BILL ANALYSIS
AB 547
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Date of Hearing: April 5, 2004
ASSEMBLY COMMITTEE ON HEALTH
Wilma Chan, Chair
AB 547 (Berg and Richman) - As Introduced: February 16, 2005
SUBJECT : Clean needle and syringe exchange projects.
SUMMARY : Creates the Clean Needle and Syringe Exchange
Program. Specifically, this bill :
1)Makes a number of findings and declarations regarding the
relationship between injection drug use and the human
immunodeficiency virus and acquired immune deficiency syndrome
(HIV/AIDS).
2)Exempts public entities, its agents, or employees from being
subject to criminal prosecution for distributing needles or
syringes as part of a locally authorized clean needle and
syringe exchange project (NEP) pursuant to this bill, without
a declaration of a local emergency.
3)Authorizes clean NEPs in any city and county, county, or city
upon the action of:
a) A county board of supervisors and the local health
officer or health commission of that county;
b) The city council, the mayor, and the local health
officer of a city with a health department; or,
c) The city council and the mayor of a city without a
health department.
4)Requires cities, counties, or cities and counties that act to
authorize a NEP pursuant to this bill to, in consultation with
the Department of Health Services (DHS), authorize the
exchange of clean hypodermic needles and syringes as
recommended by the United States Secretary of Health and Human
Services subject to the availability of funding, as part of a
network of comprehensive services, including treatment
services, to combat the spread of HIV and blood-borne
hepatitis infection among injection drug users.
5)Exempts providers of and participants in a NEP authorized by
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the county, city, or city and county pursuant to this bill
from being subject to criminal prosecution for possession of
needles or syringes during participation in a NEP.
EXISTING LAW :
1)Permits a NEP to be authorized pursuant to the declaration of
a local emergency called by the governing body of a city,
county, or city and county, or by an ordinance adopted by that
body. Prohibits the local emergency from remaining in effect
for more than seven days unless it has been ratified.
Requires the governing body to review the emergency at its
regularly scheduled meetings, no more than 21 days after the
previous review, or, if the governing body meets weekly,
requires the local emergency be reviewed at least every 14
days until the emergency is terminated.
2)Exempts a public entity and its agents or employees from
criminal prosecution for distributing hypodermic needles or
syringes to participants of a clean needle and syringe
exchange project authorized by the public entity pursuant to a
declaration of a local emergency due to the existence of a
critical local public health crisis.
FISCAL EFFECT : Unknown
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, current law
authorizes cities and counties to establish and operate needle
exchange programs only after the declaration of a local
emergency. The declaration must then be renewed every two
weeks by the Board of Supervisors or the City Council. This
renewal process has put effective needle exchange programs in
a perilous state; one absent supervisor can effectively make a
well-funded needle exchange program "illegal" until the next
declaration. It is crucial that action be taken to ensure
that needle exchange programs run efficiently, as they are a
successful tool in combating HIV and AIDS in California and
throughout the nation. This bill is necessary to ensure that
needle exchange programs and local governments can effectively
combat the amount of HIV/AIDS and Hepatitis C cases statewide.
2)BACKGROUND . According to DHS, 1,500 new syringe-sharing HIV
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infections occur annually. However, this number does not
account for women infected through sexual contact with
intravenous drug users (IDUs) or infants born to these women.
Additionally, there are 5,000 new cases of needle-related
hepatitis C virus in California each year. A 2000 DHS report
regarding HIV/AIDS and racial/ethnic groups states that the
link between injection drug use and HIV is strong for women
and people of color. In California, 37% of AIDS cases among
women, 24% of AIDS cases among African Americans, and 22% of
AIDS cases among Latinas are directly attributable to needle
sharing.
3)EFFECTIVENESS OF NEEDLE EXCHANGE PROGRAMS (NEPS) . Currently,
14 California cities and counties have authorized NEPs. To
participate in a NEP, injection drug users are required to
exchange a used syringe for a new, sterile needle. In over 80
cities in 38 states, NEPs have been created with the goal of
minimizing the risk of HIV infection among IDUs. In addition
to needle exchange, NEPs often provide peer education and
referrals to drug treatment centers and methadone clinics. A
study of San Francisco's NEP found that the program did not
encourage increased drug use. Over a five year period, there
was no significant increase in new IDUs or an increase in drug
use by current users. In fact, the frequency of injecting
among study participants decreased from an average of two
injections per day to less than one, and the rate of new IDUs
decreased from 3% to 1%. In 2002, DHS concluded that there is
conclusive scientific evidence that NEPs, as part of
comprehensive HIV prevention strategies, are an effective
public health intervention that reduces transmission of HIV
and does not encourage the illegal use of drugs. The U.S.
Public Health Service recommends that drug users who continue
to inject use a new sterile syringe for each injection to
prevent the transmission of blood-borne diseases.
4)LOCAL EMERGENCY REQUIREMENT . Under current law, County Boards
of Supervisors or City Councils must declare a local emergency
in order to implement a NEP. If a local government wishes to
continue their NEP, they must renew the local emergency
declaration every 14 to 21 days. A February 2002 Henry J.
Kaiser Family Foundation report about needle exchange in six
California communities found that this requirement may limit
the ability to implement NEPs, even in communities where there
is significant political support for them. The report states
that the renewal requirement is administratively burdensome
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and creates an unnecessary barrier for local jurisdictions.
The authors go on to recommend reconsideration of the
requirement to continually renew local declarations of
emergency or reducing emergency renewal requirements.
5)PREVIOUS LEGISLATION . This bill duplicates the introduced
version of AB 2871 (Berg) from last year. The Governor vetoed
that bill, saying: "I am willing to reconsider the concept of
this bill in the future if there are appropriate local control
measures in place." In 2002, AB 946 (Berg) contained language
similar to this bill, and was also vetoed by then Governor
Davis. In his veto message, the Governor stated that the bill
"undermines the key element" of a bill that he had previously
signed which he asserted "decriminalize(s) supervised needle
exchange programs." That bill, AB 136 (Mazzoni), Chapter 762,
Statutes of 1999, permitted NEPs that are authorized by a
county or city, based on the declaration of a local emergency.
6)SUPPORT . The sponsor of this bill, the Health Officers
Association of California , states that the current
bureaucratic hurdles not only wastes time, but also creates
instability in NEPs. A recent survey of local health officers
indicated that 21 counties felt that eliminating of the
emergency declaration would facilitate the establishment and
maintenance of more needle exchange projects. AIDS Project
Los Angeles contends that nearly 20% of AIDS cases and half of
hepatitis C cases in California are related to injection drug
use and needle sharing and that this bill will help reduce the
spread of those diseases. The Drug Policy Alliance Network
writes that studies by the Kaiser Family Foundation and RAND
conclude that current law authorizing NEPs contains several
flaws that limit the ability of public health officers and
non-profit health organizations to implement effective
programs and this bill contains necessary remedies to create
new programs that will save lives.
7)OPPOSITION . The California Peace Officers Association writes
that local governments must constantly strike balances between
the public health dimensions of needles programs and the
crime/quality of life dimensions of a community and this bill
removes that balance by removing all of the requirements of
ongoing oversight and reauthorization of the NEP.
REGISTERED SUPPORT / OPPOSITION :
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Support
Health Officers Association of California (Sponsor)
AIDS Project Los Angeles
Alameda County Board of Supervisors
Board of Supervisors of Marin County
County Health Executives Association of California
Drug Policy Alliance Network
Equality California
Ministry in Action Commission
Santa Clara County Board of Supervisors
Opposition
California Peace Officers Association
Traditional Values Coalition
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097