BILL ANALYSIS Ó
AB 1743
Page 1
Date of Hearing: March 25, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1743 (Ting) - As Introduced: February 14, 2014
SUBJECT : Hypodermic needles and syringes.
SUMMARY : Deletes the limit on the number of syringes a
pharmacist has the discretion to sell to an adult without a
prescription and deletes the sunset date of January 1, 2015,
that would end the statewide authorization to sell syringes
without a prescription, as specified.
EXISTING LAW :
1)Permits pharmacists and physicians to furnish up to 30
hypodermic needles and syringes for human use, without a
prescription or local government authorization, to a person 18
years or older until January 1, 2015.
2)Permits a person 18 years of age or older, without a
prescription or license, to obtain up to 30 hypodermic needles
and syringes from a physician or pharmacist solely for
personal use until January 1, 2015.
3)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.
4)Requires home-generated sharps waste be transported only in a
sharps container or other container approved by the applicable
enforcement agency and specifies disposal can only occur at
household hazardous waste facilities, at specified sharps
consolidation points, the facilities of medical waste
generators, or by the use of approved medical waste mail-back
containers.
5)Permits, until January 1, 2015, a city or county to authorize
a licensed pharmacist to sell or furnish up to 10 hypodermic
needles or syringes to a person for human use without a
prescription if the pharmacy is registered with a local health
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jurisdiction in disease prevention demonstration projects
(DPDP).
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the intent of
the 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. The author notes, without this
bill, persons living in many parts of California will not have
safe syringe access. At the end of this year, the state will
revert back to a piecemeal framework adopted in 2005 in which
counties or cities (with their own departments of health) can
decide if pharmacists may sell syringes over the counter. The
author states this would mean safe, over the counter syringes
would only be available through pharmacists in 15 counties and
four cities participating in the DPDP, in addition to needle
exchange programs operational in only 19 counties and two
cities. The author concludes diseases don't respect the
boundaries of our local communities and it is clear that a
statewide solution is best because diseases don't stay
confined to local borders - county line or city limits.
2)BACKGROUND . California is one of only five states having
statewide limitations on the purchase of syringes, according
to a 2014 survey by the National Association of Boards of
Pharmacy (NABP). Although statewide sales are currently
legal, there is a restriction as to the number.
California has allowed the sale of hypodermic needles and
syringes for almost 10 years. SB 1159 (Vasconcellos),
Chapter 608, Statutes of 2004, established 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. Within several years there were hundreds of
pharmacies, reaching a total of 650 by the suspension of the
pilot. The pilot was suspended when statewide sales were
authorized by SB 41 (Yee), Chapter 738, Statutes of 2011. SB
41 also required the Department of Public Health (DPH) to
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evaluate the results of the pilot project.
In July 2010, DPH published an evaluation of the pilot. The
report had a number of findings. Among the most relevant were
that an increased number of intravenous drug users (IDUs)
reported using pharmacies as a source of their syringes. The
availability of these sterile syringes seemed to impact
behavior. A significantly lower portion of IDUs reported
sharing of syringes and there was no evidence of increased
unsafe discard of used hypodermic needles or syringes was
observed in the DPDPs. DPH reported that the level of
injection of illegal drugs decreased among publicly funded HIV
testing clients. The report also found that drug related
crime remained stable in the jurisdictions that authorized
DPDPs. Nevertheless, DPH concluded that the program appeared
to be having the desired effect of augmenting access to
sterile syringes.
The most important statistic would be the HIV and AIDS
incidence rates. DPH states that between problems of data
gathering and the short duration of the projects made that
impossible to measure accurately. However, there are a host
of studies both domestically and internationally that provide
evidence that provision of sterile hypodermic needles and
syringes reduces HIV transmission.
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 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 NABP, the National Alliance of State and
Territorial AIDS Directors, and the Association of State and
Territorial Health Officials.
3)SUPPORT . The Drug Policy Alliance and San Francisco AIDS
Foundation, cosponsors of AB 1743, argue this bill will
continue cost-effective HIV and hepatitis prevention policy in
California. By lifting the current sunset and allowing
pharmacists and physicians the discretion to furnish sterile
syringes, this will be an important part of the state's
comprehensive approach to preventing the spread of HIV,
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hepatitis B, and hepatitis C. They note over 200 studies from
the United States and abroad concur that improved syringe
access reduces the rate of syringe sharing and disease
transmission without increasing rates of drug use, drug
injection, or crime. The cosponsors also note that
maintaining access to sterile syringes reduces costs to
taxpayers; the cost of treating one case of HIV can exceed
$600,000.
Supporters note that California was one of the last states to
relax restrictions on accessing a sterile syringe, leading to
an unnecessarily high rate of syringe-acquired HIV, hepatitis
B, and hepatitis C. They argue since the enactment of SB 41,
pharmacists have been free to protect the health of individual
patients and the community health at no cost to taxpayers.
They support this bill because it will make the discretion
permanent and allow the pharmacists or physicians to decide on
how many syringes can be provided.
4)OPPOSITION . The California Narcotic Officers Association and
the California Police Chiefs Association oppose this bill
arguing there is no evidence to justify an outright lifting of
the sunset or a removal of the current cap of 30 syringes.
5)PREVIOUS LEGISLATION .
a) SB 41 permits nonprescription syringe sales of a maximum
of 30 hypodermic needles or syringes to a person without a
prescription through licensed pharmacies throughout the
state until January 1, 2015 and makes inoperative until
that date, portions of the law establishing the DPDP.
b) AB 1701 (Chesbro), Chapter 667, Statues of 2010, extends
the provisions establishing the DPDP until January 1, 2018,
which permits 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.
c) SB 1029 (Yee) of 2010 contained similar provisions to SB
41, but was vetoed by Governor Schwarzenegger.
d) SB 1159 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
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prescription.
e) SB 774 (Vasconcellos) of 2003 would have permitted the
furnishing of syringes without a prescription. This bill
was vetoed by Governor Davis.
f) SB 1785 (Vasconcellos) of 2002, substantially similar to
SB 774, was also vetoed by Governor Davis.
REGISTERED SUPPORT / OPPOSITION :
Support
Drug Policy Alliance (cosponsor)
San Francisco AIDS Foundation (cosponsor)
AIDS Foundation of Chicago
AIDS Legal Referral Panel
American Civil Liberties Union of California
Asian & Pacific Islander Wellness Center
California Nurses Association
California Pharmacists Association
California Public Defenders Association
Center for Living and Learning
County Alcohol & Drug Program Administrators Association of
California
Dolores Street Community Services
Friends Committee on Legislation of California
HealthRIGHT360
HIV Prevention Justice Alliance
L.A. Gay & Lesbian Center
National Viral Hepatitis Roundtable
San Francisco HIV/AIDS Provider Network
Tarzana Treatment Centers
Transgender Law Center
UCSF Alliance Health Project
Westside Community Services
One individual
Opposition
California Narcotic Officers' Association
AB 1743
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California Police Chiefs Association
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097