BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 1029
S
AUTHOR: Yee
B
AMENDED: March 17, 2010
HEARING DATE: April 14, 2010
1
CONSULTANT:
0
Orr/
2 9
SUBJECT
Hypodermic needles and syringes
SUMMARY
Allows individuals to obtain up to 30 syringes or needles
for personal use without a prescription from a pharmacy.
Authorizes pharmacists and physicians to distribute up to
30 needles to an individual without a prescription solely
for personal use. Repeals the Disease Prevention
Demonstration Project, thereby removing a requirement for
local governments to first authorize participation in the
DPDP prior to a pharmacy's registration in the program.
CHANGES TO EXISTING LAW
Existing law:
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.
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
Continued---
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 2
registered for the Disease Prevention Demonstration Project
(DPDP) and if the pharmacy complies with other specified
provisions.
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
practices at the point of sale.
Also as part of the DPDP, proscribes requirements for the
secure storage of needles and syringes in pharmacies, and
requires pharmacies to make safe disposal options available
to users.
Also as part of DPDP, requires the California Department of
Public Health (CDPH) to evaluate the effects of allowing
pharmacists to furnish or sell a limited number of
hypodermic needles or syringes without prescription, and to
provide a report to the Governor and the Legislature on or
before January 15, 2010.
Authorizes clean needle exchange programs 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.
Requires that no person shall possess a hypodermic needle
or syringe except when acquired in accordance with
specified provisions of law.
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.
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 3
This bill:
Repeals the Disease Prevention Demonstration Project.
Repeals the prohibition on individual possession of a
hypodermic needle or syringe except under specified
circumstances, and instead allows individuals to obtain
from a physician or pharmacist up to 30 hypodermic needles
or syringes for personal use.
As a public health measure, allows a physician or
pharmacist to furnish up to 30 hypodermic needles or
syringes to an adult without a prescription or permit for
personal use.
Removes the requirement for local government authorization
of pharmacists' distribution of needles or syringes.
Increases the cap from 10 to 30 needles or syringes that a
pharmacist may distribute to any one person without a
prescription.
Requires the Office of AIDS (OA), within CDPH to develop
and maintain information for consumers on its website
regarding how to access drug treatment, access testing and
treatment for viral Hepatitis and HIV, and regarding the
safe disposal of needles and syringes. Requires the State
Board of Pharmacy to also post this information on its
website.
Declares legislative intent to improve access to syringes
and hypodermic needles, in hopes of reducing the spread of
communicable diseases and protecting public health.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
According to the author, the intent of this bill is to
improve access to syringes and hypodermic needles in order
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
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 4
sterile injection equipment and education to adults,
thereby reducing the spread of communicable diseases and
protecting the public health. According to CDPH Office of
AIDS (OA), scientific research continues to show that
access to sterile injection equipment is associated with
reduced risk of HIV infection and lower frequency of unsafe
injection practices, and is a vital component in the
struggle to reduce the spread of HIV, HCV, and other
blood-borne infections among injection drug users (IDUs),
their sex partners, and their children. Numerous studies
concur that improved syringe access reduces the rate of HIV
transmission, without increasing rates of drug use, drug
injection, or crime. To date, no study has found otherwise.
Injection drug use and disease prevalence
According to the CDPH/OA, injection drug use is the second
leading cause of HIV transmission and the leading cause of
hepatitis C virus (HCV) infection in California. Sharing of
contaminated syringes and other injection equipment is
linked to 19 percent of all reported AIDS cases in the
state. The shared use of syringes and needles was
recognized as being associated with HIV transmission among
injection drug users at the onset of the HIV/AIDS pandemic.
Nationwide, injection drug use accounted for 17 percent of
new HIV/AIDS diagnoses in adults and adolescents in 2007,
according to the Centers for Disease Control and Prevention
(CDC). California data suggests that over 1,500 new
syringe-sharing HIV infections occur annually. The link
between injection drug use and HIV is particularly strong
for women and people of color. In California, 37 percent of
cumulative AIDS cases among women, 24.3 percent of cases
among African American men and women, and 22.4 percent of
cases among Latinas are directly attributable to syringe
sharing.
In addition, there are an estimated 500,000 to 600,000
Californians currently infected with hepatitis C virus
(HCV) with an estimated 5,000 new infections annually due
to injection drug use. Viral hepatitis is a major cause of
liver cancer and the leading cause of liver transplants
nationwide. In the United States, there are more than 5
million people living with chronic hepatitis B virus (HBV)
or chronic HCV. In 2007 alone, HBV and HCV-related
hospitalization costs in California totaled $2 billion.
Over the next 20 years, annual medical costs for people
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 5
with HCV nationwide are expected to increase more than 2.5
times, from $30 billion to more than $85 billion.
Clean Needle and Syringe Exchange Programs (SEPs)
Clean needle exchange programs make sterile needles
available to intravenous drug users (IDUs), in order to
avoid acquiring and transmitting bloodborne diseases such
as HIV and HCV. SEPs provide a safe and accessible method
for IDUs to exchange used syringes for sterile ones. SEPs
use special puncture-proof containers to collect used
syringes, which are then collected and safely disposed of
according to special procedures designated for hazardous
waste.
Often, SEP programs 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. According to the National
Institutes of Health, individuals in areas with syringe
exchange programs have an increased likelihood of entering
drug treatment programs.
SEPs have been shown to be effective in reducing the
sharing of syringes and the transmission of bloodborne
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 needle stick, 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).
Over the past four years, CDPH has awarded over $3.5
million in State General Funds to authorized syringe
exchange programs across the state to provide syringe
exchange, HIV and HCV testing, counseling and referral to
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 6
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 precluded the funding of
SEPs.
Local SEP implementation
According to the Center for Health Improvement, there were
41 authorized SEPs in California as of March 2009.
Currently, a public entity that receives State General Fund
money from CDPH for the purpose of HIV education and
prevention and, as part of an authorized clean needle and
syringe exchange program, can use those funds for the
purchase of sterile hypodermic needles and syringes. Cities
and counties are enabled to authorize a clean needle and
syringe exchange project as part of a comprehensive network
of services. Under current law, 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.
Local government, local public health officials, and 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 the Office of AIDS,
seventeen County Boards of Supervisors and four City
Councils so far have authorized SEPs, and several other
counties and cities are currently planning for
authorization.
Pharmacy Sale of Syringes
Until the 2004 signing of SB 1159 (Vasconcellos) that
started the Disease Prevention Demonstration Project,
California was one of only five states that still 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,
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 7
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 prescriptions, 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 ten hypodermic needles or
syringes at pharmacies without a prescription. 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, the sale and possession of syringes without a
prescription remains illegal in California.
Under current law, pharmacies that participate in the DPDP
are required to register with their local health department
and certify that they will provide information to adult
purchasers of needles or syringes about drug treatment
programs, testing and treatment programs for HIV and HCV,
and safe disposal of sharps waste. They are also required
to store needles and syringes such that only authorized
pharmacy personnel may have access, provide on-site
collection and disposal options for used needles, and make
mail-back and personal sharps disposal containers available
to purchasers. Participating local health departments are
required to maintain a list of all pharmacies registered
under the DPDP and make available to pharmacies written
information that can be provided at the time of furnishing
or selling nonprescription needles and syringes.
CDPH evaluation of SB 1159
CDPH was required to report to the Governor and to the
Legislature by January 15, 2010, on the impact of allowing
pharmacists to furnish or sell nonprescription hypodermic
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 8
needles or syringes on rates of disease infection related
to syringe sharing, rates of crime in the vicinity of
pharmacies, rates of drug use, rates of needlestick injury
to law enforcement officers and waste management employees,
and rates of safe or unsafe discard of syringes, and
syringe sharing practice among IDUs. CDPH was also required
to convene an uncompensated evaluation panel.
To date, CDPH/OA has conducted two surveys of local health
jurisdictions, examining questions ranging from syringe
disposal mechanisms to the level of pharmacist
participation in each county. The California HIV/AIDS
Research Program has funded a qualitative study of
facilitators and obstacles to SB 1159 implementation.
CDPH/OA has also funded a study of syringe disposal and
accidental needlestick injuries. CDPH/OA plans a detailed
analysis of HIV counseling and testing data to be included
in the final report. The report has not been made public,
and it is unclear when the report will be released.
However, CDPH has released separate, but related
recommendations in the California Adult Viral Hepatitis
Prevention Strategic Plan for 2010-2014 that promote
increased access to syringe exchange programs, and to
promote other strategies, such as encouraging pharmacists
to participate in pharmacy syringe sales programs, and
removing structural barriers to accessing syringes and
other safe drug-using equipment for IDUs.
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. 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 two or more needle stick injuries.
Research has shown that 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.
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 9
Related bills
AB 1701 (Chesbro) would delete the December 31, 2010 sunset
date for the Disease Prevention Demonstration Project, and
would thereby reestablish the program indefinitely.
AB 1858 (Blumenfield) would delete the prohibition against
any person possessing or having under his or her control
any hypodermic needle or syringe, delete the requirement of
authorization by a county or city for pharmacies to
participate in the Disease Prevention Demonstration
Project, and delete the December 31, 2010 sunset. This bill
would also raise the cap of hypodermic needles and syringes
for human use obtained or possessed without a prescription
or license to 30 or fewer.
This bill would permit CDPH to authorize entities to
provide hypodermic needle and syringe exchange services in
any location where the department determines that the
conditions exist for the rapid spread of HIV, viral
hepatitis, or other potentially deadly infections spread
through the sharing of used needles. The bill would require
CDPH to establish a process to allow local entities to
apply for authorization to provide hypodermic needle and
syringe exchange services, establish reporting standards
for these entities, and establish and maintain on its
website the addresses and contact information of programs
providing hypodermic needle and syringe exchange services.
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
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 10
"authorizing the use of state funds to purchase syringes,
without appropriate local controls, including mechanisms
for input from local law enforcement, and protections
against the use of state funds to supplant private or local
resources is not prudent." The bill was held on the
Assembly Floor.
AB 547 (Berg and Richman) Chapter 692, Statutes of 2005,
authorized clean NEPs 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
authorized 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, authorized 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) 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) 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) 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.
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 11
AB 136 (Mazzoni, Chapter 762, Statutes of 1999) exempts
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 California Hepatitis Alliance claim that syringe
sharing among injection drug users who are not allowed to
buy syringes without a prescription, is the number one
cause of hepatitis C in the state, and the second most
common cause of new HIV and hepatitis B infections. They
contend that allowing adults to spend their own money to
access equipment that prevents the spread of infectious
diseases will save California taxpayers hundreds of
millions of dollars in healthcare costs. The California
Medical Association concurs with the claim that making
syringes and needles available without a prescription at
licensed pharmacies will help prevent the transmission of
diseases among IDUs. The California Retailers Association
represents many chain drug stores that chose to participate
in the DPDP, and agrees with the statewide expansion of
pharmacy syringe and needle access offered by this bill.
The County Alcohol and Drug Program Administrators
Association of California claims this bill is consistent
with their commitment to the reduction of individual and
community problems related to chronic disease of addiction.
Arguments in opposition
The California Narcotics Association opposes the bill's
removal of the local option to approve or disapprove
authorization for pharmacy syringe sales. They believe this
bill will force needle furnishing programs on every
community in California, irrespective of the wishes of that
community's elected officials.
COMMENTS
1. Accountability measures and oversight. The current
authorization for pharmacies to furnish syringes and
hypodermic needles contains several accountability measures
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 12
that have not been carried over to this bill. Among them
are a requirement that participating pharmacies register
with their local health department and a sunset date and
evaluation of the effects of the program on needle sharing,
rates of disease infection, drug crime, and needlestick
injuries. Should the bill be amended to include these
provisions?
2. Information and counseling of IDUs. The current program
requires participating pharmacies to certify that they will
provide written or verbal information on drug treatment,
testing services, and safe sharps disposal practices at the
point of sale. This bill removes this requirement, and
instead requires information be provided on the OA website
and the Board of Pharmacy website. Should the bill maintain
the requirement for pharmacists provide information or
counseling at the point of sale?
3. Double referral. This bill is double referred to
Business, Professions and Economic Development Committee.
POSITIONS
Support: Drug Policy Alliance (Co-sponsor)
San Francisco AIDS Foundation (Co-sponsor)
AIDS Project Los Angeles
American Civil Liberties Union
California Hepatitis Alliance
California Medical Association
California Opioid Maintenance Providers
California Psychiatric Association
California Retailers Association
California Society of Addiction Medicine
County Alcohol and Drug Program Administrators
Association of
California
County of Alameda
Project Inform
San Francisco HIV/AIDS Provider Network
STAFF ANALYSIS OF SENATE BILL SB 1029 (Yee) Page 13
San Francisco Mayor's Hepatitis C Task Force
Three individuals
Oppose: California Narcotics Officers' Association
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