BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1701
A
AUTHOR: Chesbro
B
AMENDED: As Introduced
HEARING DATE: June 23, 2010
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CONSULTANT:
7
Orr
0
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SUBJECT
Hypodermic needles and syringes
SUMMARY
This bill removes the sunset date for cities and counties
to authorize pharmacists to furnish or sell 10 or fewer
hypodermic needles or syringes to persons 18 years of age
or older, and removes the sunset date for persons 18 years
of age or older to be allowed to possess 10 or fewer
needles or syringes if acquired through an authorized
source, thereby extending these authorizations
indefinitely.
CHANGES TO EXISTING LAW
Existing law:
Allows a pharmacist or physician to furnish hypodermic
needles or syringes for human use without a prescription or
permit if the person is known to the furnisher and the
furnisher has been previously provided with a prescription
or proof of legitimate medical need.
Allows counties to authorize pharmacists to furnish or sell
10 or fewer hypodermic needles or syringes to persons 18
years of age or older, for the period commencing January 1,
Continued---
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2005 and ending December 31, 2010, if the pharmacy is
registered for the Disease Prevention Demonstration Project
(DPDP) and if the pharmacy complies with other specified
provisions.
Establishes the DPDP as a collaboration between pharmacies
and local and state health officials, for the purpose of
evaluating the long-term desirability of allowing licensed
pharmacists to furnish or sell nonprescription hypodermic
needles or syringes to prevent the spread of blood-borne
pathogens, including HIV and hepatitis C.
As part of the DPDP, requires participating pharmacies to
register with their local health department, and certify
that they will provide written or verbal information on
drug treatment, testing services, and safe sharps disposal
practices at the point of sale.
Also, as part of the DPDP, proscribes requirements for the
secure storage of needles and syringes in pharmacies, and
requires pharmacies to make safe disposal options available
to users.
Also, as part of DPDP, requires the California Department
of Public Health (CDPH) to evaluate the effects of allowing
pharmacists to furnish or sell a limited number of
hypodermic needles or syringes without prescription, and to
provide a report to the Governor and the Legislature on or
before January 15, 2010.
Authorizes clean needle exchange programs in any city and
county, county, or city upon the action of a county board
of supervisors and the local health officer or health
commission of that county; the city council, the mayor, and
the local health officer of a city with a health
department; or, the city council and the mayor of a city
without a health department.
Requires that no person shall possess a hypodermic needle
or syringe except when acquired in accordance with
specified provisions of law.
Stipulates that no public entity, its agents, or employees
will be subject to criminal prosecution for the
distribution of hypodermic needles or syringes to
participants in clean needle and syringe exchange projects
STAFF ANALYSIS OF ASSEMBLY BILL 1701 (Chesbro) Page
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authorized by law.
This bill:
Deletes the sunset date for cities and counties to
authorize pharmacists to furnish or sell 10 or fewer
hypodermic needles or syringes to persons 18 years of age
or older, thereby extending this authorization
indefinitely.
Deletes the sunset date for persons 18 years of age or
older to be allowed to possess 10 or fewer needles or
syringes if acquired through an authorized source, thereby
extending this authorization indefinitely.
FISCAL IMPACT
This bill is keyed nonfiscal.
BACKGROUND AND DISCUSSION
The author seeks to remove the December 31, 2010 sunset
date on the Disease Prevention Demonstration Project,
established in 2004. The program allows pharmacies who
receive local approval to sell up to 10 syringes to
individuals age 18 and over without a prescription. The
sponsor of the bill, the Health Officers Association of
California claims that since the program was enacted, 15
counties and 4 cities have successfully established
pharmacy syringe sale programs.
Injection drug use and disease prevalence
According to the CDPH Office of AIDS (CDPH/OA), injection
drug use is the second leading cause of HIV transmission
and the leading cause of hepatitis C virus (HCV) infection
in California. Sharing of contaminated syringes and other
injection equipment is linked to 19 percent of all reported
AIDS cases in the state. The shared use of syringes and
needles was recognized as being associated with HIV
transmission among injection drug users at the onset of the
HIV/AIDS pandemic. Nationwide, injection drug use accounted
for 17 percent of new HIV/AIDS diagnoses in adults and
adolescents in 2007, according to the Centers for Disease
Control and Prevention (CDC). California data suggests that
over 1,500 new syringe-sharing HIV infections occur
annually. The link between injection drug use and HIV is
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particularly strong for women and people of color. In
California, 37 percent of cumulative AIDS cases among
women, 24.3 percent of cases among African American men and
women, and 22.4 percent of cases among Latinas are directly
attributable to syringe sharing.
In addition, there are an estimated 500,000 to 600,000
Californians currently infected with hepatitis C virus
(HCV) with an estimated 5,000 new infections annually due
to injection drug use. Viral hepatitis is a major cause of
liver cancer and the leading cause of liver transplants
nationwide. In the United States, there are more than five
million people living with chronic hepatitis B virus (HBV)
or chronic HCV. In 2007 alone, HBV- and HCV-related
hospitalization costs in California totaled $2 billion.
Over the next 20 years, annual medical costs for people
with HCV nationwide are expected to increase more than 2.5
times, from $30 billion to more than $85 billion.
Pharmacy sale of syringes
In the early 1980s, insulin and allergy syringes could be
bought in any drugstore without a prescription. In spite of
the available supply, some drug users chose to reuse and
share needles, and are believed to be partly responsible
for the early spread of the AIDS epidemic. In the 1990s,
some states began requiring needles to be stored behind the
pharmacy counter and began requiring prescriptions in hopes
of cutting down on illegal drug use by making syringes more
scarce. Most states abandoned that policy once a
correlation was noted between syringe scarcity and
increased infectious disease rates in injection drug users
(IDUs). Until the 2004 signing of SB 1159 (Vasconcellos),
which started the Disease Prevention Demonstration Project,
California was one of only five states remaining that still
required a prescription in order to purchase a syringe.
To address and prevent the spread of blood-borne infectious
diseases among IDUs in California, the DPDP was established
to allow the sale of up to 10 hypodermic needles or
syringes at pharmacies without a prescription. In order to
participate in the DPDP, pharmacies must register with
their local health department and provide a contact name
and related information. They must also certify that they
will provide written or verbal counseling at the time of
furnishing or selling needles or syringes. Additionally,
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pharmacies must properly store needles and syringes so that
they are only available to authorized personnel, provide
on-site safe disposal of needles and syringes, or furnish
or sell mail-back state or federal standard personal sharps
disposal containers. In the absence of local authorization
of a DPDP, the sale and possession of syringes without a
prescription remains illegal in California.
Under current law, pharmacies that participate in the DPDP
are required to register with their local health department
and certify that they will provide information to adult
purchasers of needles or syringes about drug treatment
programs, testing and treatment programs for HIV and HCV,
and safe disposal of sharps waste. They are also required
to store needles and syringes such that only authorized
pharmacy personnel may have access, provide on-site
collection and disposal options for used needles, and make
mail-back and personal sharps disposal containers available
to purchasers. Participating local health departments are
required to maintain a list of all pharmacies registered
under the DPDP and make available to pharmacies written
information that can be provided at the time of furnishing
or selling nonprescription needles and syringes.
Clean needle and syringe exchange programs (SEPs)
Clean needle exchange programs also make sterile needles
available to IDUs, in order to avoid acquiring and
transmitting blood-borne diseases such as HIV and HCV. SEPs
provide a safe and accessible method for IDUs to exchange
used syringes for sterile ones. Often, SEP programs also
provide other public health services, such as HIV testing,
risk-reduction education, and referrals for substance-abuse
treatment. For some California residents, a SEP is the only
accessible provider of medical or social services.
SEPs have been shown to be effective in reducing the
sharing of syringes and the transmission of blood-borne
infections among drug users without increasing drug use.
SEPs can help lower the number of contaminated syringes
circulating in communities by decreasing syringe scarcity,
and in the case of an accidental needlestick, can lower the
likelihood of a needle being contaminated with a
potentially deadly disease. Since the implementation of
these programs in the late 1980s, new HIV infections among
IDUs have declined overall by 80 percent. One study
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published in 2001 found that the mean HIV prevalence rate
among IDUs in metropolitan areas that banned
over-the-counter sales or purchases of needles and syringes
was twice as high as the mean HIV prevalence rate in metro
areas that allow over-the-counter sales (13.8 percent vs.
6.7 percent respectively).
According to the Center for Health Improvement, there were
41 authorized SEPs in California as of March 2009. Cities
and counties are enabled to authorize a clean needle and
syringe exchange project as part of a comprehensive network
of services. Local government, local public health
officials, and law enforcement personnel and the public are
supposed to be given the opportunity to provide comments on
the clean needle and syringe exchange programs annually.
The local health officers are required to annually report
to the boards of supervisors or city councils, and to
include a detailed report on the status of local clean
needle and syringe exchange programs including, but not
limited to, relevant statistics on blood-borne infections
associated with needle-sharing activities and the use of
public funds for these programs. According to CDPH/OA,
seventeen county boards of supervisors and four city
councils so far have authorized SEPs, and several other
counties and cities are currently planning for
authorization.
CDPH evaluation of SB 1159
CDPH was required to report to the Governor and to the
Legislature by January 15, 2010, on the impact of allowing
pharmacists to furnish or sell nonprescription hypodermic
needles or syringes on rates of disease infection related
to syringe sharing, rates of crime in the vicinity of
pharmacies, rates of drug use, rates of needlestick injury
to law enforcement officers and waste management employees,
rates of safe or unsafe discard of syringes, and syringe
sharing practice among IDUs. CDPH was also required to
convene an uncompensated evaluation panel.
To date, CDPH/OA has conducted two surveys of local health
jurisdictions, posing questions concerning syringe disposal
mechanisms and the level of pharmacist participation in
each county. In addition, the California HIV/AIDS Research
Program has funded a qualitative study of facilitators and
obstacles to SB 1159 implementation. CDPH/OA has also
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funded a study of syringe disposal and accidental
needlestick injuries. CDPH/OA plans to include a detailed
analysis of HIV counseling and testing data in the final
report. The report required by SB 1159 has not been
released, and it is unclear when the report will be made
public.
CDPH has released recommendations in the California Adult
Viral Hepatitis Prevention Strategic Plan for 2010-2014
that promote increased access to syringe exchange programs,
and to promote other strategies, such as encouraging
pharmacists to participate in pharmacy syringe sales
programs, and removing structural barriers to accessing
syringes and other safe drug-using equipment for IDUs.
Needlestick injuries
Access to sterile syringes can affect the occupational
health and safety of peace officers and waste management
employees because they are at risk of accidental
needlestick injuries. A recent study found that 29.7
percent of San Diego Police Officers surveyed had suffered
a needlestick injury on-duty, usually during a pat-down or
search incident to arrest. A study of police officers in
Rhode Island found that nearly 30 percent had been stuck by
a syringe at one point in their career, with over 27
percent experiencing two or more needlestick injuries.
Research has shown that accidental needlesticks to police
officers have decreased significantly following the
implementation of SEPs. For instance, studies in
Connecticut and Massachusetts found that needlestick
injuries to officers were reduced 66 percent after syringe
deregulation.
Related bills
SB 1029 (Yee) would allow individuals to obtain, and
pharmacists and physicians to distribute up to 30 syringes
or needles for personal use without a prescription from a
pharmacy until December 31, 2018. Repeals the Disease
Prevention Demonstration Project (DPDP), thereby removing a
requirement for local governments to first authorize
participation in the DPDP prior to a pharmacy's
registration in the program. Pending in the Assembly.
AB 1858 (Blumenfield) would permit CDPH to authorize
certain entities that meet prescribed conditions to provide
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hypodermic needle and syringe exchange services in any
location where the department determines that the
conditions exist for the rapid spread of HIV, viral
hepatitis, or other potentially deadly infections spread
through the sharing of used needles. The bill would require
CDPH to allow local entities to apply for authorization to
provide hypodermic needle and syringe exchange services,
establish and maintain on its website the addresses and
contact information of programs providing hypodermic needle
and syringe exchange services, and change related hearing
requirements from annually to biennially. Pending in the
Senate Health Committee.
Prior legislation
AB 110 (Laird), Chapter 707, Statutes of 2007, permits a
public entity that receives General Fund (GF) money for
human immunodeficiency virus (HIV) prevention and education
from the Department of Public Health (DPH) to use that
money to support clean needle and syringe exchange projects
(NEPs), as specified.
SB 1305 (Figueroa), Chapter 64, Statutes of 2006, prohibits
a person from knowingly placing home-generated sharps waste
in the commercial and residential solid waste collection
containers after September 1, 2008.
AB 1597 (Laird) of 2005 and AB 2076 (Laird) of 2006
contained provisions substantially similar to AB 110.
Governor Schwarzenegger vetoed AB 1597, stating
"authorizing the use of state funds to purchase syringes,
without appropriate local controls, including mechanisms
for input from local law enforcement, and protections
against the use of state funds to supplant private or local
resources is not prudent." AB 2076 was held on the
Assembly Floor.
AB 547 (Berg and Richman), Chapter 692, Statutes of 2005,
authorized clean SEPs in any city and county, county, or
city upon the action of a county board of supervisors and
the local health officer or health commission of that
county; the city council, the mayor, and the local health
officer of a city with a health department; or, the city
council and the mayor of a city without a health
department.
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SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004,
authorizes the Disease Prevention Demonstration Project
(DPDP) to evaluate the long-term desirability of allowing
licensed pharmacies to sell or furnish nonprescription
hypodermic needles or syringes to prevent the spread of
blood-borne pathogens. Authorizes a licensed pharmacist,
until December 31, 2010 and subject to authorization by a
county or city, to sell or furnish 10 or fewer hypodermic
needles or syringes to a person for human use without a
prescription if the pharmacy is registered in the DPDP with
a local health department.
SB 774 (Vasconcellos) 2003 was almost identical to SB 1159;
however the hypodermic needle and syringe limit was higher,
permitting a maximum of 30. Vetoed.
SB 1785 (Vasconcellos) 2002 was nearly identical to SB 744;
however the bill included an additional provision that
would have mandated criminal penalties for discarding or
disposing of hypodermic needles or syringes on a
playground, public beach, public park, or the grounds of an
elementary school, vocational, junior high, or high school.
Vetoed
AB 1292 (Aroner) 2001 would have authorized pharmacists in
a licensed pharmacy to furnish or sell at retail hypodermic
needles or syringes for human use without a
prescription. This bill was substantively similar to SB
1785 and SB 744. The author chose not to move the bill
forward.
AB 136 (Mazzoni), Chapter 762, Statutes of 1999, exempts
from criminal prosecution public entities and their agents
and employees who distribute hypodermic needles or syringes
to participants in clean needle and syringe exchange
projects authorized by the public entity pursuant to a
declaration of a local emergency due to the existence of a
critical local public health crisis.
Arguments in support
The Health Officers Association of California, representing
physician health officers, claims this bill will protect
public health without sacrificing safety. DPH reports that
19 percent of new AIDS cases and 5,000 new Hepatitis C
infections per year in California are linked to shared
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needles. Continuing to allow access to clean syringes will
reduce the number of new infections in the state. They note
that the DPH Office of AIDS, which oversees the current
program, says participating pharmacies have reported no
adverse events or increases in criminal activity as a
result of this program.
AIDS Project Los Angeles claims the DPDP has proven
effective as a harm reduction strategy, and that making the
purchase of syringes simple and non-threatening is the best
way to encourage drug users to use new and sterile
syringes. The Santa Clara Board of Supervisors claims that
injection drug use was linked to 9 percent of new AIDS
cases diagnosed in the county in 2008. They believe this
bill would complement existing harm reduction programs,
such as their county's needle exchange program, and that
this is an appropriate response to a genuine public health
threat.
PRIOR ACTIONS
Assembly Health Committee 14- 4
Assembly Floor 49-27
COMMENTS
1. Referral to Rules Committee. Although this bill is
keyed non-fiscal, should it pass out of the Senate Health
Committee, the Rules Committee has instructed that it
should be referred to the Rules Committee for consideration
of a request from the Appropriations Committee to hear the
bill.
2. Related bill. On April 14, this committee heard a
similar measure, SB 1029 (Yee), which sought to eliminate
the DPDP entirely and more broadly authorize pharmacy
access to syringes statewide by removing the local
authorization requirement and increasing the number of
syringes from 10 to 30. AB 1701 differs from SB 1029 in
that AB 1701:
Continues the existing local authorization
requirement,
Keeps the number of allowable syringes capped at
10, and
Removes sunset dates to allow pharmacy access to
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syringes indefinitely.
SB 1029 was amended to include a sunset date of December
31, 2018 and to require pharmacists provide specified
written information or verbal counseling at the time of
furnishing needles. Committee staff suggests a similar
sunset for AB 1701.
Suggested amendment:
On page 2, line 15 after "city" insert "for the period
commencing January 1, 2005 and ending December 31, 2018."
On page 3, line 12 after "city" insert "for the period
commencing January 1, 2005 and ending December 31, 2018."
POSITIONS
Support: Health Officers Association of California
(Sponsor)
AIDS Project Los Angeles (APLA)
Alameda County Board of Supervisors
California Association of Alcohol and Drug Program
Executives, Inc.
California Medical Association
California Opioid Maintenance Providers
California Primary Care Association (CPCA)
California State Association of Counties
City of West Hollywood
City and County of San Francisco
Contra Costa County Board of Supervisors
County Alcohol and drug Program Administrators
Association of California
County Health Executives Association of California
(CHEAC)
County of Santa Cruz Health Services Agency
County of Yolo Health Department
Planned Parenthood Affiliates of California, Inc.
San Luis Obispo County Health Agency
San Mateo County Health System
Santa Clara County Board of Supervisors
Santa Clara County Public Health Department
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Oppose: None received
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