BILL ANALYSIS Ó AB 1743 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 1743 (Ting) As Amended May 27, 2014 Majority vote ----------------------------------------------------------------- |ASSEMBLY: |45-28|(April 10, |SENATE: |36-0 |(August 7, | | | |2014) | | |2014) | ----------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY : Deletes the limit on the number of syringes a pharmacist has the discretion to sell to an adult without a prescription and extends, until January 1, 2021, the statewide authorization for pharmacists to sell syringes without a prescription, as specified. The Senate amendments extend the January 1, 2015 sunset in current law to January 1, 2021. AS PASSED BY THE ASSEMBLY , this bill was largely similar, but had no sunset date. FISCAL EFFECT : None COMMENTS : According to the author, 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 public health. 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 disease prevention demonstration projects (DPDP), in addition to needle exchange programs operational in only 19 counties and two cities. The author concludes that a statewide solution is best because diseases do not stay confined to local borders - county lines or city limits. AB 1743 Page 2 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 participating, 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 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 discarding of used hypodermic needles or syringes observed in the DPDPs. DPH reported that the rate of injection of illegal drugs decreased among publicly funded human immunodeficiency virus (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 acquired immunodeficiency syndrome (AIDS) incidence rates. DPH states that between problems of data gathering and the short duration of the projects made the infection rate 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 AB 1743 Page 3 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 National Association of Boards of Pharmacy, the National Alliance of State and Territorial AIDS Directors, and the Association of State and Territorial Health Officials. The Drug Policy Alliance and San Francisco AIDS Foundation, cosponsors of this bill, 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, 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. The Los Angeles County Solid Waste Management Committee (SWMC) opposes unless amended/supports if amended to address concerns regarding collection and disposal of possible additional sharps in the municipal waste stream due to this bill. SWMC requests amendments that would expand this bill to require sharps manufacturers and distributors to provide free sharps disposal containers. Analysis Prepared by : Dharia McGrew / HEALTH / (916) 319-2097 FN: 0004156