,,ii ,calendar ,no4 #bdf #aadth ,,congress #ast ,session ,s4 #gii ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,march #ai1 #bjae,mr4 ,mc,connell 7for himself and ,mr4 ,casey1 ,ms4 ,ayotte1 ,mr4 ,portman1 ,mr4 ,isakson1 ,ms4 ,baldwin1 ,mr4 ,whitehouse1 ,mr4 ,corker1 ,mr4 ,brown1 ,mr4 ,coons1 ,mrs4 ,gillibrand1 ,mrs4 ,capito1 ,mrs4 ,fischer1 ,mr4 ,vitter1 ,mr4 ,boozman1 ,mr4 ,cotton1 ,mr4 ,donnelly1 ,mr4 ,king1 ,mr4 ,carper1 ,ms4 ,collins1 ,mrs4 ,murray1 and ,mr4 ,toomey7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,october #a1 #bjae,reported by ,mr4 ,alexander1 with an amendment and an amendment to the title,strike out all after the enacting clause and insert the part printed in italic ,a ,,bill ,to combat the rise of prenatal opioid abuse and neonatal abstinence syndrome4 #a4 ,short title ,this ,act may be cited as the ,protecting ,our ,infants ,act of #bjae4 #b4 ,findings ,congress finds as follows3 7#a7 ,opioid prescription rates have risen dramatically over the past several years4 ,according to the ,centers for ,disease ,control and ,prevention1 in some ,states1 there are as many as #if to #adc prescriptions for opioids per #ajj adults per year4 7#b7 ,in recent years1 there has been a steady rise in the number of overdose deaths involving heroin4 ,according to the ,centers for ,disease ,control and ,prevention1 the death rate for heroin overdose doubled from #bjaj to #bjab4 7#c7 ,at the same time1 there has been an increase in cases of neonatal abstinence syndrome 7referred to in this section as ,,nas74 ,in the ,united ,states1 the incidence of ,,nas has risen from #a4bj per #a1jjj hospital births in #bjjj to #c4ci per #a1jjj hospital births in #bjji4 7#d7 ,,nas refers to medical issues associated with drug withdrawal in newborns due to exposure to opioids or other drugs in utero4 7#e7 ,the average cost of treatment in a hospital for ,,nas increased from #ci1djj in #bjjj to #ec1djj in #bjji4 ,most of these costs are born by the ,medicaid program4 7#f7 ,preventing opioid abuse among pregnant women and women of childbearing age is crucial4 7#g7 ,medically-appropriate opioid use in pregnancy is not uncommon1 and opioids are often the safest and most appropriate treatment for moderate to severe pain for pregnant women4 7#h7 ,addressing ,,nas effectively requires a focus on women of childbearing age1 pregnant women1 and infants from preconception through early childhood4 7#i7 ,,nas can result from the use of prescription drugs as prescribed for medical reasons1 from the abuse of prescription drugs1 or from the use of illegal opioids like heroin4 7#aj7 ,for pregnant women who are abusing opioids1 it is most appropriate to treat and manage maternal substance use in a non-punitive manner4 7#aa7 ,according to a report of the ,government ,accountability ,office 7referred to in this section as the ,,gao report71 more research is needed to optimize the identification and treatment of babies with ,,nas and to better understand long-term impacts on children4 7#ab7 ,according to the ,,gao report1 the ,department of ,health and ,human ,services does not have a focal point to lead planning and coordinating efforts to address prenatal opioid use and ,,nas across the department4 7#ac7 ,according to the ,,gao report1 given the increasing use of heroin and abuse of opioids prescribed for pain management1 as well as the increased rate of ,,nas in the ,united ,states1 it is important to improve the efficiency and effectiveness of planning and coordination of ,federal efforts on prenatal opioid use and ,,nas4 #c4 ,developing recommendations for preventing and treating prenatal opioid abuse and neonatal abstinence syndrome 7a7 ,in general ,the ,secretary of ,health and ,human ,services 7referred to in this ,act as the ,secretary71 acting through the ,director of the ,agency for ,healthcare ,research and ,quality 7referred to in this section as the ,director71 shall conduct a study and develop recommendations for preventing and treating prenatal opioid abuse and neonatal abstinence syndrome1 soliciting input from nongovernmental entities1 including organizations representing patients1 health care providers1 hospitals1 other treatment facilities1 and other entities1 as appropriate4 7b7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,director shall publish on the ,internet ,web site of the ,agency for ,healthcare ,research and ,quality a report on the study and recommendations under subsection 7a74 ,such report shall address each of the issues described in paragraphs 7#a7 through 7#c7 of subsection 7c74 7c7 ,contents ,the study described in subsection 7a7 and the report under subsection 7b7 shall include-- 7#a7 a comprehensive assessment of existing research with respect to the prevention1 identification1 treatment1 and long-term outcomes of neonatal abstinence syndrome1 including the identification and treatment of pregnant women or women who may become pregnant who use opioids or other drugs2 7#b7 an evaluation of-- 7,a7 the causes of and risk factors for opioid use disorders among women of reproductive age1 including pregnant women2 7,b7 the barriers to identifying and treating opioid use disorders among women of reproductive age1 including pregnant and postpartum women and women with young children2 7,c7 current practices in the health care system to respond to and treat pregnant women with opioid use disorders and infants born with neonatal abstinence syndrome2 7,d7 medically indicated use of opioids during pregnancy2 7,e7 access to treatment for opioid use disorders in pregnant and postpartum women2 and 7,f7 access to treatment for infants with neonatal abstinence syndrome2 and 7#c7 recommendations on-- 7,a7 preventing1 identifying1 and treating neonatal abstinence syndrome in infants2 7,b7 treating pregnant women who are dependent on opioids2 and 7,c7 preventing opioid dependence among women of reproductive age1 including pregnant women1 who may be at risk of developing opioid dependence4 #d4 ,improving prevention and treatment for prenatal opioid abuse and neonatal abstinence syndrome 7a7 ,review of programs ,the ,secretary shall lead a review of planning and coordination within the ,department of ,health and ,human ,services related to prenatal opioid use and neonatal abstinence syndrome4 7b7 ,strategy to close gaps in research and programming ,in carrying out subsection 7a71 the ,secretary shall develop a strategy to address research and program gaps1 including such gaps identified in findings made by reports of the ,government ,accountability ,office4 ,such strategy shall address-- 7#a7 gaps in research1 including with respect to-- 7,a7 the most appropriate treatment of pregnant women with opioid use disorders2 7,b7 the most appropriate treatment and management of infants with neonatal abstinence syndrome2 and 7,c7 the long-term effects of prenatal opioid exposure on children2 and 7#b7 gaps in programs1 including-- 7,a7 the availability of treatment programs for pregnant and postpartum women and for newborns with neonatal abstinence syndrome2 and 7,b7 guidance and coordination in ,federal efforts to address prenatal opioid use or neonatal abstinence syndrome4 7c7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report on the findings of the review described in subsection 7a7 and the strategy developed under subsection 7b74 #e4 ,improving data on and public health response to neonatal abstinence syndrome 7a7 ,data and surveillance ,the ,director of the ,centers for ,disease ,control and ,prevention shall1 as appropriate-- 7#a7 provide technical assistance to ,states to improve the availability and quality of data collection and surveillance activities regarding neonatal abstinence syndrome1 including-- 7,a7 the incidence and prevalence of neonatal abstinence syndrome2 7,b7 the identification of causes for neonatal abstinence syndrome1 including new and emerging trends2 and 7,c7 the demographics and other relevant information associated with neonatal abstinence syndrome2 7#b7 collect available surveillance data described in paragraph 7#a7 from ,states1 as applicable2 and 7#c7 make surveillance data collected pursuant to paragraph 7#b7 publically available on an appropriate ,internet ,web site4 7b7 ,public health response ,the ,director of the ,centers for ,disease ,control and ,prevention shall encourage increased utilization of effective public health measures to reduce neonatal abstinence syndrome4 #a4 ,short title ,this ,act may be cited as the ,protecting ,our ,infants ,act of #bjae4 #b4 ,addressing problems related to prenatal opioid use 7a7 ,review of programs ,the ,secretary of ,health and ,human ,services 7referred to in this ,act as the ,secretary7 shall conduct a review of planning and coordination related to prenatal opioid use1 including neonatal abstinence syndrome1 within the agencies of the ,department of ,health and ,human ,services4 7b7 ,strategy ,in carrying out subsection 7a71 the ,secretary shall develop a strategy to address gaps in research and gaps1 overlap1 and duplication among ,federal programs1 including those identified in findings made by reports of the ,government ,accountability ,office4 ,such strategy shall address-- 7#a7 gaps in research1 including with respect to-- 7,a7 the most appropriate treatment of pregnant women with opioid use disorders2 7,b7 the most appropriate treatment and management of infants with neonatal abstinence syndrome2 and 7,c7 the long-term effects of prenatal opioid exposure on children2 7#b7 gaps1 overlap1 or duplication in-- 7,a7 substance use disorder treatment programs for pregnant and postpartum women2 and 7,b7 treatment program options for newborns with neonatal abstinence syndrome2 7#c7 gaps1 overlap1 or duplication in ,federal efforts related to education about1 and prevention of1 neonatal abstinence syndrome2 and 7#d7 coordination of ,federal efforts to address neonatal abstinence syndrome4 7c7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives a report concerning the findings of the review conducted under subsection 7a7 and the strategy developed under subsection 7b74 #c4 ,developing recommendations for preventing and treating prenatal opioid use disorders 7a7 ,in general ,the ,secretary shall conduct a study and develop recommendations for preventing and treating prenatal opioid use disorders1 including the effects of such disorders on infants4 ,in carrying out this subsection the ,secretary shall-- 7#a7 take into consideration-- 7,a7 the review and strategy conducted and developed under section #b2 and 7,b7 the lessons learned from previous opioid epidemics2 and 7#b7 solicit input from ,states1 localities1 and ,federally recognized ,indian tribes or tribal organizations 7as defined in the ,indian ,self-,determination and ,education ,assistance ,act 7#be ,u4,s4,c4 #dej;b771 and nongovernmental entities1 including organizations representing patients1 health care providers1 hospitals1 other treatment facilities1 and other entities1 as appropriate4 7b7 ,report ,not later than #ah months after the date of enactment of this ,act1 the ,secretary shall make available on the appropriate ,internet ,website of the ,department of ,health and ,human ,services a report on the recommendations under subsection 7a74 ,such report shall address each of the issues described in subsection 7c74 7c7 ,contents ,the recommendations described in subsection 7a7 and the report under subsection 7b7 shall include-- 7#a7 a comprehensive assessment of existing research with respect to the prevention1 identification1 treatment1 and long-term outcomes of neonatal abstinence syndrome1 including the identification and treatment of pregnant women or women who may become pregnant who use opioids or have opioid use disorders2 7#b7 an evaluation of-- 7,a7 the causes of1 and risk factors for1 opioid use disorders among women of reproductive age1 including pregnant women2 7,b7 the barriers to identifying and treating opioid use disorders among women of reproductive age1 including pregnant and postpartum women and women with young children2 7,c7 current practices in the health care system to respond to1 and treat1 pregnant women with opioid use disorders and infants affected by such disorders2 7,d7 medically indicated uses of opioids during pregnancy2 7,e7 access to treatment for opioid use disorders in pregnant and postpartum women2 and 7,f7 access to treatment for infants with neonatal abstinence syndrome2 and 7,g7 differences in prenatal opioid use and use disorders in pregnant women between demographic groups2 and 7#c7 recommendations on-- 7,a7 preventing1 identifying1 and treating the effects of prenatal opioid use on infants2 7,b7 treating pregnant women who have opioid use disorders2 7,c7 preventing opioid use disorders among women of reproductive age1 including pregnant women1 who may be at risk of developing opioid use disorders2 and 7,d7 reducing disparities in opioid use disorders among pregnant women4 #d4 ,improving data and the public health response ,the ,secretary may continue activities1 as appropriate1 related to-- 7#a7 providing technical assistance to support ,states and ,federally recognized ,indian ,tribes in collecting information on neonatal abstinence syndrome through the utilization of existing surveillance systems and collaborating with ,states and ,federally recognized ,indian ,tribes to improve the quality1 consistency1 and collection of such data2 and 7#b7 providing technical assistance to support ,states in implementing effective public health measures1 such as disseminating information to educate the public1 health care providers1 and other stakeholders on prenatal opioid use and neonatal abstinence syndrome4 ,amend the title so as to read3 ,to address problems related to prenatal opioid use44 ,october #a1 #bjae,reported with an amendment and an amendment to the title