BILL ANALYSIS Ķ
AB 604
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Date of Hearing: March 29, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 604 (Skinner) - As Amended: March 17, 2011
SUBJECT : Needle exchange programs.
SUMMARY : Permits the Department of Public Health (DPH) to
authorize specified entities to provide hypodermic needle and
syringe exchange services consistent with state and federal
standards, including those of the United States Public Health
Service, in any location where DPH determines that the
conditions exist for the rapid spread of HIV, viral hepatitis,
or any other potentially deadly or disabling infections that are
spread through the sharing of used hypodermic needles and
syringes. Specifically, this bill :
1)Permits DPH to authorize specified entities to provide
hypodermic needle and syringe exchange services consistent
with state and federal standards, including those of the
United States Public Health Service, in any location where DPH
determines that the conditions exist for the rapid spread of
HIV, viral hepatitis, or any other potentially deadly or
disabling infections that are spread through the sharing of
used hypodermic needles and syringes.
2)Requires DPH, in order for an entity to be authorized to
conduct such a project, to demonstrate that an entity:
a) Provides, directly or through referral, any of the
following services: drug abuse treatment services; HIV or
hepatitis C virus (HCV) screening; hepatitis A and
hepatitis B vaccination; screening for sexually transmitted
infections; housing services for the homeless, for victims
of domestic violence, or other similar housing services;
and services related to provision of education and
materials for the reduction of sexual risk behaviors,
including, but not limited to, the distribution of condoms.
b) Has the capacity to commence needle and syringe exchange
services within three months of authorization.
c) Has adequate funding (at reasonably projected program
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participation levels) to provide: needles and syringe
exchange services for all of its participants; HIV and
viral hepatitis prevention education services for all of
its participants; and, for the safe recovery and disposal
of used syringes and sharps waste from all of its
participants.
d) Has the capacity, and an established plan, to collect
evaluative data in order to assess program impact,
including, but not limited to: the total number of persons
served; the total number of syringes and needles
distributed, recovered, and disposed of; and, the total
numbers and types of referrals to drug treatment and other
services.
3)Requires DPH, if it deems an application to be provisionally
appropriate, to provide for a period of public comment at
least 45 days prior to approval of the application, as
specified.
4)Requires DPH to establish and maintain on its Internet Website
the address and contact information of programs providing
hypodermic needle and syringe exchange services.
5)Prohibits staff and volunteers participating in DPH-authorized
syringe exchange projects (SEPs) from being subject to
criminal prosecution for any law related to the possession,
furnishing, or transfer of hypodermic needles or syringes
during the participation in an SEP.
6)Requires DPH to provide local health officers (LHOs) biennial
status reports, as specified, based on reports to DPH from
service providers operating DPH-authorized SEPs within a LHO's
jurisdiction. Requires LHOs with county- and city-authorized
SEPs to report on the program's status biennially (rather than
annually, as required by existing law).
EXISTING LAW :
1)Regulates the sale, possession, and disposal of hypodermic
needles and syringes; and requires a prescription to purchase
a hypodermic needle or syringe for human use, except to
administer adrenaline or insulin.
2)Permits a clean needle and SEP in any city and county, county,
or city, upon the action of a county board of supervisors and
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the LHO or health commission of that county, or upon the
action of the city council, the mayor, and the LHO. Permits a
county or a city with or without a health department to
authorize a clean needle and SEP in consultation with DPH, as
specified. Requires local government, local public health
officials, and law enforcement to be given the opportunity to
comment on syringe exchange programs on an annual basis.
Requires the public to be given the opportunity to provide
input to local leaders to ensure that any potential adverse
impacts on the public welfare of SEPs are addressed and
mitigated.
3)Prohibits providers participating in an exchange project
authorized by a county or city from being subject to criminal
prosecution for possession of needles or syringes during
participation in an SEP.
4)Permits a city or county to authorize a licensed pharmacist 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 with a local health department until December
31, 2018. Prohibits the possession and sale of drug
paraphernalia; but until December 31, 2018, allows a person,
if authorized by a city or county, to possess 10 or fewer
hypodermic needles or syringes if acquired through an
authorized source.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the use of
shared syringes is the leading cause of hepatitis C infections
in the state, and the second most common means of contracting
HIV and hepatitis B. The author states that the estimated
lifetime cost to treat hepatitis C exceeds $100,000 per person
and the estimated lifetime cost to treat HIV exceeds $600,000.
Failure to prevent these infections creates a long-term
burden on state General Fund-supported health insurance and
drug programs. The author contends that SEPs are a highly
cost-effective component of a comprehensive HIV and hepatitis
control strategy, endorsed by every major national, state, and
international health and medical association including: U.S.
Centers for Disease Control & Prevention (CDC), U.S. Public
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Health Service, Institute of Medicine of the National Academy
of Sciences, National Institutes of Health, World Health
Organization, United Nations Programme on HIV/AIDS, American
Medical Association, and the American Academy of Pediatrics.
The author states that while this bill will authorize DPH to
approve SEPs, it in no way will inhibit local government's
ability to regulate programs within their jurisdiction.
According to the author, most counties do not have safe, legal
access to sterile syringes, even in areas with very high rates
of HIV and hepatitis and this bill would give appropriate
authority to DPH to prevent or address outbreaks of deadly or
disabling blood-borne diseases. Finally, the author states
that this bill does not appropriate funds for syringe
exchanges, nor does it mandate the state to fund new or
existing SEPs.
2)BACKGROUND . Injection drug use (IDU) is the second leading
cause of HIV transmission and the leading cause of HCV in
California. According to DPH's Office of AIDS, in 2009 IDU
was associated with 19% of the 190,000 reported HIV/AIDS
cases. It is also estimated that at least 60% of prevalent
cases of HCV infection are associated with IDU. In 2008, 36
acute HCV infections and 69,519 unique chronic HCV cases were
reported in California, and HCV-related deaths in the state
more than doubled from 503 in 1995 to 1,195 in 2004. The CDC
has identified access to sterile syringes as one component of
a comprehensive HIV prevention strategy designed to reduce HIV
transmission among IDUs. Federal statute was amended in
December 2009 to allow federal funds to support SEPs, and
federal agencies including CDC, Health and Human Services
(HHS), the Substance Abuse and Mental Health Services
Administration and the Health Resources and Services
Administrations have issued notices in the past fiscal year to
allow grantees to allocate their funds accordingly.
3)SEPS . According to the CDC, the first organized SEPs in the
U.S. were established in the late 1980s in Tacoma, Washington;
Portland, Oregon; San Francisco; and, New York City. According
to the CDC, as of March 2009, a total of 184 SEPs were known
to be operating in 36 states, the District of Columbia, and
Puerto Rico. According to DPH, as of January 2010, 19
California counties and four cities have authorized SEPs. In
addition to exchanging syringes, many SEPs provide a range of
related prevention and care services that are vital to helping
IDUs reduce their risks of acquiring and transmitting
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blood-borne viruses, as well as maintain and improve their
overall health. These services include: HIV/AIDS education
and counseling; condom distribution to prevent sexual
transmission of HIV and other sexually transmitted diseases;
referrals to substance abuse treatment and other medical and
social services; distribution of alcohol swabs to help prevent
abscesses and other bacterial infections; on-site HIV testing
and counseling and crisis intervention; screening for
tuberculosis, hepatitis B and C; and, primary medical
services. SEPs operate in a variety of settings, including
storefronts, vans, sidewalk tables, and health clinics. They
vary in their hours of operation, with some open for two-hour
street-based sessions several times a week, and others are
open continuously.
A January 2009 review of the effectiveness of SEPs, sponsored
by the Robert Wood Johnson Foundation's Substance Abuse Policy
Research Program, found that SEPs are cost-effective, help
reduce HIV risk behavior and transmission, can promote entry
into drug treatment, and do not encourage illegal drug use or
other crime or increase the community burden of discarded
syringes.
4)HHS DETERMINATION . In December 2009, President Obama signed
the Consolidated Appropriations Act, 2010, which ended the
21-year ban on use of federal funds for syringe access
programs. In 1998, HHS Secretary Donna Shalala issued a
finding that the overwhelming scientific consensus was that
syringe exchange programs slowed the spread of HIV, without
contributing to increased drug use. However, the ban remained
in effect. A February 2011 notice by the by HHS Secretary
Kathleen Sebelius, "Determination That a Demonstration Needle
Exchange Program Would be Effective in Reducing Drug Abuse and
the Risk of Acquired Immune Deficiency Syndrome Infection
Among Intravenous Drug Users," announced that the Surgeon
General had determined that demonstration SEPs would be
effective in reducing drug abuse and the risk of infection
with HIV, the step necessary to allow federal funds to flow to
syringe access programs.
5)PREVIOUS LEGISLATION . AB 1858 (Blumenfield) contained
provisions that are substantially similar to those in this
bill. Governor Schwarzenegger vetoed AB 1858, stating, "I
signed legislation in 2005 that reflected a careful balance
between good public health policy and local decision-making
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authority. I remain comfortable with that original decision
and do not believe it is appropriate to change this balance
and instead give authority to the state Department of Public
Health to overrule local decisions regarding syringe exchange
programs."
AB 1701 (Chesbro), Chapter 667, Statutes of 2010, extends the
sunset date, from December 31, 2010 to December 31, 2018, of
the Disease Prevention Demonstration Project (DPDP), which
permits cities or counties to authorize licensed pharmacists
to sell or furnish 10 or fewer hypodermic needles or syringes
to a person for use without a prescription, as specified.
SB 1029 (Yee), would have repealed DPDP, and permitted
pharmacists and physicians to distribute to individuals, and
individuals to receive, up to 30 needles without a
prescription solely for personal use, as specified. SB 1029
was vetoed by Governor Schwarzenegger.
AB 110 (Laird), Chapter 707, Statutes of 2007, permits a
public entity that receives General Fund money from the
Department of Health Services (now DPH) for HIV prevention and
education to use that money to support needle exchange
programs. AB 1597 (Laird) of 2005 contained substantially
similar provisions to AB 110, but was vetoed by Governor
Schwarzenegger.
AB 547 (Berg), Chapter 692, Statutes of 2005, creates the
Clean Needle and Syringe Exchange Program to permit SEPs
without a local declaration of emergency. AB 946 (Berg) of
2003 and AB 2871 (Berg) of 2004 would also have repealed the
requirement that a city or county authorize its needle
exchange program through a declaration of a local emergency.
Both bills were vetoed by Governor Davis and Governor
Schwarzenegger, respectively.
SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004,
established a five-year pilot program (DPDP) to allow
California pharmacies, when authorized by a local government,
to sell up to 10 syringes to adults without a prescription.
Prior to SB 1159 in 2004, SB 1785 (Vasconcellos) of 2002 and
SB 774 (Vasconcellos) of 2003 would have permitted the
furnishing of syringes without a prescription. Both measures
were vetoed by Governor Davis.
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AB 136 (Mazzoni), Chapter 762, Statutes of 1999, exempts
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 from criminal
prosecution.
6)TECHNICAL AMENDMENTS .
a) On page 3, line 27: delete "any" and insert "all"
b) On page 3, line 30: delete: "HIV or hepatitis C
screening" and insert "screening for hepatitis"
c) On page 4, line 28: after "services" insert "established
pursuant to this chapter"
7)SUPPORT . Clinica Monseņor Oscar A. Romero and Redwood AIDS
Information write that amongst the counties with the highest
number of AIDS cases related to syringe sharing, and with the
highest per capita rate of AIDS from syringe sharing are
counties without an SEP. The County Alcohol and Drug Program
Administrators Association of California states that this bill
would help provide more people with legal access to sterile
needles and syringes, which is a proven method for reducing
the transmission of HIV, viral hepatitis, and other costly,
deadly blood-borne diseases. Drug Policy Alliance states that
expanding syringe exchange programs statewide will reduce
costs to taxpayers as HIV and hepatitis C are two of the most
commonly and costly blood-borne diseases among people who
share syringes.
8)OPPOSITION . The League of California Cities (League) states
that while they recognize the intent of this bill, it would
override local authority and allow health service
organizations to act outside a city or county government's
discretion. The League contends that the ultimate
considerations for local health and safety impacts should be
made by the city that will directly bear the consequences, for
better or worse.
REGISTERED SUPPORT / OPPOSITION :
Support
Drug Policy Alliance (sponsor)
AIDS Community Research Consortium
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BIENESTAR Human Services
California Opioid Maintenance Providers
Clinica Monseņor Oscar A. Romero
County Alcohol and Drug Program Administrators Association of
California
Harm Reduction Coalition
Redwood AIDS Information Network & Services
Saint James Infirmary
Opposition
League of California Cities
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097