BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: AB 547
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AUTHOR: Berg and Richman
B
AMENDED: As Introduced
HEARING DATE: June 29, 2005
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FISCAL: Appropriations
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CONSULTANT:
Margolis / ag
SUBJECT
Clean needle and syringe exchange projects
SUMMARY
This bill creates the Clean Needle and Syringe Exchange
Program, which eliminates the statutory requirement for a
declaration of a local emergency by a public entity in
order to operate a needle exchange program.
ABSTRACT
Existing law:
1.Permits a needle exchange program (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.
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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.
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 NEP
pursuant to this bill, without a declaration of a local
emergency.
3.Authorizes a NEP 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 the county, city, or city and county pursuant to this
bill from being subject to criminal prosecution for
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possession of needles or syringes during participation in
a NEP.
FISCAL IMPACT
According to the Assembly Appropriations Committee:
1.No state fiscal impact to authorize needle exchange
programs for a longer period of time as these programs
are established by local governments at their option.
2.Indeterminate state treatment savings to state-funded
health programs such as Medi-Cal and the AIDS Drug
Assistance Program (ADAP) to the extent new HIV and
hepatitis cases are reduced. In 2002-03, the average
monthly cost for prescriptions for each ADAP beneficiary
was $998, and the average monthly Medi-Cal cost per user
for individuals with HIV/AIDS is $1,914.
BACKGROUND AND DISCUSSION
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. According to the author, this renewal process has
put effective NEPs in a perilous state; one absent
supervisor can effectively make a well-funded NEPs
"illegal" until the next declaration. The author asserts
that it is crucial that action be taken to ensure that
needle exchange programs run efficiently, as they are a
successful tool in combating HIV/AIDS in California and
throughout the nation. Supporters of this bill believe
that the 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.
According to DHS, 1,500 new syringe-sharing HIV 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 percent of AIDS cases
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among women, 24 percent of AIDS cases among African
Americans, and 22 percent of AIDS cases among Latinas are
directly attributable to needle sharing.
Effectiveness of needle exchange programs
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 three percent to one percent. In 2002,
DHS concluded that there is conclusive scientific evidence
that NEPs, as part of comprehensive HIV/AIDS 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.
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 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
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renewal requirements.
Arguments in support
The sponsor of this bill, the Health Officers Association
of California, states that the current bureaucratic hurdles
not only wastes time, but also create 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 percent 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.
Arguments in opposition
The California Peace Officers Association writes in
opposition that local governments must constantly strike a
balance 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. The California Narcotic
Officers' Association writes in opposition that that their
organization supported AB 136, but this bill undercuts
important local government institutional structures. They
cite research which has found that NEPs must be accompanied
by a supportive infrastructure that is constantly
reevaluated and altered as the program is being
administered.
Previous legislation
AB 2871 (Berg, 2004) -- was nearly identical to this
bill. The Governor vetoed that bill, stating, "While
cumbersome, this reauthorization ensures that local
government and local public health officials review the
status of the syringe exchange program when deciding to
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continue the program. I am willing to reconsider the
concept of this bill in the future if there are
appropriate local control measures in place. It is
imperative that local communities, public health
officials and local law enforcement are provided the
opportunity to provide input to local leaders to ensure
that the health benefits of a syringe exchange program
outweigh any potential adverse impact on the public
welfare."
Continued---
AB 946 (Berg, 2002) -- 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.
PRIOR ACTIONS
Assembly Floor: 45 - 30 Pass
Assembly Appropriations: 13 - 5 Do Pass
Assembly Health: 8 - 3 Do Pass
POSITIONS
Support: Health Officers Association of California
(sponsor)
AIDS Project Los Angeles
Alameda County Board of Supervisors
American Civil Liberties Union
Berkeley City Council
Bienestar Human Services, Inc.
California Medical Association
California National Organization of Women
California Opioid Maintenance Providers
California State Association of Counties
CARES Northern California's HIV/AIDS Healthcare
Center
City and County of San Francisco
City of Los Angeles
County Alcohol and Drug Program Administrators
Association of California
County Health Executives Association of
California
Equality California
Humboldt County Board of Supervisors
Humboldt-Del Norte County Medical Society
Los Angeles County Board of Supervisors
Los Angeles County Department of Health Services
Ministry In Action Commission
of St Mark's United Methodist Church in
Sacramento
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National Association of Social Workers,
California Chapter
North Coast Clinics Network
Planned Parenthood Affiliates of California, Inc.
Santa Clara County Board of Supervisors
1 individual
Oppose:California Family Alliance
California Narcotics Officers' Association
California Peace Officers' Association
Traditional Values Coalition
2 individuals
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