California lawmakers are mulling whether to extend or expand a state program allowing over-the-counter sales of syringes without a prescription to curb the spread of HIV, hepatitis and other diseases.
Without action, such sales will become illegal at this year's end -- and public health authorities suggest that could be a deadly tragedy.
The current law, signed by Gov. Arnold Schwarzenegger in 2004, lets counties choose whether to let pharmacists sell up to 10 syringes to someone without a prescription; it also makes an exception to drug-paraphernalia laws to allow possession of up to 10 syringes if acquired through an authorized source. Every greater Bay Area county except Napa chose to take part in this Disease Prevention Demonstration Project. Contra Costa was first in December 2004, and Santa Clara was last in January 2006.
"Our Board of Supervisors stepped up to the plate the month before the legislation went into effect and hats off to them, that was very forward-thinking," said Christine Leivermann, AIDS Program Director in the Contra Costa Health Department's Public Health Division.
"We have seen over time downward trends in the number of new AIDS cases attributed to injected drug use" as well as reduced cases of hepatitis C, she said, and while nobody can definitively attribute all of that to needle access, "certainly having access to clean needles has helped reduce the transmission of blood-borne diseases, so we need something."
AB 1701 by Assemblyman Wes Chesbro, D-Arcata, would extend the existing law for eight more years, still leaving it to city councils or county supervisors to decide whether to opt in and let pharmacies choose to take part. The Assembly passed this bill April 5 on a 49-27 vote, and the state Senate Health Committee approved it last month on a 6-1 vote; it's now pending before the Senate Appropriations Committee.
SB 1029 by state Sen. Leland Yee, D-San Francisco, would permanently give all California pharmacists discretion to sell and give adults the right to possess up to 30 syringes to adults without a prescription. The state Senate passed Yee's bill on a 21-8 vote May 28; the Assembly Health Committee and Business, Professions and Consumer Protection Committee passed it in June; and it's now pending before the Assembly Appropriations Committee.
All votes on both bills basically have been along party lines with Democrats in favor and Republicans opposed; state Sen. Lou Correa, D-Santa Ana, crossed the aisle to vote with Republicans against Yee's bill. Republicans expressed concerns that Yee's bill would replace local control with a one-size-fits-all, top-down approach, and that it doesn't specify how often someone could buy 30 syringes -- each day, perhaps.
Leivermann said she has no opinion on which bill is better, but Glenn Backes, a public policy consultant to the Drug Policy Alliance and the California Hepatitis Alliance, said Yee's bill would cut costs and widen access.
"Basically, if it is good policy for the residents of Bay Area counties, then it is good policy for the residents of Central Valley counties," Backes said. "Especially given that the indigent ill are a burden on all taxpayers, a burden on the state general fund, no matter where they reside in the state. Allowing adults to spend their own money to protect their health and the health of others is the only proven way to reduce the rate of HIV and hepatitis without spending a dime of city, county or state money."
The most recent legislative analysis shows the California Medical Association, the California Pharmacists Association, the California Psychiatric Association, the Republican Liberty Caucus, the Alameda County Board of Supervisors and many other groups support Yee's bill, with no opponents on record.
The existing law required the state Department of Public Health to evaluate the pilot program's effects and report back to the Governor and Legislature by Jan. 15 of this year. Finally released just last week, the report found syringe-sharing is rarer in places that opted into the program, and there's no evidence the program has caused drug use or crime to rise. Accidental needle-stick injuries to law enforcement officers remain rare with no difference between areas that do and don't take part in the program, the report found, and there's been no rise in unsafely discarded syringes.
But more time is needed to see whether the program has reduced HIV infection rates, the report said. The state's HIV infection tracking system dates back only a few years, and though its tracking of AIDS cases began in 1993, the long incubation period between HIV infection and AIDS diagnosis makes that an unreliable way to measure the effect of prevention measures in place for less than a decade.
The state report says the two-step opt-in process for legalizing over-the-counter syringe sales -- first at the county or city level, then by each pharmacy -- limits the program's benefits while spawning inconsistency and confusion over what's legal where. Leaving implementation to local governments' discretion "could require more time and commitment than some already overburdened health departments can handle," it said, suggesting that deleting this from future laws "could provide better access to this important prevention intervention."
Kabir Hypolite, director of the Alameda County Public Health Department's Office of AIDS Administration, basically agreed, framing clean needle availability as one of the few successful means of reducing HIV transmission. "These are critical programs."
Although he hasn't read the Chesbro and Yee bills, he said, "I know that Mr. Yee is a very responsible legislator and he represents San Francisco which also has been dealing with this epidemic for a very long time, so I would have confidence in his approach."
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