article: SECTION 1. SHORT TITLE. This Act may be cited as the ``Pain Relief Promotion Act of 2000''. SEC. 2. FINDINGS. Congress finds that-- (1) in the first decade of the new millennium there should be a new emphasis on pain management and palliative care; (2) the use of certain narcotics and other drugs or substances with a potential for abuse is strictly regulated under the Controlled Substances Act; (3) the dispensing and distribution of certain controlled substances by properly registered practitioners for legitimate medical purposes are permitted under the Controlled Substances Act and implementing regulations; (4) the dispensing or distribution of certain controlled substances for the purpose of relieving pain and discomfort even if it increases the risk of death is a legitimate medical purpose and is permissible under the Controlled Substances Act; (5) inadequate treatment of pain, especially for chronic diseases and conditions, irreversible diseases such as cancer, and end-of-life care, is a serious public health problem affecting hundreds of thousands of patients every year; physicians should not hesitate to dispense or distribute controlled substances when medically indicated for these conditions; and (6) for the reasons set forth in section 101 of the Controlled Substances Act (21 U.S.C. 801), the dispensing and distribution of controlled substances for any purpose affect interstate commerce. TITLE I--PROMOTING PAIN MANAGEMENT AND PALLIATIVE CARE SEC. 101. ACTIVITIES OF AGENCY FOR HEALTH CARE RESEARCH AND QUALITY. Part A of title IX of the Public Health Service Act (42 U.S.C. 299 et seq.) is amended by adding at the end the following: ``SEC. 903. PROGRAM FOR PAIN MANAGEMENT AND PALLIATIVE CARE RESEARCH AND QUALITY. ``(a) In General.--Subject to subsections (e) and (f) of section 902, the Director shall carry out a program to accomplish the following: ``(1) Promote and advance scientific understanding of pain management and palliative care. ``(2) Collect and disseminate protocols and evidence-based practices regarding pain management and palliative care, with priority given to pain management for terminally ill patients, and make such information available to public and private health care programs and providers, health professions schools, and hospices, and to the general public. ``(b) Definition.--In this section, the term `pain management and palliative care' means-- ``(1) the active, total care of patients whose disease or medical condition is not responsive to curative treatment or whose prognosis is limited due to progressive, far-advanced disease; and ``(2) the evaluation, diagnosis, treatment, and management of primary and secondary pain, whether acute, chronic, persistent, intractable, or associated with the end of life; the purpose of which is to diagnose and alleviate pain and other distressing signs and symptoms and to enhance the quality of life, not to hasten or postpone death.''. SEC. 102. ACTIVITIES OF HEALTH RESOURCES AND SERVICES ADMINISTRATION. (a) In General.--Part D of title VII of the Public Health Service Act (42 U.S.C. 294 et seq.) is amended-- (1) by redesignating sections 754 through 757 as sections 755 through 758, respectively; and (2) by inserting after section 753 the following: ``SEC. 754. PROGRAM FOR EDUCATION AND TRAINING IN PAIN MANAGEMENT AND PALLIATIVE CARE. ``(a) In General.--The Secretary, in consultation with the Director of the Agency for Healthcare Research and Quality, may award grants, cooperative agreements, and contracts to health professions schools, hospices, and other public and private entities for the development and implementation of programs to provide education and training to health care professionals in pain management and palliative care. ``(b) Priority.--In making awards under subsection (a), the Secretary shall give priority to awards for the implementation of programs under such subsection. ``(c) Certain Topics.--An award may be made under subsection (a) only if the applicant for the award agrees that the program to be carried out with the award will include information and education on-- ``(1) means for diagnosing and alleviating pain and other distressing signs and symptoms of patients, especially terminally ill patients, including the medically appropriate use of controlled substances; ``(2) applicable laws on controlled substances, including laws permitting health care professionals to dispense or administer controlled substances as needed to relieve pain even in cases where such efforts may unintentionally increase the risk of death; and ``(3) recent findings, developments, and improvements in the provision of pain management and palliative care. ``(d) Program Sites.--Education and training under subsection (a) may be provided at or through health professions schools, residency training programs and other graduate programs in the health professions, entities that provide continuing medical education, hospices, and such other programs or sites as the Secretary determines to be appropriate. ``(e) Evaluation of Programs.--The Secretary shall (directly or through grants or contracts) provide for the evaluation of programs implemented under subsection (a) in order to determine the effect of such programs on knowledge and practice regarding pain management and palliative care. ``(f) Peer Review Groups.--In carrying out section 799(f) with respect to this section, the Secretary shall ensure that the membership of each peer review group involved includes individuals with expertise and experience in pain management and palliative care for the population of patients whose needs are to be served by the program. ``(g) Definition.--In this section, the term `pain management and palliative care' means-- ``(1) the active, total care of patients whose disease or medical condition is not responsive to curative treatment or whose prognosis is limited due to progressive, far-advanced disease; and ``(2) the evaluation, diagnosis, treatment, and management of primary and secondary pain, whether acute, chronic, persistent, intractable, or associated with the end of life; the purpose of which is to diagnose and alleviate pain and other distressing signs and symptoms and to enhance the quality of life, not to hasten or postpone death.''. (b) Authorization of Appropriations; Allocation.-- (1) In general.--Section 758 of the Public Health Service Act (as redesignated by subsection (a)(1) of this section) is amended, in subsection (b)(1)(C), by striking ``sections 753, 754, and 755'' and inserting ``sections 753, 754, 755, and 756''. (2) Amount.--With respect to section 758 of the Public Health Service Act (as redesignated by subsection (a)(1) of this section), the dollar amount specified in subsection (b)(1)(C) of such section is deemed to be increased by $5,000,000. SEC. 103. EFFECTIVE DATE. The amendments made by this title shall take effect on the date of enactment of this Act. TITLE II--USE OF CONTROLLED SUBSTANCES CONSISTENT WITH THE CONTROLLED SUBSTANCES ACT SEC. 201. REINFORCING EXISTING STANDARD FOR LEGITIMATE USE OF CONTROLLED SUBSTANCES. (a) In General.--Section 303 of the Controlled Substances Act (21 U.S.C. 823) is amended by adding at the end the following: ``(i)(1) For purposes of this Act and any regulations to implement this Act, alleviating pain or discomfort in the usual course of professional practice is a legitimate medical purpose for the dispensing, distributing, or administering of a controlled substance that is consistent with public health and safety, even if the use of such a substance may increase the risk of death. Nothing in this section authorizes intentionally dispensing, distributing, or administering a controlled substance for the purpose of causing death or assisting another person in causing death. ``(2)(A) Notwithstanding any other provision of this Act, in determining whether a registration is consistent with the public interest under this Act, the Attorney General shall give no force and effect to State law authorizing or permitting assisted suicide or euthanasia. ``(B) Paragraph (2) applies only to conduct occurring after the date of enactment of this subsection. ``(3) Nothing in this subsection shall be construed to alter the roles of the Federal and State governments in regulating the practice of medicine. Regardless of whether the Attorney General determines pursuant to this section that the registration of a practitioner is inconsistent with the public interest, it remains solely within the discretion of State authorities to determine whether action should be taken with respect to the State professional license of the practitioner or State prescribing privileges. ``(4) Nothing in the Pain Relief Promotion Act of 2000 (including the amendments made by such Act) shall be construed-- ``(A) to modify the Federal requirements that a controlled substance be dispensed only for a legitimate medical purpose pursuant to paragraph (1); or ``(B) to provide the Attorney General with the authority to issue national standards for pain management and palliative care clinical practice, research, or quality; except that the Attorney General may take such other actions as may be necessary to enforce this Act.''. (b) Pain Relief.--Section 304(c) of the Controlled Substances Act (21 U.S.C. 824(c)) is amended-- (1) by striking ``(c) Before'' and inserting the following: ``(c) Procedures.-- ``(1) Order to show cause.--Before''; and (2) by adding at the end the following: ``(2) Burden of proof.--At any proceeding under paragraph (1), where the order to show cause is based on the alleged intentions of the applicant or registrant to cause or assist in causing death, and the practitioner claims a defense under paragraph (1) of section 303(i), the Attorney General shall have the burden of proving, by clear and convincing evidence, that the practitioner's intent was to dispense, distribute, or administer a controlled substance for the purpose of causing death or assisting another person in causing death. In meeting such burden, it shall not be sufficient to prove that the applicant or registrant knew that the use of controlled substance may increase the risk of death.''. SEC. 202. EDUCATION AND TRAINING PROGRAMS. Section 502(a) of the Controlled Substances Act (21 U.S.C. 872(a)) is amended-- (1) by striking ``and'' at the end of paragraph (5); (2) by striking the period at the end of paragraph (6) and inserting ``; and''; and (3) by adding at the end the following: ``(7) educational and training programs for Federal, State, and local personnel, incorporating recommendations, subject to the provisions of subsections (e) and (f) of section 902 of the Public Health Service Act, by the Secretary of Health and Human Services, on the means by which investigation and enforcement actions by law enforcement personnel may better accommodate the necessary and legitimate use of controlled substances in pain management and palliative care. Nothing in this subsection shall be construed to alter the roles of the Federal and State governments in regulating the practice of medicine.''. SEC. 203. FUNDING AUTHORITY. Notwithstanding any other provision of law, the operation of the diversion control fee account program of the Drug Enforcement Administration shall be construed to include carrying out section 303(i) of the Controlled Substances Act (21 U.S.C. 823(i)), as added by this Act, and subsections (a)(4) and (c)(2) of section 304 of the Controlled Substances Act (21 U.S.C. 824), as amended by this Act. SEC. 204. EFFECTIVE DATE. The amendments made by this title shall take effect on the date of enactment of this Act.
summary: (Sec. 102) Authorizes the Secretary of Health and Human Services to award grants, cooperative agreements, and contracts for development and implementation of programs to provide education and training to health care professionals in pain management and palliative care. Defines "pain management and palliative care" as certain types of actions, the purpose of which is to diagnose and alleviate pain and other distressing signs and symptoms and to enhance the quality of life, not to hasten or postpone death. Adds the provisions of this paragraph to the list of provisions for which the Secretary is required to make a specified amount available and increases the amount specified. Title II: Use of Controlled Substances Consistent With the Controlled Substances Act - Amends the Controlled Substances Act to declare that, for that Act and any implementing regulations, alleviating pain or discomfort in the usual course of professional practice is a legitimate medical purpose for the dispensing, distributing, or administering of a controlled substance that is consistent with public health and safety, even if it may increase the risk of death. Prohibits the Attorney General, in determining whether a registration (to manufacture, distribute, or dispense controlled substances) is consistent with the public interest, from giving any force and effect to State law authorizing or permitting assisted suicide or euthanasia, notwithstanding any other provision of the Act, and with regard to conduct after enactment of this Act. Gives the Attorney General, in an action to deny, revoke, or suspend a registration based on alleged intentions to cause or assist in causing death, the burden of proving, by clear and convincing evidence, that the intent was to cause death or assist another person in causing death. Declares that the burden is not met by proving that the applicant or registrant knew that the use of the controlled substance may increase the risk of death. (Sec. 202) Authorizes the Attorney General to carry out education and training programs for Federal, State, and local personnel on the means by which investigation and enforcement actions by law enforcement personnel may better accommodate the necessary and legitimate use of controlled substances in pain management and palliative care. (Sec. 203) Requires, notwithstanding any other provision of law, construing the operation of the diversion control fee account program of the Drug Enforcement Administration to include carrying out the provisions of this title (other than section 203).