughing for the first time, 
and he thought: There's hope for me.
  All these little things he forgot about himself, like humor, kindness 
and empathy. He said: I no longer felt like the shell of a person.
  He asked for our leadership for two things: the people in recovery 
need not to be ashamed. It is not what defines them, even when their 
addiction starts very young; and that we need to come up with funding 
for treatment.
  Ryan is an inspiration to me, and we owe it to the young victims of 
this epidemic to focus on the unique impact of this public health 
crisis on adolescents and young adults.
  I urge my colleagues to support this commonsense amendment.
  I reserve the balance of my time.

[[Page 5684]]


  Mrs. BROOKS of Indiana. Mr. Chairman, I claim the time in opposition, 
but I support the amendment.
  The Acting CHAIR. Without objection, the gentlewoman from Indiana is 
recognized for 5 minutes.
  There was no objection.
  Mrs. BROOKS of Indiana. Mr. Chairman, I would like to, once again, 
thank the gentlewoman from Massachusetts for this important amendment. 
As she spoke, she reminded me of a visit that I made to a recovery high 
school; and there are more recovery high schools being created across 
the country.
  But I think when I visited the recovery high school in Indianapolis, 
called Hope Academy, it reminded me, as I listened to these young 
people, of the very different needs, but the very, very serious desire 
that they have to find themselves again, as the gentlewoman just 
stated.
  A young woman who was turning 17 the next day shared that it was 
going to be her first birthday in 3 years where she would be sober, and 
she thanked her classmates and her colleagues there as they sat in that 
circle, and asked that they help her make sure that she didn't go home 
that night and relapse because she couldn't remember a birthday, 
really, where she had been sober.
  So I do believe that having more studies specifically with respect to 
the programs and the research about adolescents and young adults is 
critically important because that is where it all starts.
  I support this amendment.
  Mr. Chairman, I yield back the balance of my time.
  Ms. CLARK of Massachusetts. Mr. Chairman, again, I just want to thank 
the gentlewoman from Indiana for all her leadership and advocacy, and 
my good friend and colleague from the Commonwealth of Massachusetts 
(Mr. Kennedy) for his as well. This bill and their work will make an 
incredible difference to families across the country.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Massachusetts (Ms. Clark).
  The amendment was agreed to.


                  Amendment No. 13 Offered by Ms. Esty

  The Acting CHAIR. It is now in order to consider amendment No. 13 
printed in part A of House Report 114-551.
  Ms. ESTY. 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:

       Page 6, line 19, strike ``and''.
       Page 6, line 25, strike the period and insert ``; and''.
       Page 6, after line 25, insert the following:
       (4) review, modify, and update best practices for pain 
     management and prescribing pain medication, specifically as 
     it pertains to physician education and consumer education.
       Page 7, line 15, strike ``and''.
       Page 7, line 20, strike the period and insert ``; and''.
       Page 7, after line 20, insert the following:
       (4) the modified and updated best practices described in 
     subsection (d)(4).

  The Acting CHAIR. Pursuant to House Resolution 720, the gentlewoman 
from Connecticut (Ms. Esty) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Connecticut.
  Ms. ESTY. Mr. Chairman, I rise today in support of my amendment, 
which would empower the interagency task force to help communities 
spread awareness about the dangers of drug addiction through consumer 
education, and help medical providers more effectively and safely 
address patient pain management.
  Along with my colleague, Representative Knight, I proudly introduced 
this amendment that was inspired by bipartisan legislation that I 
introduced earlier this year, with Representatives Knight and Costello, 
and that was identified as a legislative priority by the Bipartisan 
Task Force to Combat the Heroin Epidemic that I proudly serve on with 
so many of my colleagues here in this House.
  Mr. Chairman, there is not a community in this great country that 
hasn't been touched by drug addiction, not one. Addiction knows no 
bounds. It knows no race, no gender, no economic status, no party 
affiliation.
  In January, I was honored to have James Wardwell, the Chief of Police 
in New Britain, Connecticut, join me for the President's State of the 
Union Address, and he came to join me because of his leadership and his 
concern about the need to address this growing public health crisis.
  Chief Wardwell, and many other first responders, medical 
professionals, substance abuse counselors, family members, and 
recovering addicts, have worked with me to help craft legislation to 
address our growing epidemic of prescription drug and heroin addiction.
  I am glad that today, this House is taking action. Today's 
legislation is an example of what we, in Congress, are supposed to be 
doing. Our job is to work together, Democrats and Republicans, to 
address the needs of the American people.
  Whenever I go home to central and northwest Connecticut, at community 
forums in Torrington, at Congress on Your Corner events in Waterbury 
and the Farmington Valley, constituents come up to me and ask: What are 
you in Congress doing to help our families with the heroin epidemic?
  The families in Connecticut and across this country who are losing 
loved ones to drug addiction cannot afford for us to wait. We need to 
act now.
  Recovering from addiction is possible, but it is hard. So much of our 
effort to combat drug addiction is focused on helping folks get the 
treatment they need, and that is important, but it is not enough to 
treat the crisis. We must help prevent people from getting addicted in 
the first place.
  Our bipartisan amendment does just that by directing the interagency 
task force to establish guidelines that help prescribers more 
effectively and safely manage their patients' pain, and that 
strengthens consumer education about opioid addiction.
  Our amendment takes an important step toward preventing drug 
addiction. Those who prescribe narcotics would benefit from an 
increased education about the dangers of addiction and ways in which 
they can help minimize the risks associated with prescribing narcotics.
  Those hardest hit by this epidemic would benefit from having access 
to educational materials in our schools, community centers, and from 
local law enforcement, that help warn people about the dangers of 
opioid use and possible addiction.
  I am very encouraged that the House and Senate are taking action to 
address this public health crisis, and I will continue doing everything 
within my power to make addiction prevention a priority.
  Opioid and heroin addiction have already taken so many young lives 
and needlessly torn apart so many families. We can't wait for more 
lives to be destroyed before we take action.
  So let's work together today to prevent our children, our students, 
our patients, our neighbors, our families, and our friends, from 
becoming victims of this terrible public health crisis. Let's work 
together today to stop drug addiction before it begins.
  Mr. Chairman, I reserve the balance of my time.
  Mrs. BROOKS of Indiana. Mr. Chairman, I claim the time in opposition, 
but I support the amendment.
  The Acting CHAIR. Without objection, the gentlewoman from Indiana is 
recognized for 5 minutes.
  There was no objection.
  Mrs. BROOKS of Indiana. Mr. Chairman, I would like to thank the 
gentlewoman from Connecticut for this important amendment.
  Certainly, the job of the interagency task force, besides producing 
best practices and reviewing and modifying and talking about them, is 
not just to generate a report that Congress will have, as I have said, 
sitting on a shelf someplace, and that our staff or the Congressional 
Research Service can look at and study; it is really meant to educate 
the public, to educate the public, whether or not they are people in 
schools, whether or not they are in our hospitals.
  But I think, most importantly, we need to make sure that our 
prescribers

[[Page 5685]]

are being educated. We have had roundtable discussions with our medical 
educators, and there is a push around the country, and I applaud that 
push around the country of our medical educators, whether it is in our 
med schools for physicians or for nursing programs, dental programs, 
but to try to start at a much earlier level in their medical education 
about the research and the studies and the best practices around 
opioids.
  Certainly, as being a lawyer, we are required to do continuing 
medical or continuing legal education, and it is something that I know 
that physicians and prescribers are certainly required to get 
continuing medical education. I just want to continue to encourage and 
applaud them for seeking out that medical education around opioids. I 
think it is critically important.
  With this amendment, I think it will strengthen and educate our 
prescribers about the need to continue to educate themselves on pain 
management practices and the use of opioids.
  I urge the amendment's passage.
  Mr. Chairman, I yield back the balance of my time.

                              {time}  1515

  Ms. ESTY. Mr. Chairman, again, I would like to thank my colleague, 
Representative Knight, for cosponsoring this amendment. I would like to 
thank the bipartisan leadership for taking up this issue, and my good 
friend, the gentlewoman from Indiana, Representative Brooks, for her 
leadership. I would like to thank the advocates in Connecticut who have 
worked so tirelessly with me, Chief Wardwell and Shawn Lang, among 
others. Shawn Lang recently was recognized by the White House for her 
advocacy and leadership on this issue for many, many years.
  Mr. Chairman, I urge my colleagues to support this amendment.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Connecticut (Ms. Esty).
  The amendment was agreed to.


                 Amendment No. 14 Offered by Mr. Welch

  The Acting CHAIR. It is now in order to consider amendment No. 14 
printed in part A of House Report 114-551.
  Mr. WELCH. 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:

       Page 6, line 19, strike ``and''.
       Page 6, line 25, strike the period and insert ``; and''.
       Page 6, after line 25, insert the following:
       (4) examine and identify--
       (A) the extent of the need for the development of new 
     pharmacological, nonpharmacological, and medical device 
     alternatives to opioids;
       (B) the current status of research efforts to develop such 
     alternatives; and
       (C) the pharmacological, nonpharmacological, and medical 
     device alternatives to opioids that are currently available 
     that could be better utilized.
       Page 7, line 15, strike ``and''.
       Page 7, line 20, strike the period and insert ``; and''.
       Page 7, after line 20, insert the following:
       (4) the results of the examination and identification 
     conducted pursuant to subsection (d)(4), and recommendations 
     regarding--
       (A) the development of new pharmacological, 
     nonpharmacological, and medical device alternatives to 
     opioids; and
       (B) the improved utilization of pharmacological, 
     nonpharmacological, and medical device alternatives to 
     opioids that are currently available.

  The Acting CHAIR. Pursuant to House Resolution 720, the gentleman 
from Vermont (Mr. Welch) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Vermont.
  Mr. WELCH. Mr. Chair, on January 8, 2014, an extraordinary thing 
happened in Vermont. Our Governor, Peter Shumlin, giving a State of the 
State Address, devoted its entirety to the opioid epidemic in Vermont. 
I remember how stunned people were that a Governor would take such a 
difficult topic and spend his entire address on it. I remember the 
reaction of many of my colleagues here, who said: Peter, isn't that 
dangerous? You are talking about something that is not great for the 
reputation of the State.
  What, in fact, was great for the reputation of the State was that our 
Governor and our leaders acknowledged the existence of a problem that 
was creating heartbreak and heartache in all of our communities; and a 
problem acknowledged is the first step in dealing with a problem to be 
solved.
  Since then, Vermont has been extraordinary in its efforts to attack 
this problem. Communities like Rutland, St. Albans, Barre, and 
Burlington have coordinated with the police force, with our medical 
providers and our hospitals to provide a treatment-based approach to 
helping folks who have an addiction to opioids--many of them coming by 
it as a result of prescriptions for legitimate medical needs.
  We had, in Rutland, a community coming together to create Project 
VISION, which has faith-based groups, the police, and the medical 
community doing everything they can to basically give individual 
attention to folks who are trying to help themselves get off of 
opiates.
  The problem continues to be severe, but what we have is a community 
that is fully engaged in it, including our State legislature, which 
provided funds for treatment--a treatment-based approach--to helping 
people with a hub-and-spoke system that is really working well. Folks 
who are getting prescriptions, folks who have a problem, an addiction, 
are getting access to methadone or other prescribed products, take that 
in a hub so it is supervised, and they are able then to go to work.
  So this has been a situation in Vermont where, as a result of the 
Governor's focus on the problem, we have had community engagement to 
stem the tide of this issue.
  It has been working, but challenges remain because we don't have 
enough treatment funds. This legislation is an important acknowledgment 
on the part of Congress that we are getting it, that across this 
country we are all being affected by the challenges that our 
communities face.
  I thank the sponsors of this legislation, Mr. Pallone, and Mr. Upton, 
too, for their leadership.
  My hope, by the way, is that we get the message, too, in Congress 
that we have got to send some funds back to our communities that are 
struggling with these programs. We can't micromanage the treatment 
here. It is up to the courageous people in our communities to do it, 
and some of the tax dollars that they send to us we have got to send 
back to them. That is why I, among others, am supporting an emergency 
appropriation of $600 million. That would help quite a bit.
  The amendment that I have on this bill, which establishes an 
interagency task force to review, modify, and update the best practices 
for pain management, would ask that we also review developing nonopioid 
forms of pain relief. If opioids diminish pain but they create misery, 
let's find another way to do it and help our folks who need pain relief 
to get it.
  The second thing, it would examine existing nonopioid alternatives 
that could be better utilized.
  So this is tremendous that there has been such a bipartisan coming 
together to sponsor practical steps that we can take. I see us in 
Congress as essentially acknowledging what Governor Shumlin identified 
as a real problem for us and we are hearing about in our communities. 
But I hope we are ready to take some next steps and actually focus on 
getting resources back to our communities that are doing the very, very 
challenging work at the local level where it needs to be done to help 
folks relieve themselves from the addiction of opioids.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Vermont (Mr. Welch).
  The amendment was agreed to.


                Amendment No. 15 Offered by Mr. Sessions

  The Acting CHAIR. It is now in order to consider amendment No. 15 
printed in part A of House Report 114-551.
  Mr. SESSIONS. 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:


[[Page 5686]]

       Page 6, after line 25, insert the following (and 
     redesignate the subsequent subsections accordingly):
       (e) Consideration of Study Results.--In reviewing, 
     modifying, and updating, best practices for pain management 
     and prescribing pain medication, the task force shall take 
     into consideration existing private sector, State, and local 
     government efforts related to pain management and prescribing 
     pain medication.

  The Acting CHAIR. Pursuant to House Resolution 720, the gentleman 
from Texas (Mr. Sessions) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Texas.
  Mr. SESSIONS. Mr. Chairman, I want to take time to recognize the 
gentleman from New Jersey, representing the Energy and Commerce 
Committee, and the gentlewoman from Indiana (Mrs. Brooks) for their 
service not only to this conference, but also to the issues and the 
ideas that are being brought forth.
  The gentlewoman from Indiana has served our Nation as a United States 
attorney in Indiana. She has been on the front line of battles, albeit 
a few years ago, but the front line of battles that the American people 
face, how we protect the American public from all sorts of things that 
get in our way as families and communities. But in this case today, she 
is serving as a Member of Congress firsthand to fight a problem with 
opioids. Opioids are a synthetic heroin, Mr. Chairman, and synthetic 
heroin is a national problem. It is a national problem and one which 
this Congress is undertaking.
  We are following up today on the United States Senate bill and this 
bill that came through regular order in the House of Representatives 
under two primary committees. The Judiciary Committee and the Energy 
and Commerce Committee have addressed bills that are being debated 
today that will be passed, will be done in a bipartisan way, and will 
bring the best ideas of the House of Representatives to the plate. With 
that in mind, that is what I stand for today, sir, to do.
  I join in, as my colleague from Vermont has done, in adding to this 
interagency task force with an amendment that I brought forth that I 
would ask us to consider. I will offer this amendment to ensure that 
the existing best practices of State and local governments, as well as 
the private sector, are specifically considered as the task force which 
was established by H.R. 4641 conducts their business.
  Mr. Chairman, the opportunity for us to understand the amendment 
process means that not only I, but also other Members of this body, 
bring forth ideas that we think are the best ways to combat this 
problem. I believe in State and local governments. I believe in the 
private sector. I think they are the essence of, really, where the 
rubber meets the road on the solution of problems, not to kick around 
ideas and to find something that doesn't work, but to kick around ideas 
that do work.
  Local communities, local governments, and the private sector 
collaborate back home daily. They do this in Dallas, Texas, which is my 
home, which I represent, and we have something that is called the 
Dallas Area Drug Prevention Partnership. It was established in 2007, 
and it represents what I believe is the best collaborative effort 
between local communities focusing on preventing drug abuse.
  A few years ago, Dallas, Texas, the epicenter of something that was a 
heroin epidemic, was looking at a marketing effort by Mexican drug 
dealers with something that was called cheese. Cheese was a marketing 
effort, but it was heroin, and it was being packaged and sold as 
cheese. In fact, it caused the death of some 25 people in Dallas, 
Texas, very quickly before law enforcement recognized what the problem 
was.
  Law enforcement worked with community leaders, church leaders, 
religious leaders, Boy Scout troops, Girl Scout troops, youth groups, 
YMCAs, and we got a handle on what the problem was. But it was not 
solved by the Federal Government. It was not done just by an 
interagency departmental group of people in Washington, D.C. It was 
solved with Washington, D.C., and with people back home who saw the 
problem firsthand, who took responsibility for the problem firsthand.
  In this case, what we are trying to say is we are dealing with a 
nationwide epidemic, a nationwide epidemic which we have spoken very 
plainly about today that is one that is caused through opioid use and 
then the transition to heroin at some point in a person's life. It is 
creating thousands of deaths across our country. Something must be 
done. But the something to be done is a collaborative effort between 
the Federal Government, interagency responsibility up in Washington and 
other places back home, but with State and local organizations and with 
private sector organizations that really will be not just the boots on 
the ground, but many times with the best expertise about the best way 
to do it in the best place.
  Mr. Chairman, I bring forth this amendment. I urge my colleagues to 
support this amendment and the underlying bill.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Texas (Mr. Sessions).
  The amendment was agreed to.
  The Acting CHAIR. The question is on the committee amendment in the 
nature of a substitute, as amended.
  The amendment was agreed to.
  The Acting CHAIR. Under the rule, the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Sessions) having assumed the chair, Mr. Byrne, 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. 4641) to 
provide for the establishment of an inter-agency task force to review, 
modify, and update best practices for pain management and prescribing 
pain medication, and for other purposes, and, pursuant to House 
Resolution 720, he reported the bill back to the House with an 
amendment 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 amendment to the amendment 
reported from the Committee of the Whole?
  If not, the question is on the committee amendment in the nature of a 
substitute, as amended.
  The amendment was 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.
  The SPEAKER pro tempore (Mr. Byrne). 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.
  Mrs. BROOKS of Indiana. Mr. Speaker, on that I demand the yeas and 
nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________