BILL ANALYSIS Ó AB 604 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 604 (Skinner) As Amended September 2, 2011 Majority vote ----------------------------------------------------------------- |ASSEMBLY: |52-26|(May 16, 2011) |SENATE: |21-17|(September 8, | | | | | | |2011) | ----------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY : Permits the Department of Public Health (DPH), until January 1, 2019, 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. The Senate amendments : 1)Require authorization to be made after consultation with the local health officer and local law enforcement leadership, and after a period of public comment, as specified. Requires DPH, in making the determination, to balance the concerns of law enforcement with the public health benefits. Prohibits the authorization from being for more than two years, but permits, before the end of that period, reauthorization in consultation with the local health officer and local law enforcement leadership. 2)Require, in order for an entity to be authorized to conduct a syringe exchange project (SEP) under this bill, its application to demonstrate that the entity will send a written and an e-mail notice to the chief of police, the sheriff, or both, as appropriate, of the jurisdictions in which the program will operate. 3)Sunset the bill's provisions on January 1, 2019, and make other technical changes. AS PASSED BY THE ASSEMBLY , this bill was substantially similar to the bill as passed by the Senate. AB 604 Page 2 FISCAL EFFECT : According to the Senate Appropriations Committee: Major Provisions 2011-12 2012-13 2013-14 Fund CDPH regulations and $46 $35 $49Federal* ongoing administration 2014-15 2015-16 $30 - $140 $30 - $14 Federal* * U.S. Centers for Disease Control and Prevention (CDC) Cooperative Agreement Funds 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 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 syringe exchange projects (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 States Public Health Service, 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 AB 604 Page 3 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 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. Analysis Prepared by : Melanie Moreno / HEALTH / (916) 319-2097 FN: 0002824 AB 604 Page 4