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    |     |                          |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           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