Hi All,
Brownbackhas introduced an Amendment which completely replaces Sen.
Specter's Bill with a completely new Bill........

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BROWNBACK AMENDMENT NO. 4273 (Senate - September 28, 2000)
[Page: S9525]
(Ordered referred to the Committee on Health, Education, Labor, and
Pensions.)

Mr. BROWNBACK submitted an amendment intended to be proposed by him to the
bill (S. 2015) to amend the Public Health Service Act to provide for
research with respect to human embryonic stem cells;
as follows:

Strike all after the enacting clause and insert the following:

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 HEALTHCARE 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.

[Page: S9526]
SEC. 103. DECADE OF PAIN CONTROL AND RESEARCH.

The calendar decade beginning January 1, 2001, is designated as the
`Decade of Pain Control and Research'.

SEC. 104. 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.

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