THIRD READING  

Bill No: AB 2077

Author: Ting (D)

Amended: 5/20/20 in Assembly

Vote: 21

SENATE HEALTH COMMITTEE: 6-2, 8/1/20

AYES: Pan, Lena Gonzalez, Leyva, Mitchell, Monning, Rubio

NOES: Grove, Hurtado

NO VOTE RECORDED: Melendez

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 50-18, 6/8/20 - See last page for vote

SUBJECT: Hypodermic needles and syringes

SOURCE: Drug Policy Alliance

Health Officers Association of California

San Francisco AIDS Foundation

DIGEST:

This bill extends the sunset on existing law, until January 1, 2026, which permits pharmacists to furnish hypodermic needles and syringes without a prescription or a permit, for human use to a person 18 years of age or older and which permits a person 18 years of age or older, without a prescription or license, to obtain hypodermic needles and syringes solely for personal use from a physician or pharmacist.

ANALYSIS:

Existing law:

1. Prohibits, except as specified, the sale of a hypodermic needle or syringe at retail except upon the prescription of a physician, dentist, veterinarian, podiatrist, or naturopathic doctor. [BPC §4142]
2. Permits a physician or pharmacist, until January 1, 2021, to furnish hypodermic needles and syringes without a prescription or a permit, for human use to a person 18 years of age or older. Permits a person 18 years of age or older, without a prescription or license, to obtain hypodermic needles and syringes solely for personal use from a physician or pharmacist. [BPC §4145.5(b)]
3. Makes a person who obtains a hypodermic needle or hypodermic syringe by a false or fraudulent representation or design or by a forged or fictitious name, or contrary to, guilty of a misdemeanor. Makes a person who has obtained a hypodermic needle or hypodermic syringe from any person to whom a permit has been issued and who uses, or permits or causes, directly or indirectly, the hypodermic needle or hypodermic syringe to be used for any purpose other than that for which it was obtained is guilty of a misdemeanor and punishable by a fine not exceeding $1,000, or by imprisonment in a county jail not exceeding one year, or both a fine and imprisonment. [BPC §4326]
4. Establishes the Disease Prevention Demonstration Project (DPDP), within the former Department of Health Services (DHS), 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. Requires DHS to evaluate the effects of allowing pharmacists to sell a limited number of hypodermic needles and syringes without a prescription. [HSC §121285]

This bill:

1. Extends the sunset on existing law, until January 1, 2026, which permits pharmacists to furnish hypodermic needles and syringes without a prescription or a permit, for human use to a person 18 years of age or older and which permits a person 18 years of age or older, without a prescription or license, to obtain hypodermic needles and syringes solely for personal use from a physician or pharmacist.
2. Deletes the penalties associated with obtaining a hypodermic needle or syringe without a prescription described in 3) of existing law above.
3. Repeals the DPDP statute described in 4) of existing law above.
4. Makes other technical, clarifying changes.

Comments

1. Author’s statement. According to the author, research has shown that allowing adults to purchase sterile syringes from pharmacists without prescriptions is a key component to the prevention and control of HIV and hepatitis C. Existing law allows pharmacists to sell and adults to possess sterile syringes for personal use without a prescription and no study has shown that allowing adults to purchase sterile syringes has increased the rates of drug use, drug injection, or crime. This bill will extend the sunset on this law and ensure that we are continuing to stem the spread of HIV and viral hepatitis.
2. Injection drug use and HIV/hepatitis. According to the Centers for Disease Control and Prevention (CDC), people who inject drugs (PWID) are at high risk for getting HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) infection if they use needles, syringes, or other drug injection equipment (for example, cookers) that someone with HIV, HBV, or HCV has used. The CDC estimates that 62% to 80% of PWID who are HIV-infected are also infected with HCV and at least 60% of new cases of HCV nationally are associated with injection drug use. Although new HIV diagnoses among PWID have declined in recent years, the risk for getting or transmitting HIV is very high if an HIV-negative person uses injection equipment that someone with HIV has used because the virus can survive in a used syringe for up to 42 days, depending on temperature and other factors. In 2017, PWID accounted for 9% (3,641) of the 38,739 diagnoses of HIV in the US and dependent areas (2,389 cases were attributed to injection drug use and 1,252 to male-to-male sexual contact and injection drug use). In a study of cities with high levels of HIV, 40% of new PWID (those who have been injecting for five years or less) reported sharing syringes. From 2005 to 2015, syringe sharing declined 34% among black/African American PWID and 12% among Hispanic/Latino PWID, but did not decline among white PWID. Young PWID (aged <30 years) are more likely to share syringes than older PWID.

Public health experts, including those at the CDC, have for decades identified access to sterile syringes as one component of a comprehensive HIV prevention strategy designed to reduce HIV and hepatitis transmission among PWIDs. In 1999, a number of national organizations endorsed deregulation to allow PWIDs 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 Alliance of State and Territorial AIDS Directors, and the Association of State and Territorial Health Officials.

1. California data. DPH’s Office of Viral Hepatitis Prevention estimates there are least 400,000 people living with HCV in the state and that between 2002 and 2011 there were more than 300,000 hospitalizations in California for complications related to HCV infection, at a cost of over $20 billion. DPH reports that there are approximately 136,566 persons reported to be living with HIV/AIDS in California in 2018. Of those with HIV infection, 12.2% reported injection drug use as a risk factor, including approximately 8,864 men who reported both injection drug use and having sex with men as risk factors.
2. 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 ten 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 blood-borne viral infections among PWIDs 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 PWIDs 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).

Related/Prior Legislation

AB 1743 (Ting, Chapter 331, Statutes of 2014) deleted the limit on the number of syringes a pharmacist has the discretion to sell to an adult without a prescription and extended, until January 1, 2021, the statewide authorization for pharmacists to sell syringes without a prescription, as specified.

SB 41 (Yee, Chapter 738, Statutes of 2011) permitted 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 made inoperative until that date, portions of the law establishing the DPDP.

AB 1701 (Chesbro, Chapter 667, Statues of 2010) established, indefinitely, the DPDP, permitting cities or counties to authorize licensed pharmacists to sell or furnish ten or fewer hypodermic needles or syringes to a person for use without a 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) permitted 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) created 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 136 (Mazzoni, Chapter 762, Statutes of 1999) exempted 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.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

SUPPORT: (Verified 8/14/20)

Drug Policy Alliance (co-source)

Health Officers Association of California (co-source)

San Francisco AIDS Foundation (co-source)

A New Path

A New Way of Life Re-Entry Project

Access Support Network

AIDS Healthcare Foundation

American Civil Liberties Union of California

American Congress of Obstetricians and Gynecologists – District IX

Any Positive Change, Inc.

APLA Health

Asian Liver Center at Stanford University

Being Alive LA

Biensestar Human Services, Inc.

California Access Coalition

California Association of Alcohol and Drug Program Executives

California Attorneys for Criminal Justice

California Council of Community Behavioral Health Agencies

California Medical Association

California Nurses Association

California Pharmacists Association

California Public Defenders Association

California Retailers Association

California Society of Addiction Medicine

California Society of Health-System Pharmacists

Californians for Safety and Justice

Center for Health Justice

Center for Living and Learning

CLARE|MATRIX

Community Clinic Association of Los Angeles County

County Health Executives Association of California

Democratic Party of the San Fernando Valley

Desert AIDS Project

Ella Baker Center for Human Rights

End Hep C SF

Equality California

Face to Face

Face to Face/ Sonoma County AIDS Network

Fresno Needle Exchange Program

GLIDE Foundation

Harm Reduction Coalition

Harm Reduction Services

HIV Education and Prevention Project of Alameda County

Homeless Healthcare Los Angeles

Initiate Justice

Los Angeles LGBT Center

Los Angeles Regional Reentry Partnership

Mendocino County Aids/Viral Hepatitis Network

National Association of Chain Drug Stores

National Association of Social Workers, California Chapter

National Health Law Program

NEXT Harm Reduction

Orange County Needle Exchange Program

Planned Parenthood Affiliates of California

PleasePrEPMe

Re:Store Justice

Sierra Harm Reduction Coalition

St. Anthony’s Foundation

Tarzana Treatment Centers, Inc.

Tenderloin Neighborhood Development Corporation

The Sidewalk Project

The Spahr Center

Treatment Action Group

Valley Community Healthcare

Veterans for Recovery, Ontario

Western Center on Law & Poverty

OPPOSITION: (Verified 8/14/20)

California State Sheriffs’ Association

ARGUMENTS IN SUPPORT: Drug Policy Alliance writes that decades of research have established that access to sterile syringes reduces HIV and hepatitis B and C infections, is safe, effective, and cost-saving, and do not increase illegal drug use or crime. The need for safe injection supplies is as great as it has ever been: the opioid epidemic has resulted in increased injection drug use; this in turn has resulted in steep increases in hepatitis C diagnosis rates and there is concern that HIV transmission may increase also. Allowing adults to purchase sterile syringes without a prescription costs the taxpayers of California nothing, while saving billions of dollars in healthcare costs by preventing HIV and HCV disease. The San Francisco AIDS Foundation states that syringe sharing is the most common cause of hepatitis C transmission and the second most common cause of HIV and hepatitis B transmission in the United States. These preventable infections are devastating to individuals and families, and put costs burdens on taxpayer supported healthcare and health insurance, and the CDC reports that the lifetime cost to treat a single case of HIV is $380,000 in 2010 dollars. The Health Officers Association of California states that providing discretion to pharmacists to sell syringes to adults without a prescription is an extremely effective public health tool that increases the health and safety of individuals and communities, as well as reduces the costs of treatment of diseases like hepatitis C and HIV/AIDS.

ARGUMENTS IN OPPOSITION: The California State Sheriffs’ Association writes that this bill encourages, or at least facilitates, drug use because by removing the possibility of a felony conviction for most drug possession offenses, much of the meaningful encouragement that guided users toward drug court has evaporated.

ASSEMBLY FLOOR: 50-18, 6/8/20

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bloom, Bonta, Burke, Calderon, Carrillo, Cervantes, Chau, Chiu, Chu, Eggman, Friedman, Gabriel, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager, Levine, Limón, Low, Maienschein, McCarty, Medina, Mullin, Nazarian, Obernolte, O'Donnell, Quirk-Silva, Reyes, Luz Rivas, Robert Rivas, Blanca Rubio, Santiago, Smith, Mark Stone, Ting, Waldron, Weber, Wicks, Wood, Rendon

NOES: Bigelow, Brough, Choi, Cooley, Cooper, Cunningham, Megan Dahle, Diep, Flora, Fong, Gallagher, Kiley, Lackey, Mathis, Patterson, Ramos, Salas, Voepel

NO VOTE RECORDED: Boerner Horvath, Chen, Daly, Frazier, Gray, Grayson, Mayes, Muratsuchi, Petrie-Norris, Quirk, Rodriguez

Prepared by: Melanie Moreno / HEALTH / (916) 651-4111

8/15/20 12:04:10

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 2077

SUBJECT: Hypodermic needles and syringes

SUMMARY:

1. Extends the sunset on existing law, until January 1, 2026, which permits pharmacists to furnish hypodermic needles and syringes without a prescription or a permit, for human use to a person 18 years of age or older and which permits a person 18 years of age or older, without a prescription or license, to obtain hypodermic needles and syringes solely for personal use from a physician or pharmacist.

Existing law:

1. Prohibits, except as specified, the sale of a hypodermic needle or syringe at retail except upon the prescription of a physician, dentist, veterinarian, podiatrist, or naturopathic doctor. [BPC §4142]
2. Permits a physician or pharmacist, until January 1, 2021, to furnish hypodermic needles and syringes without a prescription or a permit, for human use to a person 18 years of age or older. Permits a person 18 years of age or older, without a prescription or license, to obtain hypodermic needles and syringes solely for personal use from a physician or pharmacist. [BPC §4145.5(b)]
3. Makes a person who obtains a hypodermic needle or hypodermic syringe by a false or fraudulent representation or design or by a forged or fictitious name, or contrary to, guilty of a misdemeanor. Makes a person who has obtained a hypodermic needle or hypodermic syringe from any person to whom a permit has been issued and who uses, or permits or causes, directly or indirectly, the hypodermic needle or hypodermic syringe to be used for any purpose other than that for which it was obtained is guilty of a misdemeanor and punishable by a fine not exceeding $1,000, or by imprisonment in a county jail not exceeding one year, or both a fine and imprisonment. [BPC §4326]
4. Establishes the Disease Prevention Demonstration Project (DPDP), within the former Department of Health Services (DHS), 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. Requires DHS to evaluate the effects of allowing pharmacists to sell a limited number of hypodermic needles and syringes without a prescription. [HSC §121285]

This bill:

1. Extends the sunset on existing law, until January 1, 2026, which permits pharmacists to furnish hypodermic needles and syringes without a prescription or a permit, for human use to a person 18 years of age or older and which permits a person 18 years of age or older, without a prescription or license, to obtain hypodermic needles and syringes solely for personal use from a physician or pharmacist.
2. Deletes the penalties associated with obtaining a hypodermic needle or syringe without a prescription described in 3) of existing law above.
3. Repeals the DPDP statute described in 4) of existing law above.
4. Make other technical, clarifying changes.

FISCAL EFFECT:

According to Assembly Appropriations Committee, negligible costs.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, research has shown that allowing adults to purchase sterile syringes from pharmacists without prescriptions is a key component to the prevention and control of HIV and hepatitis C. Existing law allows pharmacists to sell and adults to possess sterile syringes for personal use without a prescription and no study has shown that allowing adults to purchase sterile syringes has increased the rates of drug use, drug injection, or crime. This bill will extend the sunset on this law and ensure that we are continuing to stem the spread of HIV and viral hepatitis.
2. Injection drug use and HIV/hepatitis. According to the Centers for Disease Control and Prevention (CDC), people who inject drugs (PWID) are at high risk for getting HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) infection if they use needles, syringes, or other drug injection equipment (for example, cookers) that someone with HIV, HBV, or HCV has used. The CDC estimates that 62% to 80% of PWID who are HIV-infected are also infected with HCV and at least 60% of new cases of HCV nationally are associated with injection drug use. Although new HIV diagnoses among PWID have declined in recent years, the risk for getting or transmitting HIV is very high if an HIV-negative person uses injection equipment that someone with HIV has used because the virus can survive in a used syringe for up to 42 days, depending on temperature and other factors. In 2017, PWID accounted for 9% (3,641) of the 38,739 diagnoses of HIV in the US and dependent areas (2,389 cases were attributed to injection drug use and 1,252 to male-to-male sexual contact and injection drug use). In a study of cities with high levels of HIV, 40% of new PWID (those who have been injecting for five years or less) reported sharing syringes. From 2005 to 2015, syringe sharing declined 34% among black/African American PWID and 12% among Hispanic/Latino PWID, but did not decline among white PWID. Young PWID (aged <30 years) are more likely to share syringes than older PWID.

Public health experts, including those at the CDC, have for decades identified access to sterile syringes as one component of a comprehensive HIV prevention strategy designed to reduce HIV and hepatitis transmission among PWIDs. In 1999, a number of national organizations endorsed deregulation to allow PWIDs 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 Alliance of State and Territorial AIDS Directors, and the Association of State and Territorial Health Officials.

1. California data. DPH’s Office of Viral Hepatitis Prevention estimates there are least 400,000 people living with HCV in the state and that between 2002 and 2011 there were more than 300,000 hospitalizations in California for complications related to HCV infection, at a cost of over $20 billion. DPH reports that there are approximately 136,566 persons reported to be living with HIV/AIDS in California in 2018. Of those with HIV infection, 12.2% reported injection drug use as a risk factor, including approximately 8,864 men who reported both injection drug use and having sex with men as risk factors.
2. 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 ten 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 blood-borne viral infections among PWIDs 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 PWIDs 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).

1. Prior legislation. AB 1743 (Ting, Chapter 331, Statutes of 2014) 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.

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 ten or fewer hypodermic needles or syringes to a person for use without a 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 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.

1. Support. Drug Policy Alliance writes that decades of research have established that access to sterile syringes reduces HIV and hepatitis B and C infections, is safe, effective, and cost-saving, and do not increase illegal drug use or crime. The need for safe injection supplies is as great as it has ever been: the opioid epidemic has resulted in increased injection drug use; this in turn has resulted in steep increases in hepatitis C diagnosis rates and there is concern that HIV transmission may increase also. Allowing adults to purchase sterile syringes without a prescription costs the taxpayers of California nothing, while saving billions of dollars in healthcare costs by preventing HIV and HCV disease. The San Francisco AIDS Foundation states that syringe sharing is the most common cause of hepatitis C transmission and the second most common cause of HIV and hepatitis B transmission in the United States. These preventable infections are devastating to individuals and families, and put costs burdens on taxpayer supported healthcare and health insurance, and the CDC reports that the lifetime cost to treat a single case of HIV is $380,000 in 2010 dollars. The Health Officers Association of California states that providing discretion to pharmacists to sell syringes to adults without a prescription is an extremely effective public health tool that increases the health and safety of individuals and communities, as well as reduces the costs of treatment of diseases like hepatitis C and HIV/AIDS.
2. Opposition. The California State Sheriffs’ Association writes that this bill encourages, or at least facilitates, drug use because by removing the possibility of a felony conviction for most drug possession offenses, much of the meaningful encouragement that guided users toward drug court has evaporated.

SUPPORT AND OPPOSITION:

Support: Drug Policy Alliance (co-sponsor)

Health Officers Association of California (co-sponsor)

San Francisco AIDS Foundation (co-sponsor)

A New Path

A New Way of Life Re-Entry Project

Access Support Network

AIDS Healthcare Foundation

American Civil Liberties Union of California

American Congress of Obstetricians and Gynecologists – District IX

Any Positive Change, Inc.

APLA Health

Asian Liver Center at Stanford University

Being Alive LA

Biensestar Human Services, Inc.

California Access Coalition

California Association of Alcohol and Drug Program Executives

California Attorneys for Criminal Justice

California Council of Community Behavioral Health Agencies

California Medical Association

California Nurses Association

California Pharmacists Association

California Public Defenders Association

California Retailers Association

California Society of Addiction Medicine

California Society of Health-System Pharmacists

Californians for Safety and Justice

Center for Health Justice

Center for Living and Learning

CLARE|MATRIX

Community Clinic Association of Los Angeles County

County Health Executives Association of California

Democratic Party of the San Fernando Valley

Desert AIDS Project

Ella Baker Center for Human Rights

End Hep C SF

Equality California

Face to Face

Face to Face/ Sonoma County AIDS Network

Fresno Needle Exchange Program

GLIDE Foundation

Harm Reduction Coalition

Harm Reduction Services

HIV Education and Prevention Project of Alameda County (HEPPAC)

Homeless Healthcare Los Angeles

Initiate Justice

Los Angeles LGBT Center

Los Angeles Regional Reentry Partnership

Mendocino County Aids/Viral Hepatitis Network

National Association of Chain Drug Stores

National Association of Social Workers, California Chapter

National Health Law Program

NEXT Harm Reduction

Orange County Needle Exchange Program

Planned Parenthood Affiliates of California

PleasePrEPMe

Re:Store Justice

Sierra Harm Reduction Coalition

St. Anthony’s Foundation

Tarzana Treatment Centers, Inc.

Tenderloin Neighborhood Development Corporation

Treatment Action Group

The Spahr Center

Valley Community Healthcare

Western Center on Law & Poverty

Oppose: California State Sheriffs Association

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 2077

Author:(Ting)

As Amended Ver:May 20, 2020

Majority vote

SUMMARY:

Extends until January 1, 2026, the following existing law provisions: 1) allowing the retail sale or furnishing of a hypodermic needle or syringe to those 18 years of age or older without prescription; 2) requiring a pharmacy that furnishes nonprescription syringes to provide written informal or verbal counseling to consumers, as specified; and, 3) ejujxempting from specified penalty provisions the possession of hypodermic needles or syringes for personal use. Repeals existing law prohibiting the sale of hypodermic needle or syringe at retail except with a prescription. Deletes the penalty associated with obtaining a hypodermic needle or syringe without a prescription.

Major Provisions

COMMENTS:

California has allowed the sale of hypodermic needles and syringes since 2004 with the passage of SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004, which 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. The Disease Prevention Demonstration Project (DPDP) was subsequently suspended when statewide sales were authorized by SB 41 (Yee), Chapter 738, Statutes of 2011. SB 41 also required the Department of Public Health (DPH) to evaluate the results of the pilot project.

In July 2010, DPH published an evaluation of the pilot. The report had a number of findings. Among the most relevant findings were that an increased number of intravenous drug users (IDUs) reported using pharmacies as a source of their syringes. The availability of these sterile syringes seemed to impact behavior. A significantly lower portion of IDUs reported sharing of syringes and there was no evidence of increased unsafe discard of used hypodermic needles or syringes in the Disease Prevention Demonstration Project (DPDPs). DPH reported that the level of injection of illegal drugs decreased among publicly funded HIV testing clients. The report also found that drug related crime remained stable in the jurisdictions that authorized DPDPs. Nevertheless, DPH concluded that the program appeared to be having the desired effect of augmenting access to sterile syringes.

The most important statistic would be the HIV and AIDS incidence rates. DPH states that between problems of data gathering and the short duration of the projects made that impossible to measure accurately. However, there are a host of studies both domestically and internationally that provide evidence that provision of sterile hypodermic needles and syringes reduces HIV transmission.

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. Over the 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 Alliance of State and Territorial AIDS Directors, and the Association of State and Territorial Health Officials.

According to the Author:

According to the author, research has shown that allowing adults to purchase sterile syringes from pharmacists without prescriptions is a key component to the prevention and control of HIV and hepatitis C. Existing law allows pharmacists to sell and adults to possess sterile syringes for personal use without a prescription and no study has shown that allowing adults to purchase sterile syringes has increased the rates of drug use, drug injection, or crime. This bill will remove the sunset on this law and ensure that we are continuing to stem the spread of HIV and viral hepatitis.

Arguments in Support:

The Drug Policy Alliance, San Francisco AIDS Foundation, and the Health Officers Association of California, cosponsors of this bill, state that this bill allows continued access to hypodermic needle or syringes which are proven public health disease prevention tools. The Drug Policy Alliance states that allowing adults to purchase syringes without a prescription costs the taxpayers nothing, while saving billions of dollars in healthcare costs by prevention HIV and hepatitis C.

Arguments in Opposition:

In its opposition, the California Sheriffs Association states it is concern that this bill does nothing to encourage or support substance use treatment while simultaneously encouraging, or at least facilitating, drug use.

FISCAL COMMENTS:

According to Assembly Appropriations Committee, negligible costs.

VOTES:

ASM HEALTH: 11-2-2

YES: Wood, Mayes, Aguiar-Curry, Bonta, Burke, Carrillo, Limón, McCarty, Nazarian, Santiago, Waldron

NO: Bigelow, Flora

ABS, ABST OR NV: Ramos, Rodriguez

ASM APPROPRIATIONS: 12-5-1

YES: Gonzalez, Bauer-Kahan, Bloom, Bonta, Calderon, Carrillo, Chau, Eggman, Gabriel, Eduardo Garcia, McCarty, Robert Rivas

NO: Bigelow, Megan Dahle, Diep, Fong, Voepel

ABS, ABST OR NV: Petrie-Norris

UPDATED:

VERSION: May 20, 2020

CONSULTANT: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0002832

Date of Hearing: June 2, 2020

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 2077

Author:(Ting) – As Introduced Ver:February 5, 2020

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill extends, until January 1, 2026, the sunset date of current law that allows the retail sale or furnishing of a hypodermic needle or syringe to a person 18 years of age or older without a prescription.

It also deletes provisions that describe the pilot project that originally allowed for the sale of syringes at pharmacies and eliminates the crime and penalty associated with obtaining a hypodermic needle or syringe without a prescription.

FISCAL EFFECT:

Negligible.

COMMENTS:

1. Purpose. According to the author, research shows allowing adults to purchase sterile syringes from pharmacists without a prescription helps prevent and control HIV and Hepatitis C. California law allows this sale, but authorization to do so is scheduled to sunset on January 1, 2021. This bill extends the sunset on this law to ensure the sale and possession of syringes may continue in order to protect public health and prevent further infections.

Background. California has allowed the sale of hypodermic needles and syringes since the passage of SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004. SB 1159 established a five-year pilot program to allow California pharmacies, when authorized by a local government, to sell up to 10 syringes to an adult without a prescription. The pilot was subsequently suspended when statewide sales were authorized by SB 41 (Yee), Chapter 738, Statutes of 2011.

SB 41 also required the Department of Public Health (DPH) to evaluate the results of the pilot project. The July 2010 evaluation of the original pilot found positive or neutral results on process indicators such as proportion of injection drug users who reported sharing syringes. The ultimate effect on disease transmission was inconclusive. A large number of reputable national health care and public health organizations, including the American Medical Association, have endorsed deregulation of syringe purchase and possession.

Support and Opposition. This bill is co-sponsored by the Drug Policy Alliance, Health Officers Association of California and San Francisco AIDS Foundation and is supported by the ACLU, a range of health advocacy groups, drug treatment providers and others for public health reasons. It is opposed by California Narcotic Officers' Association and the California State Sheriffs' Association on concerns about discarded needles and the unavailability of a more recent evaluation.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: May 18, 2020

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2077

Author:(Ting) – As Introduced Ver:February 5, 2020

SUBJECT: Hypodermic needles and syringes.

SUMMARY: Allows the retail sale or furnishing of a hypodermic needle or syringe to those 18 years of age or older without a prescription. Deletes the penalty associated with obtaining a hypodermic needle or syringe without a prescription. Specifically, this bill:

1. Deletes the requirement that a hypodermic needle or syringe can only be sold at retail upon the prescription of a dentist, veterinarian, podiatrist, or naturopathic doctor.
2. Deletes the January 1, 2021 sunset date and makes permanent the authorization on physicians or pharmacists to furnish hypodermic needles and syringes to those 18 years of age or older, and for those 18 years of age and older to obtain hypodermic needles and syringes without a prescription or license solely for personal use.
3. Deletes the prohibition on a pharmacist from furnishing a needle or syringe to a person unknown to the pharmacist or is unable to establish their identity.
4. Deletes the January 1, 2021 sunset date and makes permanent the requirement that a pharmacy that furnishes nonprescription syringes to provide written information or verbal counselling to consumers at the time of furnishing or sale of nonprescription hypodermic needles or syringes on how to do the following: a) access drug treatment; b) access testing and treatment for HIV and hepatitis C; and, c) safe disposal of sharps waste.
5. Deletes the January 1, 2021 sunset date and makes permanent the exception for making it unlawful to possess solely for personal use of hypodermic needles or syringes.
6. Deletes a misdemeanor charge for any person who obtains a hypodermic needle or syringe by false or fraudulent representation or design or by a forged or fictitious name.
7. Deletes a misdemeanor charge and penalty for any person who has obtained a hypodermic needle or syringe from any person with a permit to provide the needle or syringe, and uses or causes the use of the needle or syringe in any other purpose that that for which it was obtained.
8. Deletes exiting provisions relating to the Disease Prevention Demonstration Project (DPDP), within the former Department of Health Services to evaluate the effects of allowing pharmacists to sell a limited number of hypodermic needles and syringes without a prescription.
9. Makes other conforming and technical changes.

EXISTING LAW:

1. Permits a pharmacist or physician, without a prescription or a permit, to furnish hypodermic needles and syringes for human use.
2. Permits a person without a prescription or license to obtain hypodermic needles and syringes from a pharmacist or physician for use 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.
3. Permits, until January 1, 2021, a physician or pharmacist to furnish hypodermic needles and syringes to those 18 years of age or older, and for those 18 years of age and older to obtain hypodermic needles and syringes without a prescription or license solely for personal use.
4. Makes it unlawful to possess an opium pipe or any device, contrivance, instrument, or paraphernalia used for unlawfully injecting or smoking controlled substances except for hypodermic needles or syringes containerized for safe disposal or possession of hypodermic needles or syringes for personal use if acquired from a physician or pharmacist, as specified.
5. 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 DPDPs.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, research has shown that allowing adults to purchase sterile syringes from pharmacists without prescriptions is a key component to the prevention and control of HIV and hepatitis C. Existing law allows pharmacists to sell and adults to possess sterile syringes for personal use without a prescription and no study has shown that allowing adults to purchase sterile syringes has increased the rates of drug use, drug injection, or crime. This bill will remove the sunset on this law and ensure that we are continuing to stem the spread of HIV and viral hepatitis.
2. BACKGROUND. California has allowed the sale of hypodermic needles and syringes since 2004 with the passage of SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004, which 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. The DPDP was subsequently suspended when statewide sales were authorized by SB 41 (Yee), Chapter 738, Statutes of 2011. SB 41 also required the Department of Public Health (DPH) to evaluate the results of the pilot project.
   
   In July 2010, DPH published an evaluation of the pilot. The report had a number of findings. Among the most relevant findings were that an increased number of intravenous drug users (IDUs) reported using pharmacies as a source of their syringes. The availability of these sterile syringes seemed to impact behavior. A significantly lower portion of IDUs reported sharing of syringes and there was no evidence of increased unsafe discard of used hypodermic needles or syringes in the DPDPs. DPH reported that the level of injection of illegal drugs decreased among publicly funded HIV testing clients. The report also found that drug related crime remained stable in the jurisdictions that authorized DPDPs. Nevertheless, DPH concluded that the program appeared to be having the desired effect of augmenting access to sterile syringes.
   
   The most important statistic would be the HIV and AIDS incidence rates. DPH states that between problems of data gathering and the short duration of the projects made that impossible to measure accurately. However, there are a host of studies both domestically and internationally that provide evidence that provision of sterile hypodermic needles and syringes reduces HIV transmission.
   
   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. Over the 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 NABP, the National Alliance of State and Territorial AIDS Directors, and the Association of State and Territorial Health Officials.
3. SUPPORT. The Drug Policy Alliance, San Francisco AIDS Foundation, and the Health Officers Association of California, cosponsors of this bill, state that this bill allows continued access to hypodermic needle or syringes which are proven public health disease prevention tools. The Drug Policy Alliance states that allowing adults to purchase syringes without a prescription costs the taxpayers nothing, while saving billions of dollars in healthcare costs by prevention HIV and hepatitis C.
4. OPPOSITION. In its opposition, the California Narcotic Officers Association states it is premature to proceed with this bill prior to such an evaluation taking place. Certainly the increased homeless population, when coupled with the plethora of unrestricted needle purchases and the evidence of the increase in discarded needles (with the real danger of infecting others) merit serious examination prior to embarking on the indefinite extension of unrestricted needle distribution as contemplated by this bill.
5. POLICY COMMENT. In 2010, an evaluation was conducted on the pilot project allowing pharmacies to sell hypodermic needles or syringes. Since then, no new evaluation has been conducted to determine the efficacy of California’s needle exchange program, and its impact on public health, if any. As such, the Committee may wish to instead consider extending the sunset date of the authority of pharmacists to sell hypodermic needles or syringes for another five years.
6. PREVIOUS LEGISLATION.
   1. SB 212 (Jackson), Chapter 1004, Statutes of 2018, requires entities that sell drugs or sharps in the state to individually, or with other entities, develop and implement a statewide home-generated drug stewardship plan, or a home-generated sharps waste stewardship plan, or both for the collection and proper disposal of home-generated drug and sharps waste. Requires the Department of Resources, Recycling and Recovery to oversee and enforce each stewardship plan.
   2. AB 1973 (Ting), Chapter 331, Statutes of 2014, 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.
   3. SB 41 permits nonprescription 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.
   4. AB 1701 (Chesbro), Chapter 667, Statues of 2010, extends the provisions establishing the DPDP until January 1, 2018, which permits 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.
   5. SB 1029 (Yee) of 2010 contained similar provisions to SB 41, but was vetoed by Governor Schwarzenegger.
   6. SB 1159 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.
   7. SB 774 (Vasconcellos) of 2003 would have permitted the furnishing of syringes without a prescription. SB 774 was vetoed by Governor Davis.
   8. SB 1785 (Vasconcellos) of 2002, substantially similar to SB 774, was also vetoed by Governor Davis.

REGISTERED SUPPORT / OPPOSITION:

Support

Drug Policy Alliance (cosponsor)
Health Officers Association of California (cosponsor)
San Francisco AIDS Foundation (cosponsor)
A New Path

A New Way of Life Re-entry Project

Access Support Network

AIDS Healthcare Foundation

American Civil Liberties Union/Northern California/Southern California/San Diego and Imperial Counties

American Congress of Obstetricians & Gynecologists - District IX

Any Positive Change Inc.

APLA Health

Asian Liver Center at Stanford University

Being Alive - Los Angeles

Bienestar Human Services

California Access Coalition

California Association of Alcohol and Drug Program Executives, Inc.

California Attorneys for Criminal Justice

California Medical Association

California Nurses Association

California Pharmacists Association

California Public Defenders Association

California Retailers Association

California Society of Addiction Medicine

Californians for Safety and Justice

Center for Living and Learning

Community Clinic Association of Los Angeles County

County Health Executives Association of California

Desert Aids Project

Ella Baker Center for Human Rights

End Hep C SF

Equality California

Fresno Needle Exchange Program

Glide

Harm Reduction Coalition

Harm Reduction Services

Homeless Health Care Los Angeles

Initiate Justice

Los Angeles LGBT Center

Mendocino County AIDS/Viral Hepatitis Network

National Association of Chain Drug Stores

National Association of Social Workers, California Chapter

Orange County Needle Exchange Program

Pleaseprepme.org

Tarzana Treatment Centers, Inc.
Tenderloin Neighborhood Development Corporation

The Spahr Center

Valley Community Healthcare

Western Center on Law & Poverty, INC.

Oppose

California Narcotic Officers' Association
California State Sheriffs' Association

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097

Date of Hearing: March 17, 2020

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2077

Author:(Ting) – As Introduced Ver:February 5, 2020

SUBJECT: Hypodermic needles and syringes.

SUMMARY: Allows the retail sale or furnishing of a hypodermic needle or syringe to those 18 years of age or older without a prescription. Deletes the penalty associated with obtaining a hypodermic needle or syringe without a prescription. Specifically, this bill:

1. Deletes the requirement that a hypodermic needle or syringe can only be sold at retail upon the prescription of a dentist, veterinarian, podiatrist, or naturopathic doctor.
2. Deletes the January 1, 2021 sunset date and makes permanent the authorization on physicians or pharmacists to furnish hypodermic needles and syringes to those 18 years of age or older, and for those 18 years of age and older to obtain hypodermic needles and syringes without a prescription or license solely for personal use.
3. Deletes the prohibition on a pharmacist from furnishing a needle or syringe to a person unknown to the pharmacist or is unable to establish their identity.
4. Deletes the January 1, 2021 sunset date and makes permanent the requirement that a pharmacy that furnishes nonprescription syringes to provide written information or verbal counselling to consumers at the time of furnishing or sale of nonprescription hypodermic needles or syringes on how to do the following: a) access drug treatment; b) access testing and treatment for HIV and hepatitis C; and, c) safe disposal of sharps waste.
5. Deletes the January 1, 2021 sunset date and makes permanent the exception for making it unlawful to possess solely for personal use of hypodermic needles or syringes.
6. Deletes a misdemeanor charge for any person who obtains a hypodermic needle or syringe by false or fraudulent representation or design or by a forged or fictitious name.
7. Deletes a misdemeanor charge and penalty for any person who has obtained a hypodermic needle or syringe from any person with a permit to provide the needle or syringe, and uses or causes the use of the needle or syringe in any other purpose that that for which it was obtained.
8. Deletes exiting provisions relating to the Disease Prevention Demonstration Project (DPDP), within the former Department of Health Services to evaluate the effects of allowing pharmacists to sell a limited number of hypodermic needles and syringes without a prescription.
9. Makes other conforming and technical changes.

EXISTING LAW:

1. Permits a pharmacist or physician, without a prescription or a permit, to furnish hypodermic needles and syringes for human use.
2. Permits a person without a prescription or license to obtain hypodermic needles and syringes from a pharmacist or physician for use 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.
3. Permits, until January 1, 2021, a physician or pharmacist to furnish hypodermic needles and syringes to those 18 years of age or older, and for those 18 years of age and older to obtain hypodermic needles and syringes without a prescription or license solely for personal use.
4. Makes it unlawful to possess an opium pipe or any device, contrivance, instrument, or paraphernalia used for unlawfully injecting or smoking controlled substances except for hypodermic needles or syringes containerized for safe disposal or possession of hypodermic needles or syringes for personal use if acquired from a physician or pharmacist, as specified.
5. 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 DPDPs.

FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, research has shown that allowing adults to purchase sterile syringes from pharmacists without prescriptions is a key component to the prevention and control of HIV and hepatitis C. Existing law allows pharmacists to sell and adults to possess sterile syringes for personal use without a prescription and no study has shown that allowing adults to purchase sterile syringes has increased the rates of drug use, drug injection, or crime. This bill will remove the sunset on this law and ensure that we are continuing to stem the spread of HIV and viral hepatitis.
2. BACKGROUND. California has allowed the sale of hypodermic needles and syringes since 2004 with the passage of SB 1159 (Vasconcellos), Chapter 608, Statutes of 2004, which 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. The DPDP was subsequently suspended when statewide sales were authorized by SB 41 (Yee), Chapter 738, Statutes of 2011. SB 41 also required the Department of Public Health (DPH) to evaluate the results of the pilot project.
   
   In July 2010, DPH published an evaluation of the pilot. The report had a number of findings. Among the most relevant findings were that an increased number of intravenous drug users (IDUs) reported using pharmacies as a source of their syringes. The availability of these sterile syringes seemed to impact behavior. A significantly lower portion of IDUs reported sharing of syringes and there was no evidence of increased unsafe discard of used hypodermic needles or syringes in the DPDPs. DPH reported that the level of injection of illegal drugs decreased among publicly funded HIV testing clients. The report also found that drug related crime remained stable in the jurisdictions that authorized DPDPs. Nevertheless, DPH concluded that the program appeared to be having the desired effect of augmenting access to sterile syringes.
   
   The most important statistic would be the HIV and AIDS incidence rates. DPH states that between problems of data gathering and the short duration of the projects made that impossible to measure accurately. However, there are a host of studies both domestically and internationally that provide evidence that provision of sterile hypodermic needles and syringes reduces HIV transmission.
   
   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. Over the 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 NABP, the National Alliance of State and Territorial AIDS Directors, and the Association of State and Territorial Health Officials.
3. SUPPORT. The Drug Policy Alliance, San Francisco AIDS Foundation, and the Health Officers Association of California, cosponsors of this bill, state that this bill allows continued access to hypodermic needle or syringes which are proven public health disease prevention tools. The Drug Policy Alliance states that allowing adults to purchase syringes without a prescription costs the taxpayers nothing, while saving billions of dollars in healthcare costs by prevention HIV and hepatitis C.
4. OPPOSITION. In its opposition, the California Narcotic Officers Association states it is premature to proceed with this bill prior to such an evaluation taking place. Certainly the increased homeless population, when coupled with the plethora of unrestricted needle purchases and the evidence of the increase in discarded needles (with the real danger of infecting others) merit serious examination prior to embarking on the indefinite extension of unrestricted needle distribution as contemplated by this bill.
5. POLICY COMMENT. In 2010, an evaluation was conducted of the pilot project allowing pharmacies to sell hypodermic needles or syringes. Since then, no new evaluation was conducted to determine the efficacy of California’s needle exchange program to support unrestricted access, and its impact on public health, if any. As such, the Committee may wish to consider extending the sunset date of the provisions of law this bill seeks to make permanent.
6. PREVIOUS LEGISLATION.
   1. SB 212 (Jackson), Chapter 1004, Statutes of 2018, requires entities that sell drugs or sharps in the state to individually, or with other entities, develop and implement a statewide home-generated drug stewardship plan, or a home-generated sharps waste stewardship plan, or both for the collection and proper disposal of home-generated drug and sharps waste. Requires the Department of Resources, Recycling and Recovery to oversee and enforce each stewardship plan.
   2. AB 1973 (Ting), Chapter 331, Statutes of 2014, 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.
   3. SB 41 permits nonprescription 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.
   4. AB 1701 (Chesbro), Chapter 667, Statues of 2010, extends the provisions establishing the DPDP until January 1, 2018, which permits 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.
   5. SB 1029 (Yee) of 2010 contained similar provisions to SB 41, but was vetoed by Governor Schwarzenegger.
   6. SB 1159 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.
   7. SB 774 (Vasconcellos) of 2003 would have permitted the furnishing of syringes without a prescription. SB 774 was vetoed by Governor Davis.
   8. SB 1785 (Vasconcellos) of 2002, substantially similar to SB 774, was also vetoed by Governor Davis.

REGISTERED SUPPORT / OPPOSITION:

Support

Drug Policy Alliance (cosponsor)
Health Officers Association of California (cosponsor)
San Francisco AIDS Foundation (cosponsor)
Access Support Network
American Civil Liberties Union/northern California/Southern California/San Diego and Imperial Counties
American Congress of Obstetricians & Gynecologists - District IX
Any Positive Change Inc.
APLA Health
Asian Liver Center At Stanford University
Being Alive - Los Angeles
Bienestar Human Services
California Access Coalition
California Pharmacists Association
Californians for Safety and Justice
County Health Executives Association of California
Desert AIDS Project
Ella Baker Center for Human Rights
Fresno Needle Exchange Program
GLIDE
Harm Reduction Services
Initiate Justice
Mendocino County AIDS/Viral Hepatitis Network
Orange County Needle Exchange Program
Pleaseprepme.org
The Spahr Center
Western Center on Law & Poverty, Inc.

Oppose

California Narcotic Officers' Association
California State Sheriffs' Association

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097