BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 1743
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          CONCURRENCE IN SENATE AMENDMENTS
          AB 1743 (Ting)
          As Amended May 27, 2014
          Majority vote
           
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          |ASSEMBLY:  |45-28|(April 10,      |SENATE: |36-0 |(August 7,     |
          |           |     |2014)           |        |     |2014)          |
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           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
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          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
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          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  



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