BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1743
AUTHOR: Ting
AMENDED: May 27, 2014
HEARING DATE: June 11, 2014
CONSULTANT: Moreno
SUBJECT : Hypodermic needles and syringes.
SUMMARY : Deletes the limit on the number of syringes a
pharmacist has the discretion to sell to an adult without a
prescription and extends, until January 1, 2021, the statewide
authorization for pharmacists to sell syringes without a
prescription, as specified.
Existing law:
1.Permits pharmacists and physicians to furnish up to 30
hypodermic needles and syringes for human use, without a
prescription or local government authorization, to a person 18
years or older until January 1, 2015.
2.Permits a person 18 years of age or older, without a
prescription or license, to obtain up to 30 hypodermic needles
and syringes from a physician or pharmacist solely for
personal use until January 1, 2015.
3.Requires pharmacies that furnish non-prescription syringes to
provide written information or verbal counseling to consumers
at the time of furnishing or sale of non-prescription
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.
4.Permits, until January 1, 2015, a city or county to authorize
a licensed pharmacist to sell or furnish up to 10 hypodermic
needles or syringes to a person for human use without a
prescription if the pharmacy is registered with a local health
jurisdiction in disease prevention demonstration projects
(DPDP).
This bill: Deletes the limit on the number of syringes a
pharmacist has the discretion to sell to an adult without a
prescription and extends, until January 1, 2021, the statewide
authorization for pharmacists to sell syringes without a
Continued---
AB 1743 | Page 2
prescription, as specified.
FISCAL EFFECT : This bill has been keyed non-fiscal.
PRIOR VOTES :
Assembly Health:13- 6
Assembly Floor:45- 28
COMMENTS :
1.Author's statement. According to the author, sharing used
syringes remains the most common mode of hepatitis C
transmission, and the second most common cause of HIV and
hepatitis B transmission in the United States and California.
These diseases are costly and potentially deadly. The
California Medical Association, the California Nurses
Association, and the California Board of Pharmacies agree that
safe and legal syringe access through pharmacies is a key
component to the prevention and control of HIV/AIDS and
hepatitis B & C. The United Nations AIDS Foundation and the
World Health Organization have found that very high or no caps
on the amount of syringes an adult can purchase are associated
with less syringe sharing. Current law provides pharmacists
the discretion to sell up to 30 syringes to an adult without a
prescription. This law will sunset on January 1, 2015, and
without an extension of the law, pharmacists in only 15
counties and 4 cities will maintain the ability to sell
syringes over the counter. AB 1743 extends the sunset date in
existing law for six years and removes the cap on the number
of syringes an adult can purchase. By doing so, California
will use evidenced-based strategies to prevent thousands of
potentially deadly infections at no cost to the taxpayers.
2.Background. California Department of Public Health (DPH)
Office of AIDS estimates that of the 117,553 persons reported
to be living with HIV/AIDS in California in 2012, 16.4 percent
reported injection drug use (IDU) as a risk factor, including
approximately 9,672 men who reported both IDU and having sex
with men as risk factors. The Center for Disease Control and
Prevention (CDC) estimates that 50 to 90 percent of
HIV-infected persons who use injection drugs are also infected
with hepatitis C virus (HCV). IDU is the most commonly
reported risk for HCV infection and is the second most common
risk factor for hepatitis B virus (HBV) infection. CDPH's
Office of Viral Hepatitis Prevention estimates that at least
60 percent of prevalent cases of HCV infection in California
are associated with IDU, and reports an estimated 750,000
AB 1743 | Page
3
people living with hepatitis C in the state. The long-term
health consequences and costs associated with hepatitis C and
B are considerable. The Office of Viral Hepatitis Prevention
reports that in 2010 alone there were more than 30,000
hospitalizations in California for complications related to
HCV and HBV infection, at a cost of over 2.3 billion dollars.
According to the CDC, each year in the U.S. approximately
12,000 to 15,000 people die from HCV.
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 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 (NABP), the National Alliance of State
and Territorial AIDS Directors, and the Association of State
and Territorial Health Officials. California is one of only
five states having statewide limitations on the purchase of
syringes, according to a 2014 survey by the NABP. Although
statewide sales are currently legal, there is a restriction as
to the number.
3.DPDP. SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004,
established 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 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). By February 2010,
over 650 pharmacies were registered to participate in the
program (according to DPH, this is an estimate because some
counties did not keep fully accurate records, and some
pharmacies misunderstood DPDP requirements and sold syringes
without first registering with the local health jurisdiction
[LHJ]).
According to an evaluation of DPDP published in July 2010 by
DPH, SB 1159 appeared to have the desired effect of augmenting
access to sterile syringes to prevent transmission of
AB 1743 | Page 4
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 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. The program was
considered successful by the localities that implemented it
and the DPDP was suspended when statewide sales were
authorized by SB 41 (Yee), Chapter 738, Statutes of 2011.
4.Prior legislation. SB 41 (Yee), Chapter 738, Statutes of
2011, permits non-
prescription syringe sales of a maximum of 30 hypodermic
needles or syringes to a person without a prescription through
licensed pharmacies throughout the state until January 1, 2015
and makes inoperative until that date, portions of the law
establishing the DPDP.
AB 1701 (Chesbro), Chapter 667, Statues of 2010, 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
AB 1743 | Page
5
prescription, as specified.
AB 1858 (Blumenfield), of 2010 was substantially similar to AB
604 and was vetoed by Governor Schwarzenegger, who stated, "I
signed legislation in 2005 that reflected a careful balance
between good public health policy and local decision-making
authority. I remain comfortable with that original decision
and do not believe it is appropriate to change this balance
and instead give authority to the state Department of Public
Health to overrule local decisions regarding syringe exchange
programs."
SB 1029 (Yee) of 2010 contained similar provisions to those
contained in this bill, and was vetoed by Governor
Schwarzenegger who stated, "When I signed legislation my first
year in office allowing for a pilot program to allow the sale
of syringes through participating counties and registered
pharmacies, I was seeking to balance the competing public
health, law enforcement and local control issues that this
issue requires. I believe this balance was achieved and SB
1029 would remove the ability of local officials to best
determine policies in their jurisdiction."
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.
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 1743 | Page 6
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.Support. The Drug Policy Alliance and San Francisco AIDS
Foundation, co-sponsors of AB 1743, argue this bill will
continue cost-effective HIV and hepatitis prevention policy in
California. Lifting the current sunset and allowing
pharmacists and physicians the discretion to furnish sterile
syringes, will be an important part of the state's
comprehensive approach to preventing the spread of HIV,
hepatitis B, and hepatitis C. They note over 200 studies from
the United States and abroad concur that improved syringe
access reduces the rate of syringe sharing and disease
transmission without increasing rates of drug use, drug
injection, or crime. The co-sponsors also note that
maintaining access to sterile syringes reduces costs to
taxpayers; the cost of treating one case of HIV can exceed
$600,000. Supporters note that California was one of the last
states to relax restrictions on accessing a sterile syringe,
leading to an unnecessarily high rate of syringe-acquired HIV,
hepatitis B, and hepatitis C. They argue since the enactment
of SB 41, pharmacists have been free to protect the health of
individual patients and the community health at no cost to
taxpayers. They support this bill because it will make the
discretion permanent and allow the pharmacists or physicians
to decide on how many syringes can be provided.
SUPPORT AND OPPOSITION :
Support: Drug Policy Alliance (co-sponsor)
San Francisco AIDS Foundation (co-sponsor)
A New PATH
ACLU of California
California Association of Alcohol and Drug Program
Executives
California Communities United Institute
California Medical Association
California Nurses Association
California Pharmacists Association
California Primary Care Association
California Public Defenders Association
California Retailers Association
California Society of Addiction Medicine
AB 1743 | Page
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California Society of Health-System Pharmacists
Center for Living and Learning
City and County of San Francisco
County Alcohol and Drug Program Administrators
Association of California
Dolores Street Community Services
Friends Committee on Legislation of California
HealthRIGHT 360
Homeless Health Care Los Angeles
Los Angeles County Board of Supervisors
Los Angeles Gay and Lesbian Center
National Association of Social Workers, California
Chapter
National Viral Hepatitis Roundtable
Planned Parenthood Affiliates of California
San Francisco HIV/AIDS Provider Network
San Francisco Medical Society
Tarzana Treatment Centers, Inc.
Transgender Law Center
UCSF Alliance Health Project
Oppose: None received
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