BILL ANALYSIS
AB 1858
Page 1
Date of Hearing: April 6, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1858 (Blumenfield) - As Amended: March 24, 2010
SUBJECT : Hypodermic needles and syringes: exchange services.
SUMMARY : Permits the Department of Public Health (DPH) to
authorize clinics, health services organizations,
community-based organizations, or other entities to provide
hypodermic needle and syringe exchange services 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. Specifically, this bill :
1)Permits DPH to authorize clinics, health services
organizations, community-based organizations, or other
entities to provide hypodermic needle and syringe exchange
services 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.
2)Requires DPH to establish and maintain on its Web site the
address and contact information of programs operating a needle
exchange project (NEP) pursuant to this bill.
3)Requires DPH to authorize NEPs under this bill as recommended
by the U.S. Secretary of Health and Human Services, subject to
the availability of funding, as part of a network of
comprehensive services, including treatment services, as
specified.
4)Prohibits staff and volunteers participating in a
DPH-authorized NEP from being subject to criminal prosecution
for any law related to the possession, furnishing, or transfer
of hypodermic needles for syringes during the participation in
an exchange project.
5)Requires DPH to provide local health officers (LHOs) biennial
status reports, as specified, based on reports to DPH from
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service providers operating DPH-authorized NEPs within a LHO's
jurisdiction. Requires LHOs with county- and city-authorized
NEPs to report on the program's status biennally (rather than
annually, as required by existing law).
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 clean needle and syringe exchange project in any
city and county, county, or city, upon the action of a county
board of supervisors and the local health officer or health
commission of that county, or upon the action of the city
council, the mayor, and the local health officer. Permits a
county or a city with or without a health department to
authorize a clean needle and syringe exchange project in
consultation with DPH, as specified. Requires local
government, local public health officials, and law enforcement
to be given the opportunity to comment on syringe exchange
programs on an annual basis. Requires the public to be given
the opportunity to provide input to local leaders to ensure
that any potential adverse impacts on the public welfare of
syringe exchange programs are addressed and mitigated.
3)Prohibits providers participating in an exchange project
authorized by a county or city from being subject to criminal
prosecution for possession of needles or syringes during
participation in an exchange project.
4)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 LHD until December 31, 2010. Prohibits
the possession and sale of drug paraphernalia; but until
December 31, 2010, 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 : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
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1)PURPOSE OF THIS BILL . According to the author, there are not
nearly enough programs providing syringe exchange services to
meet the needs of injection drug users who need sterile
syringes in order to avoid transmission of HIV and viral
hepatitis. The author also states that there are significant
statutory barriers to establishing and maintaining syringe
exchange programs, which this bill seeks to ameliorate. The
requirement of a local authorization vote has resulted in
unequal access to preventative health services. This bill
will allow DPH to authorize health centers and other local
entities to offer syringe exchange services 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 thorough the
sharing of used syringes. These deadly and costly infections
in jurisdictions without syringe exchange services are a state
General Fund problem, as well as a preventable personal and
public health tragedy. The indigent ill are dependent on
state funded medical and prescription services. The author
contends that physicians report that it is extremely common to
tell a patient who has been clean and sober for many years
that they were infected with hepatitis or HIV due to syringe
sharing in their past, and then begin the process of enrolling
the patient in Medi-Cal and other state supported health
services.
2)BACKGROUND . Injection drug use (IDU) is the second leading
cause of HIV transmission and the leading cause of the
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, 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. 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
doubled from 503 in 1995 to 1,195 in 2004. Public health
experts, including the federal Centers for Disease Control and
Prevention (CDC), have identified access to sterile syringes
as one component of a comprehensive HIV prevention strategy
designed to reduce HIV transmission among IDUs.
3)NEEDLE EXCHANGE PROGRAMS . According to the CDC, the first
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organized NEPs in the U.S. were established in the late 1980s
in Tacoma, Washington; Portland, Oregon; San Francisco; and,
New York City. As of November 2007, a total of 185 NEPs were
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 NEPs. In addition to
exchanging syringes, many NEPs 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 (STDs); 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. NEPs 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 syringe exchange
sponsored by the Robert Wood Johnson Foundation's Substance
Abuse Policy Research Program found that syringe exchanges 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.
4)RELATED LEGISLATION . AB 1701 (Chesbro), currently on the
Assembly Floor, establishes, indefinitely, the Disease
Prevention Demonstration Project (DPDP), 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. AB 1701
passed by a vote of 14-4 when it was heard in the Assembly
Health Committee on March 23, 2010.
SB 1029 (Yee), currently in the Senate Business, Professions
and Economic Development Committee, eliminates most provisions
of the DPDP, including requirement that LHDs register
pharmacies and provide pharmacies with educational material
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for distribution, and instead allow pharmacists statewide the
discretion to sell 30 or fewer syringes to an adult without
the requirement of a local authorization vote and eliminates
other elements of the demonstration project including state
requirements regarding advisory board and evaluation. SB 1029
also deletes the prohibition against possession of hypodermic
needles and syringes, and permits adults to possess 30 or
fewer syringes solely for personal use. SB 1029 would also
require the Office of AIDS to develop and maintain information
on its Web site to educate consumers at risk of blood-borne
infections of opportunities to improve and protect the
consumer's health, and to protect the public health. SB 1029
would require pharmacies that provide non-prescription
syringes to promote safe syringe disposal, and to store
syringes securely. AB 1701 passed by a vote of 6-3 when it
was heard in the Senate Health Committee on March 24, 2010
5)PREVIOUS LEGISLATION . 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 1159 (Vasconcellos), Chapter 608, Statutes of 2004,
established a five-year pilot program (DPDP) to allow
California pharmacies, when authorized by a local government,
to sell up to 10 syringes to adults without a prescription.
Prior to SB 1159 in 2004, SB 1785 (Vasconcellos) of 2002 and
SB 774 (Vasconcellos) of 2003 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
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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 . Supporters of this bill write that over 200 studies
from the United States and abroad concur that improved syringe
access reduces the rate of HIV transmission, without
increasing rates of drug use, drug injection or crime.
Supporters further state that NEPs reduce the number of
syringes found in community settings and link people to
treatment and other services. The supporters assert that
science shows overwhelmingly that NEPs save lives without
increasing drug use or crime, and that preventing new
infections is sound fiscal policy.
7)OPPOSITION . Opponents write that each community should retain
sovereignty concerning these important matters as there have
been too many instances of needle users dumping needles in the
shelves of stores and in parking lots adjacent to stores, and
one instance where a needle user, caught for shoplifting,
threatened to stick the store manager with a needle.
8)POLICY CONCERNS . This bill revises the Clean Needle and
Syringe Exchange Program in existing law, which permits cities
and counties to establish NEPs, to authorize a variety of
non-governmental entities to establish NEPs with DPH approval.
However, it does not establish specific criteria for approval
of such programs, set a minimum standard for what types of
non-governmental entities could be approved to administer
NEPs, or require DPH to establish standards under which those
non-government NEPs would operate.
This bill should be amended consistent with existing state law
and national standards for NEPs as follows:
On page 4, beginning on line 12
Delete ", health services organizations, community-based
organizations," and after "entities" insert ", which apply for
such authorization and that have sufficient staff and capacity
to provide services as described in Section 121349.1, as
determined by the department"
On page 4, on line 18
After "syringes" insert "consistent with state and federal
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standards, including those of the United States Public Health
Service"
This bill also exempts DPH-authorized NEPs from provisions of
existing law provide for the public participation in project
status reports required to be made by NEPs operated by cities
and counties. This bill should be amended to make reporting
requirements consistent across all NEPs in the state,
regardless of whether a local government or non-governmental
entity is the operator.
9)TECHNICAL AMENDMENTS .
a) On page 4: delete lines 19 through 22
b) On page 4, line 13 after "entities" insert "that apply
for such authorization"
c) On page 5, delete "Secretary of Health and Human
Services" and insert "Public Health Service"
d) On page 6, lines 5 and 6 delete "public"
REGISTERED SUPPORT / OPPOSITION :
Support
Drug Policy Alliance (sponsor)
AIDS Project Los Angeles
American Civil Liberties Union
California Association of Alcohol and Drug Program Executives,
Inc.
California Hepatitis Alliance
California Opioid Maintenance Providers
Common Ground - The Westside HIV Community Center
Homeless Health Care Los Angeles
Opposition
California Narcotic Officers' Association
California Peace Officers' Association
California Police Chiefs Association
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097