BILL ANALYSIS Ó
AB 604
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ASSEMBLY THIRD READING
AB 604 (Skinner)
As Amended April 5, 2011
Majority vote
HEALTH 13-6 APPROPRIATIONS 12-3
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield, |
| |Bonilla, Eng, Gordon, | |Bradford, Charles |
| |Hayashi, | |Calderon, Campos, Davis, |
| |Roger Hernández, Bonnie | |Gatto, Hall, Hill, Lara, |
| |Lowenthal, Mitchell, Pan, | |Mitchell, Solorio |
| |V. Manuel Pérez, Williams | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Harkey, Donnelly, Nielsen |
| |Nestande, Silva, Smyth | | |
| | | | |
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SUMMARY : Permits the Department of Public Health (DPH) to
authorize specified entities to provide hypodermic needle and
syringe exchange services, as specified, in any location where DPH
determines that the conditions exist for the rapid spread of human
immunodeficiency virus (HIV), viral hepatitis, or any other
potentially deadly or disabling infections that are spread through
the sharing of used 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 (PHS), 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 spread through the sharing of used
hypodermic needles and syringes.
2)Requires DPH to demonstrate that an entity authorized to conduct
such a project provides specified services and possesses
specified capacity.
3)Requires DPH, if it deems an application to be provisionally
appropriate, to provide for a period of public comment at least
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45 days prior to approval of the application, as specified.
4)Requires DPH to establish and maintain on its Internet Web site
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).
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Annual costs to DPH of $30,000 to $40,000 in 2011-12 through
2013-14 to establish regulations. DPH indicates that the
department could absorb the additional workload with no new
funding by redirecting existing federal monies for HIV
prevention.
2)Ongoing, likely absorbable costs for DPH to continue oversight
of needle exchange projects after 2014.
3)Unknown, potentially significant savings to the extent this bill
reduces medical costs associated with infectious diseases such
as HIV and hepatitis.
COMMENTS : 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
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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:
the PHS, U.S. Centers for Disease Control & Prevention (CDC),
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
American Academy of Pediatrics. The author states that this bill
will not 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
authority to DPH to prevent or address outbreaks of deadly or
disabling blood-borne diseases.
Injection drug use (IDU) is the second leading cause of HIV
transmission and the leading cause of hepatitis C virus (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.
According to the CDC, the first organized SEPs in the United
States were established in the late 1980s and 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
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transmitting 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.
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 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.
Previous legislation: AB 1858 (Blumenfield) of 2010 contained
provisions that are substantially similar to those in this bill,
but was vetoed by Governor Schwarzenegger. 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) of 2010, would have
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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 (Yee) was vetoed by Governor Schwarzenegger.
AB 110 (Laird), Chapter 707, Statutes of 2007, permits a public
entity that receives General Fund money from 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 (Laird), 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 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 (Vasconcellos) 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. 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.
Analysis Prepared by : Melanie Moreno / HEALTH / (916) 319-2097
FN: 0000283