San Mateo County is one of California’s counties that has enacted Senate Bill 1149 authored by Sen. John Vasconcellos, D-Santa Clara, that was passed in 2004 and enacted Jan. 1, 2005, by Gov. Arnold Schwarzenegger. The law allows participating pharmacies to sell up to 10 syringes at a time to anyone over 18 without requiring a prescription or identification.
It was enacted to help prevent the spread of blood-borne illnesses and other health-related risks to those who are and can become exposed to contaminated syringes.
California was one of the last states to require a prescription to purchase syringes. California's program is unique in that each local health jurisdiction must approve over-the-counter syringe sales before pharmacies can opt-in.
The National Drug Alliance of New Jersey website said the programs “provide injection drug users with referrals to drug treatment, detoxification, social services, and primary health care.”
Syringe exchange programs are different from pharmacies in that they provide syringes on a confidential one-on-one basis, free of cost, and safely dispose of contaminated syringes. Rachel Anderson of Sacramento Area Needle Exchange said her program gives out syringes, disinfectant wipes and condoms.
On the flipside, while syringe exchanges usually operate about 20 hours a week, pharmacies that provide nonprescription syringes are usually open seven days a week and have flexible hours, making access to clean syringes more accommodating.
Unlike most syringe exchanges, pharmacies also offer treatment options and contact information for counseling services at no cost to the patron, but the syringes do come with a 50 cent price tag per syringe.
Ricky Bluthenthal, a senior social scientist with the RAND Corporation and sociology professor at California State University, Dominguez Hills, said the cost of paying for syringes – that would otherwise be free through a syringe exchange program – could inhibit the effectiveness of SB 1159.
“In a study of needle exchange participants statewide, we found half are homeless,” Bluthenthal said. “If you can't pay to have a roof over your head, you're probably not going to pay for syringes.”
SB 1159 has also received some criticism from opponents like the California Narcotics Officers Association for not requiring an even exchange of dirty syringes for clean ones, which they claim puts more syringes on the streets and increases the potential for accidental needle sticks.
According to the Los Angeles County Department of Public Health and Public Health Policy, potential victims of improperly disposed syringes, aside from intravenous drug users, include: waste management workers, law enforcement officials, maintenance personnel and children.
“Even after use, needles and syringes may still puncture the skin and potentially spread germs and diseases, such as hepatitis, HIV, tetanus and syphilis,” the department said on its website.
“‘Needle-stick’ injuries are a preventable health risk,” the department said. “Injuries resulting from improper disposal may demand expensive testing, cause long-term emotional stress and increase the risk of exposure to infectious diseases.”
Researcher Thomas Stopka, who has worked with the California Department of Public Health, Office of AIDS for six years said that, so far, data does not suggest that there has been an increase in improper syringe disposal.
Although the research is still ongoing, Stopka said that in metropolitan cities like San Francisco and Los Angeles, researchers have actually reported a lower number of syringes on the streets since SB 1159's implementation.
An evaluation on the effects of SB 1159 is currently in the process of being prepared by the Department of Public Health and will include an in-depth look at five specific “outcomes” of concern: injection drug use rates, syringe disposal, HIV and hepatitis C rates, the occurrence of accidental needle sticks, and the incidence of crime as a result of the bill's implementation.
The report will be released in January 2010 – the same year the law will either expire or be renewed by the governor.
The California Narcotics Officers Association claims that an increase in crime is one of their major concerns about the legitimacy of SB 1159.
Stopka, who is one of the lead researchers for the law's evaluation, said that although they have yet to conduct systematic analyses the correlation between crime rates and nonprescription syringe sales, “some other states have done analyses and they didn’t see any increase in crime around pharmacies.”
The California Narcotic Officers Association, however, isn't quite as positive about the bill's potential effects.
John Lovell, legal counsel for the California Narcotic Officers Association, said, “There’s no benefit to the bill.”
“Needle programs only work when there is supportive social infrastructure,” Lovell said. “You can’t be stupid about this. You have to have oversight, and you have to have responsibility.”
Lovell said not only is there is no way the law could be improved, but it has also made no impact on the intravenous drug community.
“Nothing's changed. You have the same number of IV drug users you had as before. We would just like to see this bill expire. We think 1159 is beyond repair.”
Keith Hocking, deputy director of the Programs and Services for the San Francisco AIDS Foundation, disagrees.
“Slowly but surely we see the amount of syringes we exchange go down,” Hocking said. “I do know it's had some impact on the amount of syringes we exchange, but there are a number of variables.”
Glen Backes, former director of the Drug Policy Alliance and current freelance researcher studying the implications of SB 1159, said the law doesn’t have a downside. “The opposition is based on belief and not research,” he said.
For now, both sides will have to wait until the comprehensive 2010 evaluation before anything can be proven conclusively.