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114th Congress   }                                      {       Report
                        HOUSE OF REPRESENTATIVES
 2d Session      }                                      {      114-536

======================================================================



 
   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

                                _______
                                

  May 3, 2016.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Upton, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 4641]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
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, having considered the same, report 
favorably thereon with an amendment and recommend that the bill 
as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     3
Background and Need for Legislation..............................     3
Hearings.........................................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     4
Committee Oversight Findings.....................................     4
Statement of General Performance Goals and Objectives............     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     5
Duplication of Federal Programs..................................     5
Disclosure of Directed Rule Makings..............................     6
Advisory Committee Statement.....................................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     6
    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

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.
  (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.

                          PURPOSE AND SUMMARY

    H.R. 4641 would establish an interagency task force to 
review, modify, and update best practices for acute and chronic 
pain management.

                  BACKGROUND AND NEED FOR LEGISLATION

    Health care professionals need accurate, evidence-based 
information to provide quality care to patients with acute and 
chronic pain while minimizing the potential for the development 
of substance use disorder and overdose when prescribing 
opioids. This bill will ensure that current treatment 
guidelines and best practices continue to be reviewed and, if 
appropriate, updated in a transparent manner by a wide-range of 
government agencies, experts in the field, and patient 
representatives.

                                HEARINGS

    On October 8, 2015, the Subcommittee on Health held a 
hearing entitled ``Examining Legislative Proposals to Combat 
Our Nation's Drug Abuse Crisis'' and received testimony from:
           Allen Anderson, President, American 
        Orthopaedic Society for Sports Medicine;
           Michael Botticelli, Director, Office of 
        National Drug Control Policy;
           Richard Frank, Assistant Secretary for 
        Planning and Evaluation, Department of Health and Human 
        Services;
           Paul Halverson, Dean, Indiana University;
           Richard M. Fairbanks School of Public 
        Health;
           Kenneth Katz, Lehigh Valley Health Network, 
        Department of Emergency Medicine;
           Chapman Sledge, Chief Medical Officer, 
        Cumberland Heights; and,
           Robert Corey Waller, Chair, Legislative 
        Advocacy Committee, American Society of Addiction 
        Medicine.

                        COMMITTEE CONSIDERATION

    On April 20, 2016, the Subcommittee on Health met in open 
markup session and forwarded H.R. 4641, as amended, to the full 
Committee by a voice vote. On April 26, 27, and 28, 2016, the 
full Committee met in open markup session and ordered H.R. 
4641, as amended, favorably reported to the House by a voice 
vote.

                            COMMITTEE VOTES

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 4641 reported.

                      COMMITTEE OVERSIGHT FINDINGS

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held a hearing and made 
findings that are reflected in this report.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    The purpose of this act is to ensure health care providers 
have evidence-based guidelines and best practices for treating 
patients with acute and chronic pain.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
4641 would result in no new or increased budget authority, 
entitlement authority, or tax expenditures or revenues.

       EARMARK, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI 
of the Rules of the House of Representatives, the Committee 
finds that H.R. 4641 contains no earmarks, limited tax 
benefits, or limited tariff benefits.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  CONGRESSIONAL BUDGET OFFICE ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                       Washington, DC, May 3, 2016.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce,
U.S. House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 4641, a bill 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.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Andrea Noda.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 4641--A bill 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.

    H.R. 4641 would require the Secretary of the Department of 
Health and Human Services (HHS) to establish a task force to 
review and modify best practices for the treatment of pain. The 
Secretary of HHS would be required to coordinate with the 
Secretary of Veterans Affairs, the Secretary of Defense, and 
the Administrator of the Drug Enforcement Administration. Task 
force members would include representatives from relevant 
federal agencies, medical professionals, researchers, and 
individuals who have specific expertise in pain management and 
addiction to pain medication. The task force would issue a 
report to Congress on its findings, which would include a 
strategy for disseminating information to relevant medical 
professionals about best practices in pain management.
    CBO estimates that implementing H.R. 4641 would cost $2 
million over the 2016-2021 period, assuming appropriation of 
the estimated amounts, mostly to cover administrative expenses 
associated with the task force. Estimated outlays are based on 
information from affected agencies and historical spending for 
similar types of initiatives. Enacting H.R. 4641 would not 
affect direct spending or revenues; therefore, pay-as-you-go 
procedures do not apply.
    CBO estimates that enacting H.R. 4641 would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year period beginning in 2027.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Andrea Noda. The 
estimate was approved by Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                    DUPLICATION OF FEDERAL PROGRAMS

    No provision of H.R. 4641 establishes or reauthorizes a 
program of the Federal Government known to be duplicative of 
another Federal program, a program that was included in any 
report from the Government Accountability Office to Congress 
pursuant to section 21 of Public Law 111-139, or a program 
related to a program identified in the most recent Catalog of 
Federal Domestic Assistance.

                  DISCLOSURE OF DIRECTED RULE MAKINGS

    The Committee estimates that enacting H.R. 4641 does not 
direct any specific rule making within the meaning of 5 U.S.C. 
551.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Development of best practices for the use of prescription 
        opioids

    The bill would require the Secretary of Health and Human 
Services to convene a Pain Management Best Practices Inter-
Agency Task Force. The Task Force shall be comprised of 
representatives from several Federal agencies; state medical 
boards; health care practitioners; pharmacists; experts from 
both the pain and addiction recovery community; and other 
stakeholders.
    The Task Force shall be convened no later than December 14, 
2018, and, within 180 days, review, modify, and update best 
practices for acute and chronic pain management. The Task Force 
shall, among other things, consider existing pain management 
research and guidelines, including the 2016 Guideline for 
Prescribing Opioids for Chronic Pain issued by the Centers for 
Disease Control and Prevention, as well as ongoing State, 
local, and medical professional organization efforts to develop 
pain management strategies. Further, the Task Force shall 
develop a strategy for the dissemination of such best practices 
to health care professionals and report to Congress within 270 
days.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    This legislation does not amend any existing Federal 
statute.

                                  [all]