Part Five: Stanislaus County Department of Health - Case 08-27

Hepatitis C is the second most frequently transmitted communicable disease within Stanislaus County. Calendar year 2008 has started with 155 cases the first quarter, indicating that an annualized number of 620 cases could be reported, which is up from the previous year. New cases of Hepatitis C are projected to be identified at the rate of 11.9 per week for 2008.

The most effective prevention strategy against Hepatitis C among injection drug users is the employment of a sterile syringe and needle for each injection.

According to the Stanislaus County Health Services Agency, “Table 9. Mode of exposure 2007 Hepatitis C cases in Stanislaus,” of the 519 cases identified, 69.4% did not know how they got the disease, 16.4% acquired it through injection drug use, and the remainder through other means.

Currently there are no vaccines available against Hepatitis C or HIV.

According to testimony, in a recent study in Stanislaus County, 25% of those tested at drug treatment programs tested positive for Hepatitis C.

Further, 33.4% of reported HIV/AIDS cases in Stanislaus County were related to injection drug use.

Injection drug users become infected by and transmit blood-borne pathogen disease viruses to others primarily through sharing contaminated syringes.

The National Institutes of Health estimates that in the United States, at least seventy percent (70%) of injection drug users have Hepatitis C and between fifteen and twenty percent (15%-20%) have HIV. Harm Reduction Factors

According to the HIV Prevention Bulletin issued by the US Department of Health and Human Services, Centers for Disease Control, Health Resources and Services Administration (HRSA), National Institute on Drug Abuse, (NIDA), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Morbidity and Mortality Weekly Report of the Center for Disease Control, November 9, 2007, persons who inject drugs should use sterile syringes to prevent the transmission of HIV.

Syringes and equipment are shared for many reasons, but primarily because legal barriers have limited the access to sterile syringes. Removing legal sanctions against syringe possession would encourages proper disposal of dirty syringes through a legal syringe exchange program

In a syringe exchange program, a used syringe is required in exchange for a new syringe, thereby enabling the proper disposal of dirty syringes and not increasing the number of syringes circulating in the county.

Harm reduction strategies, such as allowing legal syringe exchange programs, reduce the spread of Hepatitis C and other blood-borne pathogens to law enforcement officials, health care providers, family members, newborn infants, and uninfected injection drug users.

Outreach projects associated with syringe exchange programs provide introductions to early medical treatment for other problems affecting injection drug users. Services offered include risk reduction behavior counseling, housing programs, recovery programs, job placement, and referrals to related services.

Safe community disposal of used syringes is a significant public health issue. A legal syringe exchange program would reduce the spread of Hepatitis C and HIV/AIDS among people, their sexual partners, their children, law enforcement officials, health care providers, sanitation workers and others exposed to discarded syringes in Stanislaus County. Cost factors and related budget savings

HIV/AIDS patients are among the most expensive patients in the public health system. The direct lifetime medical cost for an HIV/AIDS patient from the time of diagnosis until death is estimated to be between $144,000 and $600,000.

The direct lifetime medical cost of a Hepatitis C patient is estimated to be $100,000. If a liver transplant is needed the additional cost would be at least $300,000.

The estimated costs of treatment of Hepatitis C and HIV do not include the social implications of lost wages, disability benefits, unemployment or the fiscal impact of lost tax revenue and Social Security contributions.

A clean syringe costs pennies compared to the lifetime medical and social costs of caring for chronically ill patients.

The 2007 budget for the Fresno syringe exchange program, a private enterprise, was $47,000. None of its budget was subsidized by Fresno County. It was funded by grants and donations.

A study titled Science-based literature on Syringe Exchange Programs (SEPs) 1996- 2007, dated October 2007, by Joanna Berton Martinez, reveals the following information: SEPs reduce HIV transmission SEPs do increase enrollment in drug treatment programs SEPs do reduce risky behaviors and injection drug use SEPs do not promote substance abuse.

Syringe exchange programs do not encourage the use of injection drugs and do not increase criminal activity. Enabling Legislation

Assembly Bill 547, Berg, was signed by Governor Schwarzenegger and went into effect January 1, 2006. The bill amends previous legislation (AB 136, Mazzoni) to allow counties and cities to authorize syringe exchange programs in their jurisdictions without the necessity to declare a state of local emergency. The purpose of AB 547 is to simplify the procedure for syringe exchange program authorization in order to encourage the integration of syringe exchanges into Hepatitis C and HIV prevention efforts throughout the State of California.

Five years ago, AB 136 was signed into law, creating Health and Safety Code Section 11364.7(a). The law reads, in part: “No public entity, its agents, or employees shall be subject to criminal prosecution for distribution of hypodermic needles or syringes to participants in clean needle and syringe exchange projects authorized by the public entity pursuant to a declaration of a local emergency due to the existence of a critical local public health crisis.” Health and Safety Code Section 11364.7(a) protected local government organizations, their employees, and authorized subcontractors in local health jurisdictions that declared a local health emergency from criminal prosecution for distribution of syringes. The requirement to declare a local emergency has been rescinded by AB 547. Support for Syringe Exchange Programs

The Stanislaus County Civil Grand Jury finds that there is considerable support for syringe exchange programs and for AB 547. National organizations in support of syringe exchange programs include the following: American Bar Association American Medical Association American Academy of Pediatrics American Nurses Association American Public Health Association American Pharmaceutical Association American Psychological Association American Red Cross Council of State and Territorial Epidemiologists 7 National Black Caucus of State Legislators National Black Police Officers Association National Alliance of State and Territorial AIDS Directors National Association of State Alcohol and Drug Abuse Directors U.S. Conference of Mayors U.S. Government Accounting Office Health & Human Services National Institute on Drug Abuse

California supporters of AB 547 and syringe exchange programs include: Health Officers Association of California California Chapter, National Association of Social Workers California Narcotic Officers’ Association California Medical Association California Peace Officer’s Association California State Association of Counties County Alcohol and Drug Program Administrators Association of California County Health Executives Association of California

Stanislaus County supporters of AB 547 and a syringe exchange program include: Advisory Board for Substance Abuse Programs of Stanislaus County Hepatitis C Coalition of Stanislaus County Local Implementation Group of Stanislaus County