Promoting a Health Approach to Drugs
Preventing HIV and Hepatitis C by Expanding Access to Sterile Syringes
Sterile syringe access is one of the most effective HIV and hepatitis C prevention tools we have. Sterile syringes help prevent transmission of blood-borne diseases such as HIV and hepatitis C among people who inject drugs, their sexual partners, and their children. There is overwhelming support in the medical and public health community for syringe access, and study after study has shown its benefits.
DPA has led the efforts to increase syringe access for more than 15 years in California. In 2011 we won a pair of victories that substantially increased syringe access across the whole state and in 2014 we are working to extend those victories.
AB 1743, introduced by Assemblymember Phil Ting (D- San Francisco), is our bill to expand and protect pharmacy access to syringes. We are co-sponsoring it with the San Francisco AIDS Foundation. This bill is designed to build on our 2011 victory, when SB 41, authored by Senator Leland Yee, expanded syringe access by allowing pharmacies throughout the state to sell syringes without a prescription. Before it passed, California was one of the last three states in the U.S. to prohibit a pharmacist from furnishing a syringe to an adult without a prescription. As of January 1, 2012, any pharmacy in California could sell an individual up to 30 syringes without a prescription. The law also creates protections from prosecution for any individual carrying up to 30 syringes that they obtained from a legal source, such as a syringe access program, pharmacy or clinic. Unfortunately, the 2011 law was written to expire December 31, 2014. AB 1743 will make the program permanent and lift the restriction on the amount of syringes.
Our other recent syringe access victory was AB 604, authored by Assemblymember Nancy Skinner, which was signed into law in 2011. It enables the California Department of Public Health (CDPH) to authorize health and social service programs to provide syringe exchange services in any location where the department determines that the conditions exist for the high transmission rates of HIV, viral hepatitis or any other potentially deadly or disabling infections that are spread through the sharing of used syringes. CDPH is in the process of implementing that law.
Get more information on syringe access in California.
Preventing Overdose Deaths
Drug overdose is now the leading cause of accidental death in California, as it is in much of the United States. More people will die this year in California of a drug overdose than a car accident. Many overdoses are reversible and survivable if the individual gets medical assistance in time. DPA is working with our allies to increase access to naloxone, the generic medication used to reverse opiate overdose.
In 2014 we are working with Assemblymember Richard Bloom (D- Santa Monica) to pass a bill to allow pharmacists to furnish naloxone, the antidote to opiate overdose, to family members of people who use drugs and patients who are at risk of an overdose (pursuant to protocols to be developed by the California Board of Medicine and Board of Pharmacy). The pharmacist will be required to counsel the individual or family member on overdose prevention, recognition, the safe administration of naloxone, its potential adverse effects, and the urgency of seeking emergency medical care. We are co-sponsoring this bill with the California Pharmacists Association.
In 2013, our allies at the Harm Reduction Coalition ran a successful campaign to increase access to naloxone by removing some of the legal and liability barriers to broader distribution. Their bill, AB 635, which we strongly supported, passed with bipartisan support and was signed into law. It addressed 3rd party prescriber liability and collaborative practice agreements. Its implementation has already led to new naloxone education programs and access to naloxone in counties that previously had none.
One of the most common reasons people cite for not calling 911 when they witness an overdose is fear of police involvement and criminal punishment for themselves or their friends. That’s why DPA took the lead in successfully passing California’s 911 Good Samaritan law, which can help prevent many of these needless overdose deaths by encouraging witnesses of drug overdoses to call 911. It provides limited immunity from arrest and prosecution for low-level drug law violations to individuals under the influence, or in possession of drugs for personal use or drug paraphernalia, if they seek medical attention to save the life of someone experiencing an overdose. The law took effect on January 1, 2013 and DPA is now working with our allies to spread the word about the new law.
Increasing Access to Effective Treatment
Health-based approaches – including harm reduction services and a range of effective drug treatment programs – are more appropriate, effective and fiscally responsible responses to drug use than the punitive approach that currently dominates U.S. drug policy. We work to support health insurance coverage for drug treatment on par with the coverage of treatments for other chronic health conditions; we work to identify federal and state funding sources for community-based treatment (including Byrne Justice Assistance Grants); and we work to eliminate barriers to treatment and recovery, including drug arrest and incarceration practices.
Too many people in California who want treatment for problematic substance use are unable to access it. The combination of increased access to health insurance under the Affordable Care Act (ACA) and the requirement for parity in mental health and substance use treatment under the Mental Health Parity and Addiction Equity Act have the potential to enable more Californians who want treatment to get it, including access to methadone and buprenorphine. DPA is committed to ensuring that health care expansion increases coverage for evidence-based treatment for problematic substance use.
DPA believes that treatment is an effective and compassionate alternative to incarceration for people convicted of drug law violations who also struggle with problematic drug use. In 2000, DPA wrote and spearheaded the campaign to pass Proposition 36, the Substance Abuse and Crime Prevention Act, the state’s landmark treatment-instead-of-incarceration law that has diverted more than 300,000 people from jail and prison and saved the state more than $2.5 billion in just ten years. This program is a significant step toward a health-based approach to drug use, but reform must go farther – so that no one enters the criminal justice system simply for using or possessing drugs, and so that treatment and other health interventions are much more widely available in the community and through the healthcare system. In 2008, DPA supported Proposition 5, which would have significantly expanded treatment opportunities in California, but the measure failed to pass.
Supervised Injection Facilities
Supervised injection facilities (SIFs) are legally sanctioned health care settings where people who use drugs can inject pre-obtained drugs under clinical supervision. SIFs are designed to reduce the health and societal problems associated with injection drug use. Extensive research has found that they can reduce HIV and hepatitis C transmission, stop overdose deaths, reduce public drug use, and increase access to primary medical care and treatment. DPA’s efforts to establish a SIF in San Francisco began in 2007, when DPA and the Alliance for Saving Lives held a well-attended symposium on the topic. DPA is committed to educating elected officials on the benefits of SIFs, building public support, and working with organizations like the San Francisco Drug Users’ Union to make the idea a reality in San Francisco. There are currently 92 SIFs operating in 62 cities around the world – but none in the U.S.