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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