Loading...
HomeMy WebLinkAboutMINUTES - 12202005 - C.129 I Contra TO:' BOARD OF SUPERVISORS . . - Costa FROM: William B. Walker, MD, Health Services Director DATE: ,l December 20, 2005 County s>q`°""TY SUBJECT: Implementation of SB 11159 (Vasconcellos), Disease Prevention Demonstration Project. SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION(S): 1. ACCEPT this report on the status of the Disease Prevention Demonstration Project (DPDP) SB 1159 activities in Contra Closta as part of a comprehensive HIV Prevention Program. 2. DIRECT the Health Services Department to continue implementing and monitoring the DPDP in Contra Costa and to report back periodically to the Board of Supervisors on this issue and other issues relating to the HIV epidemic in Contra Costa. I FISCAL IMPACT: None beyond some staff time. BACKGROUND: In December 2004, the Board of Supervisors unanimously approved a request from the Health Department to authorize and implement a local Disease Prevention Demonstration Project(DPDP) in Contra Costa. This Project, as authorized by California Senate Bill 1159, allows pharmacists registered with the Health Department to sell or furnish up to 10 syringes to an individual 18 years of age or older without a prescription. l Registration of pharmacies in the Contra Costa DPDP has been conservative but fairly smooth: all Walgreens and Rite Aid pharmacies are currently registered and additional pharmacies are expected to register. Distribution of syringes has increased slowly, with more than 69% of the 32 registered pharmacies showing some sales and those pharmacies registered for a longer period of time reporting slow increases in volume. No problems have been reported to the Health Department at this time. The Health Department is an active participant in the statewide process to develop an effective evaluation of the Disease Prevention Demonstration Project. I CONTINUED ON ATTACHMENT: YES NO XX I SIGNATURE (tk�VV RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE ",-�'APPROVE OTHER 4 SIGNATURE S : ACTION OF 130AON N 1 I APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS: UNANIMOUS (ABSENT I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN AND AYES: NOES: ENTERED ON THE MINUTES OF THE BOARD OF ABSENT: ABSTAIN: I SUPERVISORS ON THE DATE SHOWN. 7� ATTESTED � � " Contact: Christine Leivermann,313-6786 JOHN SWEETEN,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR cc: Public Health Director, 597 Center,#200,1.1-Him- Health Services Director, 50 Douglas,#300, Martinez BY: DEPUTY f � -)Status Update: Disease Prevention Demonstration Project(SB 1159) Contra Costa Health Services Second Quarter Report December 2005 RECOMMENDATIONS 1. Accept this report on the status of the Disease Prevention Demonstration Project (DPDP) SB 1159 activities in Contra Costa as part of a comprehensive HIV Prevention Program. 2. Direct the Health Services Diepartment to continue implementing and monitoring the DPDP in Contra Costa and to report back periodically to the Board of Supervisors on this issue and other issues relating to the HIV epidemic in Contra Costa. SUMMARY Registration of pharmacies in the Contra Costa DPDP has one fairly smoothly, with all Walgreens, Rite Aids, and one Safeway (estimated to be about 22% of non-hospital pharmacies) registered to participate. Additional pharmacies are expected to register as the program becomes more widely known within the community. Distribution of syringes through the DPDP has increased slowly,lwith 69% of registered pharmacies now showing some sales and those pharmacies registered for a longer period of time reporting slow increases in volume. Beyond the initial letters submitted to the Board of Supervisors following the directive to implement the DPDP, no community concerns have been expressed and no difficulties have been reported. A statewide evaluation process is being developed with input from Contra Costa Health Services. c - Status Update: Disease Prevention Demonstration Project(SB 1159) Contra Costa Health Services Second Quarter Report December 2005 In December 2004, the Board of Supervisors unanimously approved a request from Contra Costa Health Services to autho ize and implement a local Disease Prevention Demonstration Project in Contra Costa. This Project, as authorized by California Senate Bill 1159, allows pharmacists registered with Contra Costa Health Services to sell or furnish up to 10 syringes to an individual 18 years of age or older without a prescription. This report outlines the status of activities to implement the DPDP in Contra Costa. DATA REVIEW There is a higher rate of HIV infection attributed to injection drug use (IDU) in Contra Costa than in the State. As of May 2005, 19% of cumulative AIDS cases statewide and nearly 28% of all people ever diagnosed with AIDS in Contra Costa are attributed to injection drug use. These figures include men who have sex with other men and also inject drugs. Currently, there are approximately 950 people living with AIDS (PLWA) in Contra Costa.' • 26% are IDU • Among women, approximatily 41% are IDU The statewide evaluation of the DPDP plans to look at reported needle stick injuries. In Contra Costa, available City Risk Management data on needle stick injuries incurred by public employees shows that from Fiscal Year 2001/2002 to June of 2005, approximately 14 individuals have reported being stuck by needles during the course of business. Nine of the sticks occurred during police "patdowns," three were to maintenance workers and one was to a firefighter. The highest number of sticks (5) occurred in fiscal year 2003/2004.2 County Risk Management data for the same period shows approximately five accidental needle sticks among sheriff and fire department staff for the same period. ESTABLISHING THE CONTRA COSTA DPDP Registration of pharmacies in the Contra Costa DPDP has gone fairly smoothly. Following the December 2004 Board meeting, a mailing was sent to all pharmacies in Contra Costa informing them of the DPDP and the enrollment process. Follow-up phone calls were made, a press release was sent, and information was posted on the Contra Costa Health Services website. Follow-up phone calls continue on a quarterly basis to all pharmacies expressing interest but not yet enrolled in the Project. Chain pharmacies may elect to submit one registration per district. At this time a total of 32 pharmacies, including all Walgreen and Rite Aid pharmacies and one Safeway store in Martinez are registered in the DPDP. Savon (Albertsons) has declined to participate. Longs Drugs has stated their intention to enroll soon. Smaller, independent pharmacies have expressed some reserved interest but have not yet decided to participate. ' Contra Costa Health Services 2 Municipal Pooling Authority of Nort ern California— 13 total incidents reported for the cities of Antioch, Brentwood, Clayton, Danville, EI Cerrito, Hercules, Lafayette, Martinez, Moraga, Oakley, Orinda, Pinole, Pittsburg, Pleasant Hill, San Pablo and San Ramon: May 2005 correspondence. County Risk Management-one incident reported in April 2005 correspondence. Status Update: Disease Prevention Demonstration Project(SB 1159) Contra Costa Health Services C - td—� `] Second Quarter Report December 2005 Each pharmacy registering with the DPDP submits a one-page application with a copy of their current State Board of Pharmacy retail permit. A registration letter and certificate are issued and pharmacy managers are offered an orientation to the philosophy, goals and process in Contra Costa. Orientations have been an opportunity for Health Services staff to review the legislation and the local epidemiology, as well as to answer questions from the managers. Health education and referral materials are provided and are available on our web site. A primary education and referral resource page is available in Spanish. PRELIMINARY PHARMACY DATA Distribution of syringes through the DPDP has increased slowly, with those pharmacies registered for a longer period of time reporting slow increases in volume. Some of the major pharmacy chains have sent letters to their California outlets stating that they are supportive of the legislation but are leaving participation up to the local pharmacists. Consequently, not all registered pharmacies are selling syringes. Some pharmacists have raised moral or ethical concerns. Our approach has been not to force participation but to register these pharmacies and keep them on the list for follow-up phone contact, education, and information. In June and September 2005, the AIDS Program conducted an informal phone survey of all registered pharmacies. Sixty-nine percent of the registered pharmacies indicated they had sold syringes at least once to at least one individual. Approximately 82% of Walgreen's pharmacies and 54% of Rite Aid pharmacies have sold syringes at some point since registration. The cost of syringes is between $3.00 and $4.25 per 10-pack. The number of sales by individual pharmacy site varies significantly, averaging between two and 10 sales per week among those sites with sales. DISPOSAL Hazardous waste staff report a slight increase in the volume of sharps waste. Hazardous waste facilities located in Richmond and Antioch accept household sharps waste for disposal. Neither facility has data on actual volume that could be attributed to the implementation of SB 1159, but both sites anecdotally report an increase in sharps waste. Both sites will mail containers or request. There is no comparable service in Central County. INTERACTION WITH LOCAL LAW ENFORCEMENT There have been no reports of incidents or problems reported to date with the implementation of SB 1159 in Contra Costa. No pharmacies have reported any difficulties associated with participation in the DPDP. An apparent surveyor or community)member interested in viewing the health education materials approached one pharmacy. The Sheriff has assigned a liaisoin to discuss issues or concerns as they arise. The Sheriff's Department expects some communication from the State Attorney General will ensure that Status Update: Disease Prevention Demonstration Project(SB 1159) `' J d,6l Contra Costa Health Services t� Second Quarter Report December 2005 their procedures for managing SB 1159 interactions are consistent with the intent of the legislation. The District Attorney is aware of the legislation and the Board directive but has declined to discuss any issues at this time. The State Office of AIDS has offered to provide a presentation to any law enforcement body with questions or concerns. EVALUATION PROCESS Contra Costa Health Services sits on the advisory panel to develop a statewide evaluation of SB 1159. The legislation requires the State to convene an advisory panel charged with developing a statewide evaluation process of SB 1159 by December 2010. The panel meets regularly. Participants include Sonoma, Los Angeles, San Francisco and Contra Costa counties as well as representatives from State Waste Management, the State Board of Pharmacy, law enforcement, advocates and consumers, private sector waste management, the State Office of AIDS, and evaluators. At this time, 13 jurisdictions have approved the implementation of the DPDP: Contra Costa, Sonoma, Solano, Yuba, Alameda, San Francisco, Santa Cruz, San Mateo, Marin, Yolo, Los Angeles, and the cities of Los Angeles and West Hollywood. An additional nine jurisdictions are preparing for implementation. A grant application for funding of a statewide evaluation process was submitted by the State in September. Proposed objectives, sample data elements, and potential data sources include: 1) Survey of counties to compare the characteristics of counties that implement the program and counties that do not implement the program (population density, needle exchange programs, drug crime, needle stick injuries, how discard is handled, HIV among drug users, etc.). 2) Review the impact of increased access to clean needles on drug use behavior (sources of syringes, methods of discard, frequency of syringe use and reuse, use of drug treatment services). , 3) Impact of DPDP on the community (volume of discards near the pharmacies, accidental sticks, crime rates). 4) Monitoring of participation/non-participation (surveys of pharmacies, sample of population data collected by pharmacies). CONCLUSIONS Registration of pharmacies in the Contra Costa DPDP has gone fairly smoothly, with approximately 22% of(non-hospital) pharmacies registered to participate. Additional pharmacies are expected to register. Distribution of syringes through the DPDP has increased slowly, with more than i69% of registered pharmacies showing some sales and those pharmacies registered for a longer period of time reporting slow increases in volume. Neither participating pharmacies nor local law enforcement have reported any difficulties.