BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1858
A
AUTHOR: Blumenfield
B
AMENDED: June 10, 2010
HEARING DATE: June 30, 2010
1
CONSULTANT:
8
Orr
5
8
FOR VOTE ONLY
SUBJECT
Hypodermic needles and syringes: exchange services
SUMMARY
This bill allows the California Department of Public Health
(CDPH) to authorize entities to provide hypodermic needle
and syringe exchange programs in any location where the
department determines conditions exist for the rapid spread
of deadly or disabling disease spread through the sharing
of unclean hypodermic needles and syringes.
CHANGES TO EXISTING LAW
Existing law:
Requires that no person shall possess a hypodermic needle
or syringe except when acquired in accordance with
specified provisions of law.
Authorizes a clean needle and syringe exchange program in
any city, county, or city and county upon action by the
county board of supervisors and the local health officer or
health commission as applicable, or action of the city
council, mayor and local health officer as applicable. The
Continued---
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programs shall be authorized using recommendations from the
United States Secretary of Health and Human Services,
subject to availability of funding, and shall be offered as
part of a comprehensive network of services.
Allows local governments, public health officials, and law
enforcement agencies the opportunity to comment on clean
needle and syringe exchange programs on an annual basis to
address potential adverse impacts to the public.
Requires health officers of jurisdictions that participate
in clean needle and syringe exchange programs to annually
report the status of those programs and at an open meeting
of the board of supervisors or city council.
Allows counties to authorize pharmacists to furnish or sell
10 or fewer hypodermic needles or syringes to persons 18
years of age or older, for the period commencing January 1,
2005 and ending December 31, 2010, if the pharmacy is
registered for the Disease Prevention Demonstration Project
(DPDP) and if the pharmacy complies with other specified
provisions.
Stipulates that no public entity, its agents, or employees
will be subject to criminal prosecution for the
distribution of hypodermic needles or syringes to
participants in clean needle and syringe exchange projects
authorized by law.
Finds and declares that needle exchange programs have been
shown to serve as a bridge to treatment and recovery from
drug abuse, curtail the spread of HIV infection through the
IDU population, and do not increase drug use.
Establishes the DPDP as a collaboration between pharmacies
and local and state health officials, for the purpose of
evaluating the long-term desirability of allowing licensed
pharmacists to furnish or sell nonprescription hypodermic
needles or syringes to prevent the spread of blood-borne
pathogens, including HIV and hepatitis C.
As part of the DPDP, requires participating pharmacies to
register with their local health department, and certify
that they will provide written or verbal information on
drug treatment, testing services, and safe sharps disposal
STAFF ANALYSIS OF ASSEMBLY BILL 1858 (Blumenfield) Page
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practices at the point of sale.
Allows a pharmacist or physician to furnish hypodermic
needles or syringes for human use without a prescription or
permit if the person is known to the furnisher and the
furnisher has been previously provided with a prescription
or proof of legitimate medical need.
This bill:
Authorizes CDPH to allow entities to apply for
authorization to provide hypodermic needles and syringe
exchange services in any location where the department
determines that conditions exist for the rapid spread of
HIV, viral hepatitis, or any other potentially deadly or
disabling infectious disease, spread through the sharing of
unclean hypodermic needles and syringes.
The department or other authorizing city and county,
county, or city with or without a health department must
authorize the needle or syringe exchange services in
consultation with CDPH, as recommended by the US Public
Health Service and consistent with state and federal
standards. The entity must have sufficient staff and
capacity to provide such services. The provision of
services is subject to the availability of funding.
Allows participants in the newly authorized syringe
exchange programs to lawfully possess 10 or fewer
hypodermic needles or syringes, if acquired from an
authorized source, until December 31, 2010.
Requires CDPH to establish and maintain the addresses and
contact information of programs providing services pursuant
to this section on its website.
Provides that staff and volunteers participating in
exchange projects authorized by the state shall not be
subject to criminal prosecution for violation of any law
related to the possession, furnishing, or transfer of
hypodermic needles in an exchange project.
Changes the frequency with which local governments, public
health officials, law enforcement agencies, and the public
may comment on clean needle and syringe exchange programs
from once per year to once every two years. Also changes
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the requirement for local health officials to report to the
board of supervisors or city council on the status of such
programs from once per year to once every two years.
Requires CDPH to provide biennial reports to local health
officers in jurisdictions where CDPH has authorized needle
exchange services.
Replaces a reference to recommendations by the US Secretary
of Health and Human Services, with the US Public Health
Service.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, AB 1858 would result in Annual General Fund
costs to CDPH of $30,000 to $40,000 in 2011 through 2013 to
comply with requirements of this bill.
Ongoing, likely absorbable costs for CDPH to continue
oversight of needle exchange projects after 2013.
Unknown, but potentially significant savings to the
extent this bill reduces medical costs associated with
infectious diseases such as HIV and hepatitis.
BACKGROUND AND DISCUSSION
According to the author, this bill would allow CDPH to
authorize community clinics or other health agencies to
provide syringe exchange services in any location where the
department determines that the conditions exist for the
rapid spread of HIV, viral hepatitis, or any other
potentially deadly or disabling infection that is spread
through the sharing of used syringes. This bill will
authorize CDPH to approve syringe exchange programs (SEPs)
without inhibiting the ability of local governments to
regulate SEPs within their jurisdiction. The author claims
that most counties in California do not have safe, legal
access to sterile syringes, even in areas with high rates
of HIV and hepatitis. The provision of sterile syringes
through exchange programs is considered a vital component
of a comprehensive HIV and hepatitis control strategy, and
is endorsed by every major state, national, and
international health and medical association, including the
US Centers for Disease Control and Prevention, U.S. Public
Health Service, National Institutes of Health, and the
World Health Organization, among others.
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The author notes that this bill does not appropriate funds
for syringe exchanges, nor does it mandate the state to
fund new or existing syringe exchanges. The author claims
that a sterile syringe costs approximately $.10. Most SEPs
in California operate on very modest budgets, primarily
funded by private donors and foundations. As President
Obama recently signed legislation lifting the ban on the
use of federal funds for syringe exchange, AB 1858 creates
the statutory conditions to make the best use of federal
HIV prevention dollars that may become available in the
future.
Clean needle and syringe exchange programs (SEPs)
Clean needle exchange programs make sterile needles
available to injection drug users (IDUs), in order to
mitigate the transmission of bloodborne diseases such as
HIV and HCV. SEPs provide a safe and accessible method for
IDUs to exchange used syringes for sterile ones. Often,
SEPs also provide other public health services, such as HIV
testing, risk-reduction education, and referrals for
substance-abuse treatment. For some California residents, a
SEP is the only accessible provider of medical or social
services.
SEPs have been shown to be effective in reducing the
sharing of syringes and the transmission of blood-borne
infections among drug users, without increasing drug use.
SEPs can help lower the number of contaminated syringes
circulating in communities by decreasing syringe scarcity,
and in the case of an accidental needlestick, can lower the
likelihood of a needle being contaminated with a
potentially deadly disease. Since the implementation of
these programs in the late 1980s, new HIV infections among
IDUs have declined overall by 80 percent. One study
published in 2001 found that the mean HIV prevalence rate
among IDUs in metropolitan areas that banned
over-the-counter sales or purchases of needles and syringes
was twice as high as the mean HIV prevalence rate in metro
areas that allow over-the-counter sales (13.8 percent vs.
6.7 percent respectively).
According to the Center for Health Improvement, there were
41 authorized SEPs in California as of March 2009. Cities
and counties are enabled to authorize a clean needle and
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syringe exchange project as part of a comprehensive network
of services. Local government, local public health
officials, law enforcement personnel, and the public are
supposed to be given the opportunity to provide comments on
the clean needle and syringe exchange programs annually.
The local health officers are required to annually report
to the boards of supervisors or city councils, and to
include a detailed report on the status of local clean
needle and syringe exchange programs including, but not
limited to, relevant statistics on blood-borne infections
associated with needle-sharing activities and the use of
public funds for these programs. According to CDPH/OA,
seventeen county boards of supervisors and four city
councils have authorized SEPs, and several other counties
and cities are currently considering them.
Funding for syringe exchange
On December 16, 2009, President Obama signed the
Consolidated Appropriations Act of
2010, which lifts the 1989 ban on the use of federal funds
for syringe exchange programs (SEPs). According to CDPH
Office of AIDS (CDPH/OA), CDPH considers syringe exchange
to be "unquestionably vital in the struggle to reduce the
spread of HIV, HCV and other bloodborne infections among
injection drug users, their partners, and their children."
Over the past four years, CDPH has awarded over 3.5 million
dollars in state General Funds to authorized syringe
exchange programs across the state to provide syringe
exchange, HIV and HCV testing, counseling and referral to
needed services. Recent cuts in state General Funds for HIV
prevention have resulted in elimination of all state
funding of SEPs; HIV prevention in the state is now solely
funded by federal dollars, which had precluded the funding
of SEPs. The lifting of the federal ban will mean that CDC
funds for FY 2010-2011 and future fiscal year funds can be
used to support SEPs when they are awarded. The Division of
HIV/AIDS Prevention (DHAP) of the Centers for Disease
Control and Prevention (CDC), is developing policy guidance
for grantees around the use of federal funds for SEPs; when
the guidance is provided to CDPH/OA, they will provide the
information to grantees in order to allow local health
jurisdictions the flexibility to use these funds to support
syringe exchange programs where they are authorized.
Pharmacy sale of syringes
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Until the 2004 signing of SB 1159 (Vasconcellos), which
started the Disease Prevention Demonstration Project,
California was one of only five states that required a
prescription in order to purchase a syringe. In the early
80s, insulin and allergy syringes could be bought in any
drugstore without a prescription. In spite of the available
supply, some drug users chose to reuse and share needles,
and are believed to be partly responsible for the early
spread of the AIDS epidemic. In the 90s, some states began
requiring needles to be stored behind the pharmacy counter
and began requiring a prescription, in hopes of cutting
down on illegal drug use by making syringes more scarce.
Many states abandoned that policy once a correlation was
noted between syringe scarcity and increased infectious
disease rates in IDUs.
To address and prevent the spread of blood-borne infectious
diseases among IDUs in California, the DPDP was established
to allow the sale of up to 10 hypodermic needles or
syringes without a prescription at pharmacies. In order to
participate in the DPDP, pharmacies must register with
their local health department and provide a contact name
and related information. They must also certify that they
will provide written or verbal counseling at the time of
furnishing or selling needles or syringes. Additionally,
pharmacies must properly store needles and syringes so that
they are only available to authorized personnel, provide
on-site safe disposal of needles and syringes, or furnish
or sell mail-back state or federal standard personal sharps
disposal containers. In the absence of local authorization
of a DPDP or a SEP, the sale and possession of syringes
without a prescription remains illegal in California.
Needlestick injuries
Access to sterile syringes can affect the occupational
health and safety of peace officers and waste management
employees because they are at risk of accidental
needlestick injuries from improperly disposed needles. A
recent study found that 29.7 percent of San Diego Police
Officers surveyed had suffered a needlestick injury on
duty, usually during a pat-down or search incident to
arrest. A study of police officers in Rhode Island found
that nearly 30 percent had been stuck by a syringe at one
point in their career, with over 27 percent experiencing 2
or more needle stick injuries. Research has shown that
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accidental needlesticks to police officers have decreased
significantly following the implementation of SEPs. For
instance, studies in Connecticut and Massachusetts found
that needlestick injuries to officers were reduced 66
percent after syringe deregulation.
Related bills
SB 1029 (Yee) would allow individuals to obtain, and
pharmacists and physicians to distribute up to 30 syringes
or needles for personal use without a prescription from a
pharmacy until December 31, 2018. Repeals the Disease
Prevention Demonstration Project (DPDP), thereby removing a
requirement for local governments to first authorize
participation in the DPDP prior to a pharmacy's
registration in the program. Pending in the Assembly.
AB 1701 (Chesbro) removes the sunset date for cities and
counties to authorize pharmacists to furnish or sell 10 or
fewer hypodermic needles or syringes to persons 18 years of
age or older, and removes the sunset date for persons 18
years of age or older to be allowed to possess 10 or fewer
needles or syringes if acquired through an authorized
source, thereby extending these authorizations
indefinitely. Pending hearing in the Senate Health
Committee.
Prior legislation
AB 110 (Laird), Chapter 707, Statutes of 2007, permits a
public entity that receives General Fund (GF) money for
human immunodeficiency virus (HIV) prevention and education
from the Department of Public Health (DPH) to use that
money to support clean needle and syringe exchange projects
(NEPs), as specified.
SB 1305 (Figueroa), Chapter 64, Statutes of 2006, prohibits
a person from knowingly placing home-generated sharps waste
in the commercial and residential solid waste collection
containers after September 1, 2008.
AB 1597 (Laird) of 2005 and AB 2076 (Laird) of 2006,
contained provisions substantially similar to AB 110.
Governor Schwarzenegger vetoed AB 1597, stating
"authorizing the use of state funds to purchase syringes,
without appropriate local controls, including mechanisms
for input from local law enforcement, and protections
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against the use of state funds to supplant private or local
resources is not prudent." AB 2076 was held on the
Assembly Floor.
AB 547 (Berg and Richman), Chapter 692, Statutes of 2005,
authorized clean SEPs 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; the city council, the mayor, and the local health
officer of a city with a health department; or, the city
council and the mayor of a city without a health
department.
SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004,
authorizes the Disease Prevention Demonstration Project
(DPDP) to evaluate the long-term desirability of allowing
licensed pharmacies to sell or furnish nonprescription
hypodermic needles or syringes to prevent the spread of
blood-borne pathogens. Authorizes a licensed pharmacist,
until December 31, 2010 and subject to authorization by a
county or city, 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 in the DPDP with
a local health department.
SB 774 (Vasconcellos) of 2003 was almost identical to SB
1159; however the hypodermic needle and syringe limit was
higher, permitting a maximum of 30. Vetoed.
SB 1785 (Vasconcellos) of 2002 was nearly identical to SB
744; however the bill included an additional provision that
would have mandated criminal penalties for discarding or
disposing of hypodermic needles or syringes on a
playground, public beach, public park, or the grounds of an
elementary school, vocational, junior high, or high school.
Vetoed
AB 1292 (Aroner) of 2001 would have authorized pharmacists
in a licensed pharmacy to furnish or sell at retail
hypodermic needles or syringes for human use without a
prescription. This bill was substantively similar to
SB 1785 and SB 744. The author chose not to move the bill
forward.
AB 136 (Mazzoni), Chapter 762, Statutes of 1999, exempts
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from criminal prosecution public entities and their agents
and employees who distribute 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 due to the existence of a
critical local public health crisis.
Arguments in support
The Health Officers Association of California claims that
by allowing CDPH to establish vital disease-prevention
programs in high-risk areas, this bill will protect public
health without sacrificing public safety. This bill will
permit the state to empower clinics, health service
organizations, community-based organizations, and other
entities to establish needle exchange programs. Such
programs are a proven way to minimize the burden of
HIV/AIDS and hepatitis among injection drug users and those
who come into contact with them.
Planned Parenthood Affiliates of California (PPAC) claims
that while cities and counties currently have the ability
to authorize a syringe exchange program, some of the
counties with the highest rates of AIDS infections do not
presently have exchange programs. PPAC states that data
collected by CDPH shows that 19 percent of new AIDS cases,
and over 5,000 new hepatitis C infections per year are
linked to shared needles. Once infected, an individual can
pass the disease to sexual partners, children, and others
in the community. They believe that allowing access to
clean syringes will help reduce new infections among
injection drug users and the rest of the community.
AIDS Project Los Angeles believes expanding access to
syringe exchange programs statewide will reduce costs to
taxpayers. They claim that more than 600,000 Californians
are living with hepatitis C and their health care costs are
expected to rise over the next decade. Syringe exchanges
deliver cost-effective results and money-saving benefits.
Preventing disease before it spreads is sound fiscal
policy, particularly in light of our current recession and
budget cuts.
The Solid Waste Association of North America is supportive
of the intent of this legislation, but believes that
organizations that are allowed to distribute needles and
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syringes should also be required to take back the waste and
provide safe methods to transport the products. They
believe an amendment to address safe sharps disposal would
assist local governments in creating safer environments for
their constituents, including those using the needles.
Arguments in opposition
The League of California Cities recognizes the intent of
this legislation, but opposes this bill because they claim
it overrides local authority and allows health service
organizations and clinics to operate outside city or county
government's discretion. They believe that authorizing CDPH
to declare an area in need of a needle exchange program and
permit the clinics and community-based organizations to
operate them without the approval of the city blatantly
undermines the authority and autonomy of that city. In
addition, to be fully successful, a needle exchange program
needs to have companion programs such as drug treatment and
rehabilitation. Without local support, they believe AB 1858
will not address the root of the problem.
PRIOR ACTIONS
Assembly Health Committee 11-5
Assembly Appropriations 12-5
Assembly Floor 44-29
COMMENTS
1. For vote only. This bill was heard at the June 23,
2010 Senate Health Committee hearing, where it failed
passage. It was granted reconsideration by the Committee.
Therefore, this bill is set for vote only.
2. Related bills. On April 14, 2010 this committee heard a
similar measure, SB 1029 (Yee), which sought to authorize
broad access to syringes in participating pharmacies
statewide by removing the existing requirement for local
authorization and increasing the number of syringes a
person can lawfully possess from an authorized source from
10 to 30. SB 1029 was amended in committee to include a
sunset date of December 31, 2018 and to require pharmacists
to provide specified written information or verbal
counseling at the time of furnishing needles.
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This committee will also hear an additional similar
measure, AB 1701 (Chesbro) which removes sunset dates to
allow pharmacy access to syringes indefinitely, but
continues the existing local authorization requirement and
keeps the number of allowable syringes capped at 10.
The key difference between AB 1858 and both SB 1029 and AB
1701 is that AB 1585 deals with allowing new entities to
create needle exchange programs in various locations at the
discretion of the state public health department. SB 1029
and AB 1701 deal solely with allowing access to syringes
and needles through pharmacies.
3. Local authority. AB 1858 allows CDPH to determine where
to provide authorization for needle and syringe exchange
programs for the purpose of addressing a public health
problem, and circumvents the existing local control over
the authorization of such programs. Given the concern about
bypassing local authority and that this change in policy
would allow additional unknown entities to engage in needle
and syringe exchanges, should this bill also apply a sunset
provision to this expansion of CDPH's authority?
Also, under the existing authorization of SEPs, there is an
opportunity for notice and comments when local governments
take the authorizing action. Should this bill be amended to
allow for a similar opportunity for public comment prior to
the initiation of a new SEP in jurisdictions authorized by
CDPH?
4. Eligible entities. The bill does not define which
entities will be eligible to apply to CDPH to operate SEPs.
The bill also does not specify or reference which specific
state and federal standards these entities will have to
meet in order to be eligible to apply. The author may wish
to provide further clarification.
5. Technical amendments.
Section 2 of this bill seeks to amend HSC 121349.1 by
adding a provision that "Program participants shall be
allowed to possess syringes consistent with (HSC) Section
11364." The referenced provision in HSC Section 11364 that
allows the possession of 10 or fewer hypodermic needles or
syringes if acquired from an authorized source is scheduled
to sunset as of December 31, 2010. Staff suggests technical
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amendments to address this. Since the other pending syringe
exchange bills maintain the sunset in HSC 11364, the author
may wish to consider double-jointing amendments.
6. Author's amendments. At the bill's first hearing on June
23, the author agreed to take the following amendments at
the committee's suggestion:
1. Allow for an opportunity for public comment prior
to the initiation of a new SEP in jurisdictions
authorized by CDPH.
2. Describe which entities will be eligible to apply
to CDPH to operate SEPs.
3. Specify or reference which standards these entities
will have to meet in order to be eligible to apply.
4. Technical amendments referenced in Comment 5.
The author did not agree to accept the suggestion in
Comment 3 above to apply a sunset provision to this
expansion of CDPH's authority.
POSITIONS
Support: AIDS Project Los Angeles
American Civil Liberties Union
Asian Pacific AIDS Intervention Team
California Association of Alcohol and Drug Program
Executives, Inc.
California Hepatitis Alliance (CalHEP)
California Medical Association
Community Health Empowerment/Exchange Works
County Alcohol and Drug Program Administrators
Association of California
Drug Policy Alliance
Friends Committee on Legislation of California
Harm Reduction Coalition
HIV Education and Prevention Project of Alameda
County
Homeless Health Care Los Angeles
Planned Parenthood Affiliates of California
Health Officers Association of California
Solid Waste Association of North America (if
amended)
Oppose: California Narcotic Officers' Association
League of California Cities
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