BILL ANALYSIS Ó
SB 41
Page 1
Date of Hearing: June 21, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 41 (Yee) - As Amended: May 24, 2011
SENATE VOTE : 24-13
SUBJECT : Hypodermic needles and syringes.
SUMMARY : Suspends certain provisions of the Disease Prevention
Demonstration Project (DPDP), including the ability for a city
or county to authorize pharmacists to provide up to 10
hypodermic needles and syringes without a prescription, until
January 1, 2015, and until then permits pharmacists and
physicians to furnish up to 30 hypodermic needles and syringes
for human use, without a prescription or city/county
authorization, to a person 18 years or older, as specified.
Specifically, this bill :
1)Suspends certain provisions of the DPDP, including the ability
for a city or county to authorize pharmacists to provide up to
10 hypodermic needles and syringes without a prescription,
until January 1, 2015, and until then:
a) Permits pharmacists and physicians to furnish up to 30
hypodermic needles and syringes for human use, without a
prescription or city/county authorization, to a person 18
years or older if the person is known to the furnisher and
the furnisher has previously been provided a prescription
or other proof of a legitimate medical need requiring a
hypodermic needle or syringe to administer a medicine or
treatment. Permits a person 18 years of age or older,
without a prescription or license, to obtain 30 or fewer
hypodermic needles and syringes solely for personal use
from a physician or pharmacist.
b) Requires pharmacies that furnish nonprescription
hypodermic needles and syringes to store them in a manner
that ensures that they are available only to authorized
personnel and to provide consumers with one or more of the
following disposal options:
i) An onsite, safe, hypodermic needle and syringe
collection and disposal program;
SB 41
Page 2
ii) Mail-back sharps disposal containers authorized by
the United States Postal Service that meet applicable
state and federal requirements, and that provide tracking
forms to verify destruction at a certified disposal
facility; and,
iii) A personal medical sharps disposal container that
meets applicable state and federal standards for disposal
of medical sharps waste.
c) Requires pharmacies that furnish nonprescription
syringes to provide written information or verbal
counseling to consumers at the time of furnishing or sale
of nonprescription hypodermic needles or syringes on how to
access drug treatment and testing and treatment for HIV and
hepatitis C, and how to safely dispose of sharps waste.
2)Requires the Department of Public Health (DPH) Office of AIDS
to develop and maintain specified information regarding HIV
and hepatitis testing and treatment, safe needle disposal, and
drug treatment on its Internet Website. Requires the
California State Board of Pharmacy to also post, or maintain a
link to, that information on its Internet Website.
EXISTING LAW :
1)Regulates the sale, possession, and disposal of hypodermic
needles and syringes; and, requires a prescription to purchase
a hypodermic needle or syringe for human use, except to
administer adrenaline or insulin.
2)Permits a city or county to authorize a licensed pharmacist to
sell or furnish 10 or fewer hypodermic needles or syringes to
a person for human use without a prescription if the pharmacy
is registered with a local health jurisdiction (LHJ) in the
DPDP.
3)Prohibits the possession and sale of drug paraphernalia; but
allows a person, if authorized by a city or county, to possess
10 or fewer hypodermic needles or syringes if acquired through
an authorized source.
FISCAL EFFECT : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8 negligible state costs.
SB 41
Page 3
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, California is
suffering an unnecessarily high rate of HIV and viral
hepatitis due to syringe scarcity. The author states that
California is one of only three states in the US that prohibit
a pharmacist from furnishing a syringe to an adult without a
prescription. Most states never required a prescription to
purchase a sterile syringe, and of those that did, most
amended their laws in light of the AIDS epidemic and the clear
evidence that shows that allowing adults to access sterile
syringes prevents the transmission of HIV, hepatitis C virus
(HCV), and other blood-borne diseases, without contributing to
increased drug use, drug injection, crime, or unsafe discard
of syringes. The author states that while many states allow
an unlimited number of syringes to be sold to an adult, this
bill is an incremental move away from complete prohibition of
sale and possession of syringes, allowing an adult to purchase
and possess 30 or fewer syringes for personal use. The author
states that the intent of this bill is to improve access to
syringes and hypodermic needles so as to remove significant
barriers for persons seeking to protect their health and the
health of other persons, and to remove barriers for programs
or businesses to provide sterile injection equipment and
education to adults, thereby reducing the spread of
communicable diseases and protecting the public health.
2)BACKGROUND . According to the DPH Office of AIDS, in 2009
injection drug use (IDU) was associated with approximately 19%
of the 190,000 reported HIV/AIDS cases, and it is estimated
that approximately 750 new HIV infections may be attributed to
IDU each year. The link between IDU and HIV transmission is
particularly strong for women and minorities. It is also
estimated that at least 60% of prevalent cases of HCV
infection are associated with IDU. HCV affects approximately
600,000 people in California (2% of the state's population).
Complications of liver disease associated with HCV have
resulted in an estimated 8,000 to10,000 deaths per year in the
United States.
Public health experts, including the Centers for Disease Control
and Prevention, have identified access to sterile syringes as
one component of a comprehensive HIV prevention strategy
SB 41
Page 4
designed to reduce HIV transmission among IDUs. In the last
10 years, a number of national organizations have endorsed
deregulation to allow IDUs to purchase and possess syringes
and needles without a prescription, including the American
Medical Association, the American Pharmaceutical Association,
the National Association of Boards of Pharmacy, the National
Alliance of State and Territorial AIDS Directors, and the
Association of State and Territorial Health Officials.
3)DPDP . SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004,
establishes a five-year pilot program to allow California
pharmacies, when authorized by a local government, to sell up
to 10 syringes to adults without a prescription. According to
the DPH Office of AIDS, 16 counties and four cities in
California have authorized a DPDP (counties: Alameda, Contra
Costa, Humboldt, Los Angeles, Mendocino, Marin, San Francisco,
San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa
Cruz, Solano, Sonoma, Yolo, and Yuba; cities: Long Beach, Los
Angeles, Sacramento, and West Hollywood). One other county is
currently considering implementation of the program, and four
County Boards of Supervisors have rejected authorization of a
DPDP. According to DPH, in 2005, the first wave of LHJs and
pharmacies in California began to authorize and implement
local DPDPs. By February 2010, over 650 pharmacies were
registered to participate in the program. Among the LHJs not
planning to authorize DPDP, the top four reasons were: limited
time (38%), limited interest (31%), pharmacy disinterest
(29%), and law enforcement opposition (22%). While the
proportion of LHJs that authorized a DPDP is relatively small,
those that have implemented one are home to 70% of
Californians currently living with HIV/AIDS.
According to an evaluation of DPDP published in July 2010 by
DPH, SB 1159 appears to be having the desired effect of
augmenting access to sterile syringes to prevent transmission
of HIV and other blood-borne viral infections among IDUs
without many of the negative consequences that some had
feared. DPH's evaluation suggests that counties authorizing
over-the-counter (OTC) sale of syringes without a prescription
possess lower syringe sharing levels among IDUs than counties
that have not authorized OTC sale. Additionally, since
implementation of SB 1159, fewer clients presenting for
testing for HIV at state-funded testing sites report injecting
illegal drugs, suggesting that authorization of OTC syringe
sales did not have the negative impact of increased injection
SB 41
Page 5
drug activity, a concern expressed by some prior to
authorization. DPH's evaluation found that, following
implementation of SB 1159, accidental needle-stick injury to
law enforcement officers remained rare in California. Between
2005 and 2009, post-authorization of DPDPs, 19 accidental
needle-stick injuries were reported among law enforcement in
LHJs that had authorized DPDPs and 15 accidental needle-stick
injuries were reported among law enforcement in LHJs that had
not authorized DPDPs. The variation in recent years is not
great enough to suggest a statistically significant
relationship to the authorization of DPDP. DPH's evaluation
found no increase in unsafe discard of syringes since
implementation of SB 1159. Finally, comparing time periods
prior to and following SB 1159 authorization, DPH found no
evidence of an increase in drug use or crime in the state of
California as a whole or in areas that authorized sale of
syringes without a prescription. The overall findings are
consistent with those of other states that have transitioned,
as California has, from a complete prohibition on sale and
possession of syringes, to allowing a limited number to be
sold to adults.
4)RELATED LEGISLATION . AB 604 (Skinner) permits DPH to
authorize specified entities to provide hypodermic needle and
syringe exchange services consistent with state and federal
standards, including those of the United States Public Health
Service, in any location where DPH determines that the
conditions exist for the rapid spread of HIV, viral hepatitis,
or any other potentially deadly or disabling infections that
are spread through the sharing of used hypodermic needles and
syringes. AB 604 is set to be heard in the Senate Health
Committee on June 22, 2011.
5)PREVIOUS LEGISLATION . AB 1701 (Chesbro), Chapter 667, Statues
of 2010, establishes, indefinitely, the DPDP, permitting
cities or counties to authorize licensed pharmacists to sell
or furnish 10 or fewer hypodermic needles or syringes to a
person for use without a prescription, as specified.
AB 1858 (Blumenfield) of 2010 was substantially similar to AB
604 and was vetoed by Governor Schwarzenegger, who stated, "I
signed legislation in 2005 that reflected a careful balance
between good public health policy and local decision-making
authority. I remain comfortable with that original decision
and do not believe it is appropriate to change this balance
SB 41
Page 6
and instead give authority to the state Department of Public
Health to overrule local decisions regarding syringe exchange
programs."
SB 1029 (Yee) of 2010 contained similar provisions to those
contained in this bill, and was vetoed by Governor
Schwarzenegger who stated, "When I signed legislation my first
year in office allowing for a pilot program to allow the sale
of syringes through participating counties and registered
pharmacies, I was seeking to balance the competing public
health, law enforcement and local control issues that this
issue requires. I believe this balance was achieved and SB
1029 would remove the ability of local officials to best
determine policies in their jurisdiction."
AB 110 (Laird), Chapter 707, Statutes of 2007, permits a
public entity that receives General Fund money from the
Department of Health Services (now DPH) for HIV prevention and
education to use that money to support needle exchange
programs. AB 1597 (Laird) of 2005 contained substantially
similar provisions to AB 110, but was vetoed by Governor
Schwarzenegger.
AB 547 (Berg), Chapter 692, Statutes of 2005, creates the
Clean Needle and Syringe Exchange Program to permit needle
exchange programs without a local declaration of emergency.
AB 946 (Berg) of 2003 and AB 2871 (Berg) of 2004 would also
have repealed the requirement that a city or county authorize
its needle exchange program through a declaration of a local
emergency. Both bills were vetoed by Governor Davis and
Governor Schwarzenegger, respectively.
SB 774 (Vasconcellos) of 2003 and SB 1785 (Vasconcellos) of
2002 would have permitted the furnishing of syringes without a
prescription. Both measures were vetoed by Governor Davis.
AB 136 (Mazzoni), Chapter 762, Statutes of 1999, exempts
public entities and their agents and employees who distribute
hypodermic needles or syringes to participants in clean needle
and syringe exchange projects authorized by the public entity
pursuant to a declaration of a local emergency from criminal
prosecution.
6)SUPPORT . The California Hepatitis Alliance (CHA) states that
syringe sharing among injection drug users who are not allowed
to buy syringes without a prescription, is the number one
SB 41
Page 7
cause of hepatitis C in the state, and the second most common
cause of new HIV and hepatitis B infections. CHA contends
that allowing adults to spend their own money to access
equipment that prevents the spread of infectious diseases will
save California taxpayers hundreds of millions of dollars in
healthcare costs. The California Medical Association supports
making syringes and needles available without a prescription
at licensed pharmacies in order to prevent the transmission
HIV and hepatitis among IDUs. Equality California writes that
allowing for an increase in the number of needles an
individual can obtain, as well as decriminalizing the
possession of needles and syringes will together help in the
fight against the spread of HIV and AIDS. The Health Officers
Association of California states that this bill will protect
public health without sacrificing public safety. The
California Retailers Association and the National Association
of Chain Drug Stores writes that over 200 studies have found
that improved syringe access reduces the rate of HIV
transmission without increasing rates of drug use, drug
injection or crime and that preventing disease before it
spreads is sound fiscal policy, particularly in light of
California's current recession and budget cuts. The County
Alcohol and Drug Program Administrators Association of
California states that expanding access to sterile syringes
statewide will reduce costs to taxpayers for health care costs
of those infected with blood-borne diseases.
7)OPPOSITION . The opposition states that the removal of the
local option forces needle furnishing programs on every
community in California, irrespective of the wishes of that
community's elected officials. They further state that the
quality of life implications of this bill are significant,
since local communities and their wishes are removed from the
equation and pharmacies would be permitted to distribute
needles irrespective of community sentiment. The opposition
contends that there have been too many instances of needle
users dumping their used needles in the shelves of stores, in
parking lots adjacent to stores, and even one instance where a
needle user, caught shoplifting, threatened to stick the store
manager with a needle. The opposition asserts that this type
of behavior is of interest to local communities, and the
removal of any local determination before needle furnishing
pharmacies maybe authorized flies in the face of those
concerns.
SB 41
Page 8
REGISTERED SUPPORT / OPPOSITION :
Support
Drug Policy Alliance (sponsor)
AIDS Project Los Angeles
Alameda County Board of Supervisors
Alliance for a Better District 6
American Civil Liberties Union
American Federation of State, County and Municipal Employees,
AFL-CIO
California Academy of Family Physicians
California Association of Alcohol and Drug Program Executives,
Inc.
California Communities United Institute
California Family Health Council
California Hepatitis Alliance
California Medical Association
California Nurses Association
California Opioid Maintenance Providers
California Pharmacists Association
California Psychiatric Association
California Public Defenders Association
California Retailers Association
Central City Democrats
City and County of San Francisco
County Alcohol and Drug Program Administrators Association of
California
Equality California
Friends Committee on Legislation of California
Health Officers Association of California
Los Angeles Gay and Lesbian Center
Milk Club
National Association of Chain Drug Stores
Planned Parenthood Advocacy Project of Los Angeles County
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Rite Aid
Ross Mirkarimi, San Francisco District 5 Supervisor
San Francisco Mayor's Hepatitis C Task Force
Santa Clara County Board of Supervisors
Opposition
California Chief Probation Officers of California
SB 41
Page 9
California District Attorneys' Association
California Narcotic Officers Association
California Peace Officers' Association
California Police Chiefs' Association
California State Sheriffs' Association
International Faith Based Coalition
Peace Officers Research Association of California
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097