BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 604
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          CONCURRENCE IN SENATE AMENDMENTS
          AB 604 (Skinner)
          As Amended September 2, 2011
          Majority vote
           
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          |ASSEMBLY:  |52-26|(May 16, 2011)  |SENATE: |21-17|(September 8,  |
          |           |     |                |        |     |2011)          |
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           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.








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           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 








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          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








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