BILL ANALYSIS
SB 1029
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Date of Hearing: June 22, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 1029 (Yee) - As Amended: April 7, 2010
SENATE VOTE : 21-6
SUBJECT : Hypodermic needles and syringes.
SUMMARY : Repeals the Disease Prevention Demonstration Project
(DPDP) in existing law. Permits pharmacists and physicians to
distribute to individuals, and individuals to receive, up to 30
needles without a prescription solely for personal use, as
specified. Specifically, this bill :
1)Repeals the DPDP in existing law. Permits pharmacists and
physicians to furnish hypodermic needles and syringes for
human use, without a prescription, if the person is known to
the furnisher and the furnisher has previously been provided a
prescription or other proof of a legitimate medical need
requiring a hypodermic needle or syringe to administer a
medicine or treatment.
2)Permits pharmacists and physicians to distribute to
individuals, and individuals to obtain, as a public health
measure, as specified, up to 30 needles without a prescription
solely for personal use until December 31, 2018.
3)Requires pharmacies to store hypodermic needles and syringes
in a manner that ensures that they are available only to
authorized personnel, and are not accessible to other persons.
4)Requires pharmacies that furnish nonprescription hypodermic
needles and syringes to provide consumers with one or more of
the following disposal options:
a) An onsite, safe, hypodermic needle and syringe
collection and disposal program;
b) Mail-back sharps disposal containers authorized by the
United States Postal Service that meet applicable state and
federal requirements, and that provide tracking forms to
verify destruction at a certified disposal facility; and,
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c) A personal medical sharps disposal container that meets
applicable state and federal standards for disposal of
medical sharps waste.
5)Requires pharmacies that furnish nonprescription syringes to
provide written information or verbal counseling to consumers
at the time of furnishing or sale of nonprescription
hypodermic needles or syringes on how to access drug treatment
and testing and treatment for Human immunodeficiency virus
(HIV) and hepatitis C, and how to safely dispose of sharps
waste.
6)Requires the Department of Public Health (DPH) Office of AIDS
to develop and maintain specified information regarding HIV
and hepatitis testing and treatment, safe needle disposal, and
drug treatment on its Internet Web site. Requires the
California State Board of Pharmacy to also post, or maintain a
link to, that information on its Internet Web site.
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 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 local health jurisdiction (LHJ) in the
DPDP until December 31, 2010.
3)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 : According to the Senate Appropriations
Committee, pursuant to Senate Rule 28.8 negligible state costs.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, California is
suffering an unnecessarily high rate of HIV and viral
hepatitis due to syringe scarcity. Injection drug use (IDU)
is the second leading cause of HIV transmission and the
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leading cause of the hepatitis C virus (HCV) in California.
The author, citing a report by the California Research Bureau
based on data provided by DPH, states that hospitalizations
for hepatitis B and C cost the state $2 billion in
2007. California is one of three states that still require a
pharmacist to verify a prescription before furnishing syringes
to an adult. Most states never prohibited furnishing of
syringes by a pharmacist without prescription, and of those
that did, most amended their laws when it became clear that
syringe scarcity was encouraging the sharing of used syringes
and that sharing was the second most common cause of HIV
transmission. The author states that while many states allow
an unlimited number of syringes to be sold to an adult, this
bill is an incremental move away from complete prohibition of
sale and possession of syringes, allowing an adult to purchase
and possess 30 or fewer syringes for personal use.
2)BACKGROUND . According to the DPH 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 Centers for Disease Control
and Prevention, have identified access to sterile syringes as
one component of a comprehensive HIV prevention strategy
designed to reduce HIV transmission among IDUs. In the last
10 years, a number of national organizations have endorsed
deregulation to allow IDUs to purchase and posses syringes and
needles without a prescription, including the American Medical
Association, the American Pharmaceutical Association, the
National Association of Boards of Pharmacy, the National
Alliance of State and Territorial AIDS Directors, and the
Association of State and Territorial Health Officials.
3)DPDP . SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004,
establishes a five-year pilot program to allow California
pharmacies, when authorized by a local government, to sell up
to 10 syringes to adults without a prescription. According to
the DPH Office of AIDS, 15 counties and four cities in
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California have authorized a DPDP (counties: Alameda, Contra
Costa, Humboldt, Los Angeles, Marin, San Francisco, San Luis
Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz,
Solano, Sonoma, Yolo, and Yuba; cities: Long Beach, Los
Angeles, Sacramento, and West Hollywood). Two other counties
are currently considering or planning to implement the
program, and four County Boards of Supervisors have rejected
authorization of a DPDP. According to DPH, in 2005, the first
wave of LHJs and pharmacies in California began to authorize
and implement local DPDPs. By the end of 2007, 532 pharmacies
in 17 LHJs registered to participate in the program. Among
the LHJs not planning to authorize DPDP, the top four reasons
were: limited time (38%) or interest (31%), pharmacy
disinterest (29%), and law enforcement opposition (22%).
While the proportion of LHJs that authorized a DPDP is
relatively small, those that have implemented one are home to
70% of Californians currently living with HIV/AIDS.
Analyses of HIV counseling and testing data found that
reported use of pharmacies as a source for sterile syringes
increased significantly in early adopting counties from
2004-2006: Sonoma (2.9% vs. 28.8%), Los Angeles (6.5% vs.
21.3%), Contra Costa (1.5% vs. 16.2%), San Francisco (1.9% vs.
13.5%), and Alameda (1.5% vs. 5.3%). Syringe sharing levels
among IDUs attending HIV counseling and testing sites were
consistently lower in LHJs that had authorized the sale of
syringes without a prescription than sharing levels in LHJs
that had not. While these differences in syringe sharing
levels cannot be solely attributed to the DPDP, from a public
health perspective it is another indication that enhanced
syringe access can help reduce injection-associated risks.
RELATED LEGISLATION . AB 1858 (Blumenfield) deletes the
prohibition against any person possessing hypodermic needles
or syringes, deletes the December 31, 2010 sunset date for
DPDP, and increases the number of hypodermic needles and
syringes permitted to be obtained or possessed without a
prescription from 10 needles to 30 needles. AB 1858 also
permits DPH to authorize entities to provide hypodermic needle
and syringe exchange services in any location where it
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 sharing needles
and syringes. AB 1858 is set to be heard in the Senate Health
Committee on June 23, 2010.
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AB 1701 (Chesbro) establishes, indefinitely, the DPDP,
permitting 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. SB 1701 is set to be heard in the Senate Health
Committee on June 23, 2010.
4)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.
Prior to SB 1159 in 2004, SB 774 (Vasconcellos) of 2003 and SB
1785 (Vasconcellos) of 2002 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
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.
5)DOUBLE REFERRAL . This bill has been double referred. Should
it pass out of this Committee, it will be referred to the
Committee on Business, Professions and Consumer Protection.
6)TECHNICAL AMENDMENT . On page 4, line 22:
(d) Pharmacies that furnish nonprescription syringes shall
store hypodermic needles and syringes in a manner that ensures
that they are available only to authorized personnel, and are
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not accessible to other persons.
7)SUPPORT . The California Hepatitis Alliance states 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.
8)OPPOSITION . The California Narcotics Association opposes the
bill's removal of the local option to approve or disapprove
authorization for pharmacy syringe sales as it will force
needle furnishing programs on every community in California,
irrespective of the wishes of that community's elected
officials. The League of California Cities writes that the
considerations for local fiscal, health, and safety impacts of
providing needles without a prescription should be made by the
city or county that will directly bear the consequences, for
better or worse.
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REGISTERED SUPPORT / OPPOSITION :
Support
Drug Policy Alliance (cosponsor)
San Francisco AIDS Foundation (cosponsor)
AIDS Project Los Angeles
American Civil Liberties Union
California Association of Alcohol and Drug Program Executives,
Inc.
California Communities United Institute
California Hepatitis Alliance
California Medical Association
California Nurses Association
California Opioid Maintenance Providers
California Pharmacists Association
California Psychiatric Association
California Retailers Association
California Society of Addiction Medicine
City and County of San Francisco
City of West Hollywood
Clean Needles Now
County Alcohol and Drug Program Administrators Association of
California
County of Alameda
Drug Policy Alliance
Equality California
Health Officers Association of California
Osteopathic Physicians and Surgeons of California
Planned Parenthood Advocacy Project of Los Angeles County
Planned Parenthood Affiliates of California
Planned Parenthood of San Diego and Riverside Counties
Rite Aid
San Francisco Mayor's Hepatitis C Task Force
Walgreens
Opposition
California Narcotics Officers' Association
California Peace Officers' Association
California Police Chiefs' Association
League of California Cities
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097
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