BILL ANALYSIS
AB 1858
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 1858 (Blumenfield)
As Amended August 18, 2010
Majority vote
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|ASSEMBLY: |44-29|(May 13, 2010) |SENATE: |21-15|(August 24, |
| | | | | |2010) |
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Original Committee Reference: HEALTH
SUMMARY : Permits the Department of Public Health (DPH) to
authorize certain entities to provide hypodermic needle and
syringe exchange services consistent with state and federal
standards, including those of the United States Public Health
Service, 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.
The Senate amendments :
1)Require, in order for an entity to be authorized by DPH to
provide hypodermic needle and syringe exchange services, its
application to demonstrate that the entity:
a) Provides, directly or through referral, any of the
following services:
i) Drug abuse treatment services;
ii) HIV or hepatitis C screening;
iii) Hepatitis A and hepatitis B vaccination.
iv) Screening for sexually transmitted infections;
v) Housing services for the homeless, for victims of
domestic violence, or other similar housing services;
and,
vi) Services related to provision of education and
materials for the reduction of sexual risk behaviors,
AB 1858
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including, but not limited to, the distribution of
condoms.
b) Has the capacity to commence needle and syringe exchange
services within three months of authorization;
c) Has adequate funding to provide needles and syringe
exchange services, HIV and viral hepatitis prevention
education services, and safe recovery and disposal of used
syringes and sharps waste for all of its participants, as
specified; and,
d) Has the capacity, and an established plan, to collect
evaluative data in order to assess program impact, as
specified.
2)Require DPH, if it deems the application to be provisionally
appropriate, to provide for a period of public comment at
least 45 days prior to approval of the application, as
specified.
3)Require DPH, commencing not later than November 1, 2014, to
submit to the Senate Committee on Budget and Fiscal Review,
and Assembly Committee on Budget, the Senate and the Assembly
Committees on Health, and the Joint Legislative Budget
Committee, all biennial reports made to open meetings of
county boards of supervisors or city councils pursuant to 2)
above, and the number and location of all programs authorized
by the department since January 1, 2011.
4)Repeal the provisions of this bill effective July 1, 2016.
AS PASSED BY THE ASSEMBLY , this bill permitted DPH to authorize
clinics or other entities to provide hypodermic needle and
syringe exchange services consistent with state and federal
standards, including those of the United States Public Health
Service, 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.
FISCAL EFFECT : According to the Senate Appropriations
Committee:
Fiscal Impact (in thousands)
AB 1858
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Major Provisions 2010-11 2011-12 2012-13 Fund
CDPH regulations and $45 $35 $35Federal*
ongoing administration
2013-14 2014-15
$30 - $170 $30 - $170 Federal*
*Centers for Disease Control and Prevention (CDC) Cooperative
Agreement Funds
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
syringes. The author contends 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.
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 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.
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According to the CDC, the first organized needle exchange
programs (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 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.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097
FN: 0006680