BILL ANALYSIS
AB 1858
Page 1
ASSEMBLY THIRD READING
AB 1858 (Blumenfield)
As Amended April 13, 2010
Majority vote
HEALTH 11-5 APPROPRIATIONS 12-5
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|Ayes:|Monning, Ammiano, Carter, |Ayes:|Fuentes, Ammiano, |
| |Bradford, De Leon, Eng, | |Bradford, |
| |Hayashi, Hernandez, | |Charles Calderon, Coto, |
| |Jones, Bonnie Lowenthal, | |Davis, |
| |V. Manuel Perez | |De Leon, Hall, Skinner, |
| | | |Solorio, Torlakson, |
| | | |Torrico |
|-----+--------------------------+-----+--------------------------|
|Nays:|Fletcher, Emmerson, |Nays:|Conway, Harkey, Miller, |
| |Gaines, Smyth, Audra | |Nielsen, Norby |
| |Strickland | | |
| | | | |
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SUMMARY : Permits the Department of Public Health (DPH) to
authorize clinics 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 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 US Public Health Service, subject to the availability
of funding, as part of a network of comprehensive services,
including treatment services, as specified.
AB 1858
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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
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 biennially (rather than
annually, as required by existing law).
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)Annual General Fund costs to the DPH of $30,000 to $40,000 in
2011 through 2013 to establish regulations and comply with
other requirements of this bill, including hosting information
about projects on the internet and an expansion of reporting
related to local health jurisdictions.
2)Ongoing, likely absorbable costs for DPH to continue oversight
of needle exchange projects after 2013.
3)Unknown, potentially significant savings to the extent this
bill reduces medical costs associated with infectious diseases
such as HIV and hepatitis.
COMMENTS : 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
AB 1858
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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.
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 injection drug users.
According to the CDC, the first 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 injection drug users 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;
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
AB 1858
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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.
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.
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.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097
FN: 0004257