BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



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          |SENATE RULES COMMITTEE            |                   AB 604|
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                                 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

           SENATE FLOOR  :  20-16, 8/30/11 (FAIL)
          AYES:  Alquist, De León, DeSaulnier, Evans, Hancock, 
            Hernandez, Kehoe, Leno, Liu, Lowenthal, Negrete McLeod, 
            Padilla, Pavley, Price, Simitian, Steinberg, Vargas, 
            Wolk, Wright, Yee
          NOES:  Anderson, Berryhill, Blakeslee, Calderon, Cannella, 
            Correa, Dutton, Emmerson, Fuller, Gaines, Huff, La Malfa, 
            Rubio, Strickland, Walters, Wyland
          NO VOTE RECORDED:  Corbett, Harman, Lieu, Runner

           ASSEMBLY FLOOR  :  52-26, 5/16/11 - See last page for vote


           SUBJECT  :    Needle exchange programs

           SOURCE  :     Drug Policy Alliance 


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          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 
          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 

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             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. 

          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.

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          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 
             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. 

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           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. 

           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 

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          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.  
          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 

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          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. 

          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

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           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 
          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 

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          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 
          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, 

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            Morrell, Nestande, Nielsen, Olsen, Silva, Smyth, Valadao, 
            Wagner
          NO VOTE RECORDED:  Gorell, Norby


          CTW:mw  9/2/11   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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