BILL ANALYSIS Ó AB 604 Page 1 ASSEMBLY THIRD READING AB 604 (Skinner) As Amended April 5, 2011 Majority vote HEALTH 13-6 APPROPRIATIONS 12-3 ----------------------------------------------------------------- |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 AB 604 Page 2 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 AB 604 Page 3 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 AB 604 Page 4 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 AB 604 Page 5 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