BILL ANALYSIS Ó ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 604| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ THIRD READING Bill No: AB 604 Author: Skinner (D), et al. Amended: 8/22/11 in Senate Vote: 21 SENATE HEALTH COMMITTEE : 5-3, 6/22/11 AYES: Hernandez, Alquist, De León, DeSaulnier, Wolk NOES: Strickland, Anderson, Blakeslee NO VOTE RECORDED: Rubio SENATE APPROPRIATIONS COMMITTEE : 6-3, 7/11/11 AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg NOES: Walters, Emmerson, Runner ASSEMBLY FLOOR : 52-26, 5/16/11 - See last page for vote SUBJECT : Needle exchange programs SOURCE : Drug Policy Alliance DIGEST : This bill allows the Department of Public Health (DPH) to authorize entities meeting specified criteria to provide clean hypodermic needle and syringe exchange programs in any location where DPH determines conditions exist for the rapid spread of deadly or disabling disease spread through the sharing of unclean hypodermic needles and syringes. This bill sunsets on January 1, 2019. Senate Floor Amendments of 8/22/11 modify sources of standards and recommendations for clean needle and syringe CONTINUED AB 604 Page 2 exchange. ANALYSIS : Existing law: 1. Requires that no person shall possess a hypodermic needle or syringe except when acquired in accordance with specified provisions of law. 2. Authorizes a syringe exchange program (SEP) in any city, county, or city and county upon action by the county board of supervisors and the local health officer or health commission as applicable, or action of the city council, mayor and local health officer as applicable. The programs are to be authorized using recommendations from the United States Secretary of Health and Human Services, subject to availability of funding, and are to be offered as part of a comprehensive network of services. 3. Requires health officers of jurisdictions that participate in SEPs to annually report the status of those programs and at an open meeting of the board of supervisors or city council. 4. Allows local governments, public health officials, and law enforcement agencies the opportunity to comment on SEPs on an annual basis to address potential adverse impacts to the public. 5. 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. 6. 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, 2005 and ending December 31, 2018, if the pharmacy is registered for the Disease Prevention Demonstration Project (DPDP) and if the pharmacy complies with other specified provisions. CONTINUED AB 604 Page 3 7. 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. 8. 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. 9. Describes requirements for the secure storage of needles and syringes in pharmacies, and requires pharmacies to make safe disposal options available to users. 10.Requires DPH to evaluate the DPDP and provide a report to the Governor and the Legislature on or before January 15, 2010. 11.Requires that no public entity, its agents, or employees be subject to criminal prosecution for the distribution of hypodermic needles or syringes to participants in clean needle and syringe exchange projects authorized by law. 12.Finds and declares that needle exchange programs have been shown to serve as a bridge to treatment and recovery from drug abuse, curtail the spread of HIV infection through the IDU population, and do not increase drug use. This bill: 1.Authorizes DPH to allow entities meeting specified criteria to apply for authorization to provide hypodermic needles and syringe exchange services in any location where DPH determines that conditions exist for the rapid spread of HIV, viral hepatitis, or any other potentially deadly or disabling infectious disease, spread through the sharing of unclean hypodermic needles CONTINUED AB 604 Page 4 and syringes. The entity must have sufficient staff, capacity and funding to provide these services, and must demonstrate the ability to do the following: A. Provide specified services for drug treatment and disease testing. B. Begin the SEP within three months of DPH's authorization. C. Collect specified evaluative data to assess the program's impact. 2.Requires DPH to provide for a public comment period at least 45 days prior to the approval of an application by posting a notice on its Web site and notifying the health officer of the jurisdiction where the entity submitting the application is located. 3.Requires DPH to post addresses and contact information of all SEPs on its Web site. 4.Requires DPH to provide biennial reports to local health officers in jurisdictions where DPH has authorized needle exchange services. 5.Provides that staff, volunteers and participants in an authorized exchange project will not be subject to criminal prosecution for violation of any law related to the possession, furnishing, or transfer of hypodermic needles in an exchange project. 6.Changes the frequency with which local governments, public health officials, law enforcement agencies, and the public may comment on local SEPs from once per year to once every two years. 7.Changes the requirement for local health officials to report to the board of supervisors or city council on the status of such programs from once per year to once every two years. 8.Replaces a reference to recommendations by the United States Secretary of Health and Human Services, with the United States Public Health Service. CONTINUED AB 604 Page 5 9.States that local government and health officials, as well as law enforcement, must be given the opportunity to comment on needle exchange programs yearly, and that the public will be given the opportunity to provide input regarding the effects of needle and syringe exchange programs. 10.States that a health officer of the participating jurisdiction must present (annually) at an open meeting of the board of supervisors or city council, a report detailing the status of needle and syringe programs. States the law enforcement, administrators of alcohol and drug treatment programs, other stakeholders, and the public to be able to comment at the annual meeting. 11.Requires that an entity which authorizes a needle and syringe exchange do so in accordance with recommendations by the United States Secretary of Health and Human Services instead of the U.S. Public Health Service. 12.Makes findings and declarations regarding scientific data that suggests that needle exchange programs do not increase drug use, and can curtail the spread of human immunodeficiency virus (HIV). 13.Sunsets on January 1, 2019. Background Clean needle and SEPs . Clean needle exchange programs make sterile needles available to injection drug users (IDUs), in order to mitigate the transmission of bloodborne diseases such as HIV and HCV. SEPs provide a safe and accessible method for IDUs to exchange used syringes for sterile ones. Often, SEPs 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. CONTINUED AB 604 Page 6 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 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 an SEP as part of a comprehensive network of services. Local government, local public health officials, law enforcement personnel, and the public are supposed to be given the opportunity to provide comments on local SEPs 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 SEPs 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 DPH Office of Aids (OA), 17 county boards of supervisors and four city councils have authorized SEPs, and several other counties and cities are currently considering them. Funding for syringe exchange . According to DPH/OA, DPH considers syringe exchange to be "unquestionably vital in the struggle to reduce the spread of HIV, HCV and other bloodborne infections among injection drug users, their partners, and their children." In the past, DPH has distributed millions of dollars in state funding to authorized SEPs across the state to provide syringe exchange, HIV and HCV testing, counseling and referral to needed services. Recent cuts in state General Funds for HIV prevention have resulted in elimination of all state funding of SEPs; HIV prevention in the state is now solely funded by federal dollars, which had precluded the funding of SEPs. CONTINUED AB 604 Page 7 On December 16, 2009, President Obama signed the Consolidated Appropriations Act of 2010, which began the process of lifting the 1989 ban on the use of federal funds for SEPs. This action allowed the CDC and its partners to more fully implement a comprehensive, evidence-based approach for reducing HIV infection among injecting drug users. The United States Surgeon General, Regina Benjamin, M.D. also announced on February 23, 2011 in the Federal Register that federal Substance Abuse Prevention and Treatment Block Grant funds could now be used to support syringe services programs. This determination permitted states and territories to use their Substance Abuse Prevention and Treatment Block Grant funds for needle exchange. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: No According to the Senate Appropriations Committee analysis as it relates to the 7/14 version of the bill: Fiscal Impact (in thousands) Major Provisions 2011-12 2012-13 2013-14 2014-15 2015-16 Fund DPH regulations $46 $35 $49 $30-$140$30-$140Federal* and ongoing administration * Centers for Disease Control and Prevention Cooperative Agreement Funds SUPPORT : (Verified 8/22/11) Drug Policy Alliance (source) AIDS Project Los Angeles American Civil Liberties Union American Nurses Association California California Association of Alcohol and Drug Program Executives, Inc. California Hepatitis Alliance CONTINUED AB 604 Page 8 California Nurses Association California Opioid Maintenance Providers California Society of Addiction Medicine California State Board of Pharmacy California Syringe Exchange Provider Network Center for Health Justice Clinica Monsenor Oscar A. Romero Common Ground: The Westside HIV Community Center County Alcohol and Drug Program Administrators Association of California Harm Reduction Coalition L.A. Gay and Lesbian Center National Association of Social Workers Redwood AIDS Information Network and Services Saint James Infirmary San Francisco AIDS Foundation San Francisco Hepatitis C Task Force Santa Clara County Board of Supervisors Waste Management OPPOSITION : (Verified 8/22/11) Association of Los Angeles Deputy Sheriffs California Narcotic Officers' Association California Police Chiefs Association City of Highland City of Visalia International Faith Based Coalition League of California Cities League of California Cities, Los Angeles Division Riverside Sheriffs' Association Chief Probation Officers of California ARGUMENTS IN SUPPORT : AIDS Project Los Angeles asserts that expanding SEPs will reduce the future costs of HIV and hepatitis C to taxpayers. More than 600,000 Californians are living with hepatitis C, and their health care costs are expected to soar over the next decade. This bill will help to bring SEPs to communities that currently have no access to sterile syringes and thus are experiencing high rates of HIV and hepatitis C infections. The California Hepatitis Alliance asserts that sharing needles is the leading cause of hepatitis C infections in the state, and the second most common means of contracting HIV and CONTINUED AB 604 Page 9 hepatitis B. The estimated lifetime cost to treat hepatitis C exceeds $100,000 per person, and the lifetime cost to treat HIV exceeds $600,000. Failure to prevent these infections creates long-term burden on state General Fund-supported health insurance and drug programs. ARGUMENTS IN OPPOSITION : The League of California Cities opposes the bill because they believe the ultimate considerations for local health and safety impacts should be made by the city that will directly bear the consequences, for better or for worse. The League asserts that this bill overrides local authority and allows health services organizations to act outside of a city or county government's discretion. The International Faith-Based Coalition believes this bill will have a devastating impact on the neighborhoods that their pastors shepherd. The Coalition believes that having local government bodies make these decisions is not only good public safety and quality of life policy, it is good public health policy. ASSEMBLY FLOOR : 52-26, 5/16/11 AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block, Blumenfield, Bonilla, Bradford, Brownley, Buchanan, Butler, Charles Calderon, Campos, Carter, Cedillo, Chesbro, Davis, Dickinson, Eng, Feuer, Fong, Fuentes, Furutani, Galgiani, Gatto, Gordon, Hall, Hayashi, Roger Hernández, Hill, Huber, Hueso, Huffman, Lara, Bonnie Lowenthal, Ma, Mendoza, Mitchell, Monning, Pan, Perea, V. Manuel Pérez, Portantino, Skinner, Solorio, Swanson, Torres, Wieckowski, Williams, Yamada, John A. Pérez NOES: Achadjian, Bill Berryhill, Conway, Cook, Donnelly, Fletcher, Beth Gaines, Garrick, Grove, Hagman, Halderman, Harkey, Jeffries, Jones, Knight, Logue, Mansoor, Miller, Morrell, Nestande, Nielsen, Olsen, Silva, Smyth, Valadao, Wagner NO VOTE RECORDED: Gorell, Norby CTW:mw 8/22/11 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED AB 604 Page 10 CONTINUED