BILL NUMBER: AB 518	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY   APRIL 28, 1999

INTRODUCED BY   Assembly Member Mazzoni
   (Principal coauthor: Assembly Member Shelley)
   (Coauthors:  Assembly Members Aroner,  Hertzberg, 
Keeley, Kuehl, Lempert, Longville, Migden, Romero,  and
Washington)   Steinberg, Washington, Wesson, and
Wiggins) 
   (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   to 
Part 4 of Division 105 of the Health and Safety Code, relating to
AIDS.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 518, as amended, 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 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 OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:


  SECTION 1.  The Legislature hereby finds and declares all of the
following:
   (a) The rapidly spreading acquired immune deficiency syndrome
(AIDS) epidemic, and the more recent spread of blood-borne hepatitis,
pose an unprecedented public health crisis in California, and
threaten, in one way or another, the life and health of every
Californian.
   (b) Injection drug users are the second largest group at risk of
becoming infected with the human immunodeficiency virus (HIV) and
developing AIDS, and they are the primary source of heterosexual,
female, and perinatal transmission in California, the United States,
and Europe.
   (c) According to the State Office of AIDS, injection drug use has
emerged as one of the most prevalent risk factors for new AIDS cases
in California.
   (d) Studies indicate that the lack of sterile needles available on
the streets, and the existence of laws restricting needle
availability promote needle sharing, and consequently the spread of
HIV among injection drug users. The sharing of contaminated needles
is the primary means of HIV transmission within the injection drug
user population.
   (e) As of December 1996, 32 percent of the 573,800 reported cases
of AIDS in the United States were associated with injection drug use.
  Of the 49,764 cases of AIDS presumed to be transmitted through
heterosexual sex, 44 percent of the cases occurred among the sexual
partners of injection drug users.  Of the 6,891 pediatric AIDS cases
related to a mother with or at risk for HIV infection, 59 percent
were related to injection drug use.  The number of reported AIDS
cases reflects only a fraction of the total number of persons
infected with HIV.
   (f) An estimated 5.7 percent, 10.3 percent, and 7.1 percent of
injection drug users entering methadone treatment programs between
1993 and 1994 in Contra Costa, San Francisco, and Alameda Counties,
respectively, were infected with HIV.  Public health officials
generally consider the seroprevalence rates of those entering
treatment to be significantly lower than the true rate of HIV
infection among the injection drug user population as a whole.
   (g) Most injection drug users use a variety of drugs, mainly
heroin, cocaine, and amphetamines.  Because amphetamine- and
cocaine-injecting drug users inject more frequently than heroin
users, their risk for HIV infection is higher.
   (h) Studies of injection drug users in New York, New York; San
Francisco, California; Tacoma, Washington; Boulder, Colorado;
Portland, Oregon; and other cities in the United States indicate that
injection drug users are concerned about AIDS and do change their
behavior when offered, in a nonjudgmental setting, reasonable
strategies to protect themselves.  A UCLA study of prisoners in the
county jail who injected drugs indicated a significant decrease in
needle sharing after the inception of clean needle and syringe
exchange in Los Angeles.
   (i) The United States Secretary of Health and Human Services
announced findings on April 20, 1998, stating that "needle exchange
programs can be an effective part of a comprehensive strategy to
reduce the incidence of HIV transmission and do not encourage the use
of illegal drugs."  Secretary Shalala further stated that "The
science reveals that successful needle exchange programs refer
participants to drug counseling and treatment as well as necessary
medical services, and make needles available on a replacement basis
only."
   (j) California is one of 10 states that criminalizes the
furnishing, possession, or use of hypodermic needles or syringes
without a prescription. Of these 10 states, four have either passed
legislation or waived the prohibition through administrative action
over the last several years to permit the development of needle
exchange programs.  California has the highest seroprevalence rate of
HIV infection of any state that has not waived the prohibition or
adopted a statute to permit needle exchange programs.
  SEC. 2.  Section 4145 of the Business and Professions Code is
repealed.
  SEC. 3.  Section 4145 is added to the Business and Professions
Code, to read:
   4145.  (a) Notwithstanding any other provision of law, the
following persons may, without a prescription or permit, furnish a
hypodermic needle or syringe if all the requirements in subdivision
(c) are met:
   (1) A pharmacist or physician may, without a prescription or a
permit, furnish hypodermic needles and syringes for human use in the
administration of insulin or adrenaline.
   (2) A pharmacist or veterinarian may, without a prescription or
permit, furnish hypodermic needles and syringes for use on poultry or
animals.
   (3) A pharmacist, physician, or other person designated under the
operating procedures developed pursuant to paragraph (1) of
subdivision  (a)   (b)  of Section 121341
of the Health and Safety Code may, without a prescription or permit,
furnish hypodermic needles and syringes when operating a clean needle
and syringe exchange and any person may, without a prescription or a
permit, obtain hypodermic needles and syringes from a program
established pursuant to Chapter 15 (commencing with Section 121340)
of Part 4 of Division 105 of the Health and Safety Code.
   (b) Any person may, without a prescription or permit, obtain
hypodermic needles and syringes from a pharmacist or physician for
human use in the administration of insulin or adrenaline, or from a
pharmacist, veterinarian, or permitholder for use on poultry or
animals if all the requirements in subdivision (c) are met.
   (c) (1) No needle or syringe shall be furnished to a person who is
unknown to the furnisher and unable to properly establish his or her
identity.
   (2) The furnisher, at the time the furnishing occurs, shall make a
record of the furnishing in the manner required by Section 4146.
  SEC. 4.  Chapter 15 (commencing with Section 121340) is added to
Part 4 of Division 105 of the Health and Safety Code, to read:

      CHAPTER 15.  CLEAN NEEDLE AND SYRINGE EXCHANGE

   121340.  (a) The Legislature finds and declares that scientific
data from needle exchange programs in the United States and in Europe
have shown that the exchange of used hypodermic needles and syringes
for clean hypodermic needles and syringes does not increase drug use
in the population, can serve as an important bridge to treatment and
recovery from drug abuse and can curtail the spread of human
immunodeficiency virus (HIV) infection among the intravenous drug
user population.
   (b) In order to attempt to reduce the spread of HIV infection and
blood-borne hepatitis among the intravenous drug user population
within California, the Legislature hereby authorizes a clean needle
and syringe exchange pursuant to this chapter in any city and county,
county, or city upon the action of a county board of supervisors and
the local health officer or health commission of that county, or
upon the action of the city council, the mayor, and the local health
officer of a city with a health department, or upon the action of the
city council and the mayor of a city without a health department.
   (c) The authorization provided under this section shall only be
for a clean needle and syringe exchange project as described in
Section 121341.
   121341.  (a) A city and county, or a county, or a city with or
without a health department that acts to authorize a clean needle and
syringe exchange project pursuant to this chapter shall, in
consultation with the State Department of Health Services, authorize
the exchange of clean hypodermic needles and syringes, as recommended
by the United States Secretary of Health and Human Services, as part
of a network of comprehensive services, including treatment
services, to combat the spread of HIV and blood-borne hepatitis
infection among injection drug users.  Providers and users of an
exchange project authorized by the county, city, or city and county
shall not be subject to criminal prosecution for possession of
syringes or needles  obtained from an exchange project
  during participation in an exchange project  .
   (b) Each project shall include, but not be limited to, all of the
following:
   (1) The development of a set of operating procedures by the local
health officer for the furnishing and exchange of hypodermic needles
and syringes for injection drug users and the approval of the
operating procedures by the county, city, or city and county.
   (2) The development of a data base and collection of data relating
to the furnishing and replacement of clean hypodermic needles and
syringes to injection drug users by persons designated in the
operating procedures developed pursuant to paragraph (1).  The data
collected pursuant to this paragraph shall be reported to the
department annually commencing two years after the inception of the
project.
   (3) The provision of community outreach and preventive education
that is culturally sensitive and linguistically appropriate to reduce
project participants' exposure to HIV infection and blood-borne
hepatitis.
   (4) A demonstrated effort to secure treatment for drug addiction
for participants upon their request.
   (5) The involvement of the community in the development of the
program.
   (6) The involvement of local public safety officials in the
development of the program.
   (7) Accessibility of the project to the target population while
being sensitive to community concerns.
   (8) Appropriate levels of staff expertise in working with
injection drug users and adequate staff training in providing
community referrals, needle hygiene, and safety precautions.
   (9) Enhanced treatment capacity, insofar as possible, for
injection drug users.
   (10) Preferential acceptance, insofar as possible, of HIV-infected
drug users into drug treatment programs.
   (c) The projects authorized pursuant to this chapter shall be part
of a network of voluntary and confidential HIV services, where
available, including, but not limited to, all of the following:
   (1) Anonymous HIV antibody testing and counseling.
   (2) Hepatitis screening, counseling, and vaccination.
   (3) Notwithstanding Section 121015, voluntary, anonymous, or
confidential partner notification.
   (4) Early intervention and ongoing primary medical care followup
for infected persons and their partners.
   (5) Social services to support families of HIV-infected drug
users.
   (d) Components of the projects authorized pursuant to this chapter
shall be assessed as to their effectiveness by the participating
city and county, county, or city.  Assessment shall include, but not
be limited to, the following measures, where they are available:
   (1) The incidence of HIV among the subject population.
   (2) Needle exchange rates.
   (3) Level of drug use.
   (4) Level of needle sharing.
   (5) Use of condoms.
   (6) Availability of needle exchange programs in the jurisdiction.

   (7) Program participation rates.
   (8) The number of participants referred for treatment.
   (9) The status of treatment and recovery of those entering
substance abuse treatment programs.
   (10) Referrals for HIV, sexually transmitted diseases, and
hepatitis screening and treatment.
   (11) Referrals for, or provision of, primary medical care.
   (e) All components of the projects authorized pursuant to this
chapter shall be voluntary.  Where persons are provided services as a
part of a project, including, but not limited to, antibody testing,
counseling, or medical or social services, those provisions of law
governing the confidentiality and anonymity of that information shall
apply.  All information obtained in the course of implementing a
project that personally identifies any person to whom needle
furnishing and exchange services are provided shall remain
confidential and shall not be released to any person or agency not
participating in the project without the person's written consent.
   (f) A city and county, county, or city with or without a health
department initiating a clean needle and syringe exchange project,
shall submit a progress report two years from the project's
inception.  The report shall take into consideration available data
on factors listed in subdivision (d).  The report shall be submitted
to the director, the Governor, and the chairpersons of both health
committees of the Legislature.