BILL ANALYSIS �
SB 41
Page 1
SENATE THIRD READING
SB 41 (Yee)
As Amended August 15, 2011
Majority vote
SENATE VOTE :24-13
HEALTH 12-6 APPROPRIATIONS 11-4
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield, |
| |Bonilla, Eng, Gordon, | |Bradford, Charles |
| |Hayashi, | |Calderon, Davis, |
| |Roger Hern�ndez, Bonnie | |Dickinson, Hall, Hill, |
| |Lowenthal, Mitchell, Pan, | |Lara, Norby, Solorio |
| |Williams | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Harkey, Donnelly, |
| |Nestande, Silva, Smyth | |Nielsen, Wagner |
| | | | |
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SUMMARY : Suspends certain provisions of the Disease Prevention
Demonstration Project (DPDP), including the ability for a city
or county to authorize pharmacists to provide up to 10
hypodermic needles and syringes without a prescription, until
January 1, 2015, and until then permits pharmacists and
physicians to furnish up to 30 hypodermic needles and syringes
for human use, without a prescription or city/county
authorization, to a person 18 years or older, as specified.
Specifically, this bill :
1)Suspends certain provisions of the DPDP, including the ability
for a city or county to authorize pharmacists to provide up to
10 hypodermic needles and syringes without a prescription,
until January 1, 2015, and until then:
a) Permits pharmacists and physicians to furnish up to 30
hypodermic needles and syringes for human use, without a
prescription or city/county authorization, to a person 18
years or older 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. Permits a person 18 years of age or older,
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without a prescription or license, to obtain 30 or fewer
hypodermic needles and syringes solely for personal use
from a physician or pharmacist;
b) Requires pharmacies that furnish nonprescription
hypodermic needles and syringes to store them in a manner
that ensures that they are available only to authorized
personnel and to provide consumers with one or more of the
following disposal options:
i) An onsite, safe, hypodermic needle and syringe
collection and disposal program;
ii) 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,
iii) A personal medical sharps disposal container that
meets applicable state and federal standards for disposal
of medical sharps waste.
c) 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 HIV and
hepatitis C, and how to safely dispose of sharps waste.
2)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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, minor, absorbable workload costs to the Department of
Public Health Office of AIDS and the California Board of
Pharmacy to provide specified information on their Web sites,
and to continue oversight of the sale and disposal of needles
and syringes.
COMMENTS : According to the author, California is suffering an
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unnecessarily high rate of HIV and viral hepatitis due to
syringe scarcity. The author states that California is one of
only three states in the United States that prohibit a
pharmacist from furnishing a syringe to an adult without a
prescription. Most states never required a prescription to
purchase a sterile syringe, and of those that did, most amended
their laws in light of the AIDS epidemic and the clear evidence
that shows that allowing adults to access sterile syringes
prevents the transmission of HIV, hepatitis C virus (HCV), and
other blood-borne diseases, without contributing to increased
drug use, drug injection, crime, or unsafe discard of syringes.
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. The author
states that the intent of this bill is to improve access to
syringes and hypodermic needles so as 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 sterile injection equipment and education
to adults, thereby reducing the spread of communicable diseases
and protecting the public health.
According to the DPH Office of AIDS, in 2009 injection drug use
(IDU) was associated with approximately 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. HCV
affects approximately 600,000 people in California (2% of the
state's population). Complications of liver disease associated
with HCV have resulted in an estimated 8,000 to 10,000 deaths
per year in the United States.
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 possess syringes and
needles without a prescription, including the American Medical
Association, the American Pharmaceutical Association, the
National Association of Boards of Pharmacy, the National
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Alliance of State and Territorial AIDS Directors, and the
Association of State and Territorial Health Officials.
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, 16 counties and four cities in California
have authorized a DPDP (counties: Alameda, Contra Costa,
Humboldt, Los Angeles, Mendocino, 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). One other county is currently
considering implementation of the program, and four County
Boards of Supervisors have rejected authorization of a DPDP.
According to DPH, in 2005, the first wave of local health
jurisdictions (LHJs) and pharmacies in California began to
authorize and implement local DPDPs. By February 2010, over 650
pharmacies were registered to participate in the program. Among
the LHJs not planning to authorize DPDP, the top four reasons
were: limited time (38%), limited 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.
According to an evaluation of DPDP published in July 2010 by
DPH, SB 1159 appears to be having the desired effect of
augmenting access to sterile syringes to prevent transmission of
HIV and other blood-borne viral infections among IDUs without
many of the negative consequences that some had feared. DPH's
evaluation suggests that counties authorizing over-the-counter
(OTC) sale of syringes without a prescription possess lower
syringe sharing levels among IDUs than counties that have not
authorized OTC sale. Additionally, since implementation of SB
1159, fewer clients presenting for testing for HIV at
state-funded testing sites report injecting illegal drugs,
suggesting that authorization of OTC syringe sales did not have
the negative impact of increased injection drug activity, a
concern expressed by some prior to authorization. DPH's
evaluation found that, following implementation of SB 1159,
accidental needle-stick injury to law enforcement officers
remained rare in California. Between 2005 and 2009,
post-authorization of DPDPs, 19 accidental needle-stick injuries
were reported among law enforcement in LHJs that had authorized
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DPDPs and 15 accidental needle-stick injuries were reported
among law enforcement in LHJs that had not authorized DPDPs.
The variation in recent years is not great enough to suggest a
statistically significant relationship to the authorization of
DPDP. DPH's evaluation found no increase in unsafe discard of
syringes since implementation of SB 1159. Finally, comparing
time periods prior to and following SB 1159 authorization, DPH
found no evidence of an increase in drug use or crime in the
state of California as a whole or in areas that authorized sale
of syringes without a prescription. The overall findings are
consistent with those of other states that have transitioned, as
California has, from a complete prohibition on sale and
possession of syringes, to allowing a limited number to be sold
to adults.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097
FN: 0001780