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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