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FROM: PHIS BATCHELOR, COUNTY ADMINISTRATOR
Costa
County
DATE: February 24, 1999 rn0r- N''``
cv
SUBJECT: LEGISLATION: A$ 518 (MAZZONI)
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ADOPT a position in SUPPORT of AB 518 by Assemblywoman Kerry Mazzoni of
Ban Rafael which would authorize counties and cities to develop a clean needle and
syringe exchange project under certain circumstances.
BACKGROUND:
The Board's 1999 Legislative Program contains a provision that the Board will
"Support efforts to enact legislation which would allow local health jurisdictions to
legally support needle exchange programs."
Assemblywoman Mazzoni has introduced AB 518 which, as introduced, does all of
the following;
Adopts findings which,among other items, notes the public health crisis posed
by the spreading AIDS epidermic, the fact that injection drug users are the
second largest group at risk of becoming infected with HIV and developing
AIDS, that studies indicate that the lack of sterile needles promotes the
spread of HIV among injection drug users and that as of December 1995,
82% of reported cases of AIDS in the United States were associated with
injection drug used
CONTINUES ON ATTACHMENT: YES SIGNATURE:
�,.-.REC{SMMENDATION OF COUNTY ADMINISTRATOR —RECOMMENDATION OF BOARD COMMITTEE
APPROVE —OTHER
OTHER
SIGNATURE S: 2_�L_ `
ACTION OF BOA3 D CSN
--.—APPROVED APPROVED AS RECOMMENDED _XY_ OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A TRUE
X.UNANIMOUS(ABSENT j AND CORRECT COPY OF AN ACTION TAKEN
AYES: -- - — . NOES: AND ENTERED ON THE MINUTES OF THE BOARD
ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN.
ATTESTED March 2 1999
Contact. PHIL BATCHELOR,CLERK OF THE BOARD OF
cc: SUPERVISORS AND COUNTY ADMINISTRATOR
BY DEPUTY
Repeals a section of the Business and Professions Cade which restricts the
ability to furnish hypodermic needles and syringes for human use.
Enacts a new section in the Business and Professions Code which specifically
allows a pharmacist or physician to furnish,without a prescription or a permit,
hypodermic needles and syringes when operating a clean needle and syringe
exchange.
Authorizes a board of supervisors and the County Health Officer to develop
and implement a clean needle and syringe exchange program, providing the
program is operated in a specified manner and as recommended by the U. S.
Secretary of Health and Human Services as part of a network of
comprehensive services.
Requires that the project be assessed as to Its effectiveness, according to
specified measures.
Since AS 518 appears to be consistent with the Board's adopted 1999 Legislative
Program, it would be appropriate for the Board to indicate its support for AES 518.
cc. County Administrator
Health Services Director
Public Health director
Assemblywoman Kerry Mazzoni
Room 3123 State Capitol
Sacramento, CA 95814
Les Spahnn
Heim, Noack, Kelly & Spahnn
1121 L Street, Suite 100
Sacramento, CA 95814
-2-
CALIFORNIA LEGISLATURE-1999--2000 REGULAR SESSION
ASSEMBLY DILL No. 518
Introduced by Assembly Member Mazzoni
(Principal coauthor: Assembly Member Shelley)
(Coauthors. Assembly Members Aroner,Keeley, Kuehl,
Lempert,Longville,Migden,Romero,and Washington)
(Coauthor; Senator Solis)
February 18, 1999
An act to repeal and add ,Section 4145 of the Business and
Professions Code, and to add and repeal Chapter 15
(commencing with Section 121340) of Part 4 of Division 105
of the Health and Safety Code, relating to AIDS.
LEGISLATIVE COUNSEL'S DIGEST
AB 518, as introduced, Mazzoni. AIDS: clean needle and
syringe exchange projects.
Existing law authorizes pharmacists and physicians to
furnish hypodermic needles and syringes without a
prescription or permit for human use in the administration of
insulin or adrenaline.
This bill would authorize clean needle and syringe
exchange projects, and would authorize pharmacists,
physicians, and certain persons authorized under those
projects to furnish hypodermic needles and syringes without
a prescription or permit.
This bill would state the findings and declarations of the
Legislature regarding infection with the human
immunodeficiency virus (HIV), and development of
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AB 518 —2—
acquired
--2--
acquired immune deficiency syndrome (AIDS) among
injection drug users.
This bill would authorize counties, cities, or cities and
counties to develop a clean needle and syringe exchange
project upon the action of that county, city, or city and county
and certain other local officers.
This bill would enumerate the components of a clean
needle and syringe exchange project, and would require that
the project be part of a network of voluntary and confidential
services where available. This bill would require that a
participating county; city, or city and county assess the project
using certain criteria, and submit a progress report that takes
into consideration data from the assessment to the State
Director of Health. Services, the governor, and the
chairpersons of both health committees of the Legislature.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program.: no.
The people r?f°the State of California do enact as follows:
I SECTION 1. The Legislature hereby finds and
declares all of the following:
3 (a) The rapidly spreading acquired immune
4 deficiency syndrome (AIDS) epidemic, and the more.
5 recent spread of blood-borne hepatitis, pose an
6 unprecedented public health crisis in California, and
7 threaten, in one way or another, the life and health of
8 every Californian.
9 (b) Injection drug users are the second largest group
10 at risk of becoming infected with the human
11 immunodeficiency virus (HIV) and developing AIDS,
12 and they are the primary source of heterosexual, female,
13 and perinatal transmission in California, the United
14 States, and Europe.
15 (c) According to the State Office of AIDS, injection
16 drug use has emerged as one of the most prevalent risk
17 factors for new AIDS cases in California.
18 (d) Studies indicate that the lack of sterile needles
19 available on the streets, and the existence of laws
20 restricting needle availability promote needle sharing,
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-3— AB 518
1 and consequently the spread of HIV among injection
2 drug users. The sharing of contaminated needles is the
3 primary means of HIV transmission within the injection
4 drug user population.
5 (e) As of December 1996, 32 percent of the 573,800
6 reported cases of AIDS in the United States were
7 associated with injection drug use. Of the 49,764 cases of
8 AIDS presumed to be transmitted through heterosexual
9 sex, 44 percent of the cases occurred among the sexual
10 partners of injection drug users. Of the 6,891 pediatric
11 AIDS cases related to a mother with or at risk for HIV
12 infection, 59 percent were related to injection drug use.
13 The number of reported AIDS cases reflects only a
14 fraction of the total number of persons infected with HIV.
15 (f) An estimated 5.7 percent, 10.3 percent, and 7.1
16 percent of injection drug users entering methadone
17 treatment programs between 1993 and 1994 in Contra
18 Costa, San Francisco, and Alameda Counties,
19 respectively, were infected with HIV. Public health
20 officials generally consider the seroprevalence rates of
21 those entering treatment to be significantly lower than
22 the true rate of HIV infection among the injection drug
23 user population as a whole.
24 (g) Most injection drug users use a variety of drugs,
25 mainly heroin, cocaine, and amphetamines. Because
26 amphetamine- and cocaine-injecting drug users inject
27 more frequently than heroin users, their risk for HIV
28 infection is higher.
29 (h) Studies of injection drug users in New York, New
30 York; San Francisco, California; Tacoma, Washington;
31 Boulder, Colorado; Portland, Oregon; and other cities in
32 the United States indicate that injection drug users are
33 concerned about AIDS and do change their behavior
34 when offered, in a nonjudgmental setting, reasonable
35 strategies to protect themselves. A UCLA study of
36 prisoners in the county jail who injected drugs indicated
'17 a significant decrease in needle sharing after the
38 inception of clean needle and syringe exchange in Los
39 Angeles.
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AB 518 —4-
1
4-1 (i) The United States Secretary of Health and Human
Services announced findings on April 20, 1998, stating that
3 "needle exchange programs can be an effective part of a
4 comprehensive strategy to reduce the incidence of HIV
5 transmission and do not encourage the use of illegal
6 drugs." Secretary Shalala further stated.. that "The science
7 reveals that successful needle exchange programs refer
8 participants to drug counseling and treatment as well as
9 necessary medical services, and make needles available
10 on a replacement basis only."
11 6) California is one of 10 states that criminalizes the
12 furnishing, possession, or use of hypodermic needles or
13 syringes without a prescription. Of these 10 states, four
14 have either passed legislation or waived the prohibition
15 through administrative action over the last several years
16 to permit the: development of needle exchange programs.
17 California has the highest seroprevalence rate of HIV
18 infection of any state that has not waived the prohibition
19 or adopted a statute to permit needle exchange
20 programs.
21 SEC. 2. Section 4145 of the Business and Professions
22 Code is repealed.
23 4145. D
24 D
25 permit,
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27
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32 the of ft or ft&eftaline, or frem -a
33 D or Reeftseholder, for ese eft
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99
}
AB 518
9 at the tifft fwnishing 9
3 by Se en 4146.
4 SEC. 3. Section 4145 is added to the Business and
5 Professions Code, to read:
6 4145. (a) Notwithstanding any other provision of
7 law, the fallowing persons may, without a prescription or
8 permit, furnish a hypodermic needle or syringe if all the
9 requirements in subdivision (c) are met:
10 (1) A pharmacist or physician may, without a
11 prescription or a permit, furnish hypodermic needles and
12 syringes for human use in the administration of insulin or
13 adrenaline.
14 (2) A pharmacist or veterinarian may, without a
15 prescription or permit, furnish hypodermic needles and
16 syringes for use on poultry or animals.
17 (3) A pharmacist, physician, or other person
18 designated under the operating procedures developed
19 pursuant to paragraph (1) of subdivision (a) of Section
20 121341 of the Health and Safety Code may, without a
21 prescription or permit, furnish hypodermic needles and
22 syringes when operating a clean needle and syringe
23 exchange and any person may, without a prescription or
24 a permit, obtain hypodermic needles and syringes from
25 a program established pursuant to Chapter 15
26 (commencing with Section 121340) of Part 4 of Division
27 105 of the Health and Safety Code.
28 (b) Any person may, without a prescription or permit,
29 obtain hypodermic needles and syringes from. a
30 pharmacist or physician for human use in the
31 administration of insulin or adrenaline, or from a
32 pharmacist, veterinarian, or permitholder for use on
33 poultry or animals if all the requirements in subdivision
34 (c) are met.
35 (c) (1) No needle or syringe shall be furnished to a
36 person who is unknown to the furnisher and unable to
37 properly establish his or her identity.
38 (2) The furnisher, at the time the furnishing occurs,
39 shall make a record of the furnishing in the manner
40 required by Section 4146.
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AB 518 —6-
1
6w--
1 SEC. 4. Chapter 15 (commencing with Section
2 121340) is added to Part 4 of Division 105 of the Health
3 and Safety Code,to read:
4
5 CHAR'I'ER 15. CLEAN NEEDLE AND SYRINGE ExcHAPdGE
6
7 121340. (a) The Legislature finds and declares that
8 scientific data from needle exchange programs in the
9 United States and in Europe have shown that the
10 exchange of used hypodermic needles and syringes for
11 clean hypodermic needles and syringes does not increase
12 drug use in the population, can serve as an important
13 bridge to treatment and recovery from drug abuse and
14 can curtail the spread of human immunodeficiency virus
15 (HIV) infection among the intravenous drug user
16 population.
17 (b) In order to attempt to reduce the spread of HIV
18 infection and bloodborne hepatitis among the
19 intravenous drug user population within California, the
20 Legislature hereby authorizes a clean needle and syringe
21 exchange pursuant to this chapter in any city and county,
22 county, or city upon the action of a county board of
23 supervisors and the local health officer or health
24 commission of that county, or upon the action of the city
25 council, the mayor, and the local health officer of a city
26 with a health department, or upon the action of the city
27 council and the mayor of a city without a health
28 department.
29 (c) The authorization provided under this section
30 shall only be for a clean needle and syringe exchange
31 project as described in Section 121341.
32 121341. (a) A city and county, or a county, or a city
33 with or without a health department that acts to
34 authorize a clean needle and syringe exchange project
35 pursuant to this chapter shall, in consultation with the
36 State Department of Health Services, authorize the
37 exchange of clean hypodermic needles and syringes, as
38 recommended by the United States Secretary of Health
39 and Human Services, as part of a network of
40 comprehensive services, including treatment services, to
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1
-7— AB 518
1 combat the spread of HIV and blood-borne hepatitis
2 infection among injection drug users. Providers and users
3 of an exchange project authorized by the county, city, or
4 city and county shall not be subject to criminal
5 prosecution for possession of syringes or needles obtained
6 from an exchange project.
7 (b) Each project shall include, but not be limited to, all
8 of the following:
9 (1) The development of a set of operating procedures
10 by the local health officer for the furnishing and exchange
11 of hypodermic needles and syringes for injection drug
12 users and the approval of the operating procedures by the
13 county, city, or city and county.
14 (2) The development of a data base and collection of
15 data relating to the furnishing and replacement of clean
16 hypodermic needles and syringes to injection drug users
17 by persons designated in the operating procedures
18 developed pursuant to paragraph (1). The data collected
19 pursuant to this paragraph shall be reported to the
20 department annually commencing two years after the
21 inception of the project.
2 (3) The provision of community outreach and
23 preventive education that is culturally sensitive and
24 linguistically appropriate to reduce project participants'
25 exposure to HIV infection and blood-borne hepatitis.
26 (4) A demonstrated effort to secure treatment for
27 drug addiction for participants upon their request.
28 (5) The involvement of the community in the
29 development of the program.
30 (6) The involvement of local public safety officials in
31 the development of the program.
32 (7) Accessibility of the project to the target population
33 while being sensitive to community concerns.
34 (8) Appropriate levels of staff expertise in working
35 with injection drug users and adequate staff training in
36 providing community referrals, needle hygiene, and
37 safety precautions.
38 (9) Enhanced treatment capacity, insofar as possible,
39 for injection drug users.
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AB 518 —8-
1
--8-1 (10) Preferential acceptance, insofar as possible, of
2 HIV-infected drug users into drug treatment programs.
3 (c) The projects authorized pursuant to this chapter
4 shall be part of a network of voluntary and confidential
5 HIV services, where available, including, but not limited
6 to, all of the following:
7 (1) Anonymous HIV antibody testing and counseling.
8 (2) Hepatitis screening, counseling, and vaccination.
9 (3) Notwithstanding Section. 121015, voluntary,
10 anonymous, or confidential partner notification.
11 (4) Early intervention and ongoing primary medical
12 care followup for infected persons and their partners.
13 (5) Social services to support families of HIV-infected
14 drug users.
1 (d) Components of the projects authorized pursuant
16 to this chapter shall be assessed as to their effectiveness
17 by the participating city and county, county, or city.
18 Assessment shall include, but not be limited to, the
19 following measures, where they are available:
20 (1) The incidence of HIV among the subject
21 population.
22 (2) Needle exchange rates.
23 (3) Level of drug use.
24 (4) Level of needle sharing.
2 (5) Use of condoms.
26 (6) Availability of needle exchange programs in the
27 jurisdiction.
28 (7) Program participation.rates.
29 (8) The number of participants referred for
30 treatment.
31 (9) The status of treatment and recovery of those
32 entering substance abuse treatment programs.
33 (10) Referrals for HIV, sexually transmitted diseases,
34 and hepatitis screening and treatment.
35 (11) Deferrals for, or provision of, primary medical
36 care.
37 (e) All components of the projects authorized
38 pursuant to this chapter shall be voluntary. Where
39 persons are provided services as a part of a project,
40 including, but not limited to, antibody testing,
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1 counseling, or medical or social services, those provisions
2 of law governing the confidentiality and anonymity of
3 that information shall apply. All information obtained in
4 the course of implementing a project that personally
5 identifies any person to whom needle furnishing and
b exchange services are provided shall remain confidential
7 and shall not be released to any person or agency not
8 participating in the project without the person's written
9 consent.
10 (f) A city and county, county, or city with or without
11 a health department initiating a clean needle and syringe
12 exchange project, shall submit a progress report two years
13 from the project's inception. The report shall take into
14 consideration available data on factors listed in
15 subdivision (d). The report shall be submitted to the
16 director, the Governor, and the chairpersons of both
17 health committees of the Legislature.
0
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