SB 235

This bill would establish the Alabama Injection-Associated Infectious Disease Elimination Act

This bill would authorize the Department of Public Health and local health authorities to establish injection-associated infectious disease elimination pilot programs in certain counties

This bill would provide guidelines for injection-associated infectious disease elimination pilot programs

This bill would also provide criminal and civil immunity to certain individuals and entities to facilitate and encourage participation in infectious disease elimination programs

Relating to infectious diseases; to create the Alabama Injection-Associated Infectious Disease Elimination Act; to authorize the Department of Public Health or local health authorities to establish injection-associated infectious disease elimination pilot programs in certain counties; to provide guidelines for injection-associated infectious disease elimination pilot programs; and to provide criminal and civil immunity to certain individuals and entities to facilitate and encourage participation in infectious disease elimination programs.

Section 1

This act shall be known and may be cited as the Alabama Injection-Associated Infectious Disease Elimination Act.

Section 2

The Legislature finds each of the following: (1) Heroin use and other injection drug use is at a 20-year high. (2) The epidemic of opioid misuse and addiction has led to increased numbers of people who inject drugs, placing new populations at increased risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Rural and nonurban areas with limited HIV and HCV prevention and treatment services or substance use disorder treatment services, traditionally areas at low risk for HIV and HCV, have been disproportionately affected. (3) Sharing needles, syringes, and other injection drug use equipment is a direct route of transmission for both HIV and HCV, as well as some other infections. Persons of all ages who do not misuse, abuse, or inject heroin, opioids, or other drugs may nevertheless be exposed to and contract injection-associated infectious diseases including, but not limited to, HIV and HCV. (4) Alabama continues to see new cases of HIV, with 672 newly diagnosed in 2016, bringing the total number of individuals living with HIV in Alabama to at least 13,437. Injection drug use accounts for at least nine percent of all cases of HIV in Alabama. (5) Cases of acute HCV in Alabama increased 360 percent in the period from 2010 to 2016, and most new cases are related to injection drug use. (6) There were 836 confirmed drug overdose deaths in Alabama in 2017, a 44 percent increase from 2013. (7) Several counties in Alabama share characteristics with Scott County, Indiana, which experienced a major outbreak of HIV and HCV in late 2014 and early 2015 directly related to injection drug use brought on by the epidemic of prescription opioid misuse and abuse. Other counties in Alabama may be at risk based on the number of drug overdose deaths and overdose reversals by emergency responders. (8) The lifetime treatment cost of an individual living with HIV is conservatively estimated at three hundred eighty thousand dollars ($380,000), and the average treatment cost for an individual who contracts HCV is approximately eighty thousand dollars ($80,000). The estimated lifetime cost of treating all the people infected in the 2014-15 Scott County, Indiana, outbreak was seventy million dollars ($70,000,000). (9) Injection-associated infectious diseases such as HIV and HCV can also be contracted accidentally by health care providers, law enforcement officers, first responders, other emergency personnel, sanitation workers and other individuals, including members of the general public, through needle stick injuries.

Section 3

As used in this act, the following words shall have the following meanings: (1) CONTROLLED SUBSTANCE. The term as defined in Section 20-2-2, Code of Alabama 1975. (2) DEMONSTRATED NEED. Experiencing or at risk for a significant increase in infectious disease due to factors including, but not limited to, those identified by the federal Centers for Disease Control and Prevention (CDC). (3) INDIVIDUAL WHO INJECTS DRUGS. An individual who uses a syringe or hypodermic needle to inject a controlled substance into the individual's own body. (4) INFECTIOUS DISEASE. A disease that may be spread by intentional or unintentional needle sticks, including, but not limited to, the Human Immunodeficiency Virus and the Hepatitis C Virus. (5) LOCAL HEALTH AUTHORITY. A county board of health constituted under Section 22-3-1, Code of Alabama 1975. (6) PROGRAM. An injection-associated infectious disease elimination pilot program established pursuant to

Section 4

(7) PROGRAM PARTICIPANT. An individual who injects drugs and who is an active registered participant in a program and who is provided an official certificate card from a program.

Section 5

(a) The Department of Public Health or a local health authority may establish and operate injection-associated infectious disease elimination pilot programs in counties identified to have a demonstrated need, either directly or through an agreement with an outside organization that promotes scientifically proven ways of mitigating health risks associated with controlled substance use and other high-risk behaviors. The duration of a pilot program shall be no more than three years, except as provided in subsection (g). The objectives of the program shall include all of the following: (1) Reduce the spread of the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV), and other injection-associated infectious diseases in the state. (2) Reduce the risk of infectious diseases from needle stick injuries to health care providers, law enforcement officers, first responders, other emergency personnel, sanitation workers, and the general public. (3) Encourage individuals who inject drugs to enroll in evidence-based treatment for substance use disorder. (b) Programs established pursuant to this section, at a minimum, shall do all of the following with respect to the program's operation and its participants: (1) Safely dispose of used needles, hypodermic syringes, and other injection supplies. (2) Provide needles, hypodermic syringes, and other injection supplies at no cost and in quantities sufficient to reduce sharing or reuse of needles, hypodermic syringes, and other injection supplies; provided, however, that state funds may not be used to purchase needles, hypodermic syringes, or other injection supplies. (3) Provide educational materials on each of the following: a. Overdose prevention. b. Prevention of infectious diseases. c. Drug abuse prevention. d. Treatment for mental illness, including treatment referrals. e. Treatment for substance abuse, including referrals for medication assisted treatment. (4) Provide access to naloxone kits that contain naloxone hydrochloride, or equivalent, that is approved by the federal Food and Drug Administration (FDA) for the treatment of an opioid drug overdose, or referrals to programs that provide access to naloxone hydrochloride, or equivalent, that is approved by the FDA for the treatment of an opioid drug overdose. (5) For each individual requesting service under the program, provide personal consultations from a program employee or volunteer concerning mental health or substance use disorder treatment as appropriate. (6) Encourage each individual who injects drugs to seek appropriate medical, mental health, or social services. (7) Use a recordkeeping system that ensures the identity of each individual who injects drugs remains anonymous. (8) Notify relevant local law enforcement agencies regarding the program, including information on the limited immunity from criminal liability granted by subsection (e). (9) Provide an official certificate card to each individual served by the program so law enforcement personnel, employees, and volunteers of the program can quickly identify the individual. This certificate card shall also serve as proof of the limited immunity from criminal liability granted by subsection (e), and shall bear relevant information produced according to standards to be issued by the Department of Public Health or local health authority. (10) Provide emergency medical care or referrals for program participants in need of immediate medical attention at the time they receive services through the program. (11) Comply with applicable state and federal rules and regulations governing participant confidentiality. (c)(1) Before a program in an incorporated area may begin operating, it must receive written approval endorsed by a publicly recorded vote of the incorporated area's governing body, such as a city council. (2) Before a program in an unincorporated area of a county can begin operating, it must have received the written approval, endorsed in a public, recorded vote, of the county commission for that county. (3) Consent by the incorporated area's local governing body or the county commission shall not be required if there exists a Public Health Emergency, as declared by the Governor pursuant to Section 31-9-8, Code of Alabama 1975, the Alabama Emergency Management Act of 1955 due to an injection-associated outbreak of infectious disease or overdose deaths that includes the county in which the program is being established. (d)(1) Before establishing a program, the following interested parties in the area to be served shall be consulted: a. Law enforcement representatives. b. Prosecutors. c. Representatives of substance use disorder treatment facilities certified by the Department of Mental Health. d. Individuals who inject drugs and individuals in recovery from substance use disorder, to the extent practicable. e. Nonprofit organizations focused on HIV, HCV, substance use disorder, and mental health, to the extent practicable. f. Residents of the geographical area to be served by the program, to the extent practicable. (2) When consulting with interested parties, the program is encouraged to consider the following: a. The population to be served. b. Concerns of law enforcement representatives and prosecutors. c. Day-to-day administration of the program, including security of program sites, equipment, personnel, and use of volunteers. (e)(1) a. An individual who injects drugs and who is an active participant in a program and in possession of an official program certificate card is granted immunity from and shall not be subject to criminal prosecution or liability under Sections 13A-12-202, 13A-12-203, 13A-12-204, 13A-12-205, 13A-12-212, 13A-12-260, or 13A-12-281, Code of Alabama 1975, arising from possession or use of a needle, hypodermic syringe, or other injection supply obtained from a program established pursuant to this section, or arising from a used needle or hypodermic syringe containing residual amounts of a controlled substance from being returned for disposal to a program established pursuant to this section. b. The immunity provided in this subsection shall apply to an individual who injects drugs and who is an active program participant only if the individual claiming immunity provides an official certificate card stating that the individual is or was an active participant in a program at the time the act for which immunity is sought was committed. Provision of the card at any point from initial contact with a law enforcement officer and throughout the judicial process, shall immediately create a presumption that the person is immune from criminal liability as provided in this subsection. (2) In addition to any other applicable immunity from civil liability, a law enforcement officer who arrests or charges a person who is thereafter determined to be entitled to immunity from prosecution under this subsection shall not be subject to civil liability for the arrest of, or the filing of charges against, the person, unless the card was provided to the officer prior to the arrest or prior to charging the person under circumstances where there could be no reasonable doubt that the card provided was legitimate, and unless the circumstances faced by the officer during the encounter created no reasonable fear of risk to the safety of the officer, fellow officers, the person, or other individuals present at the time of the encounter, or the public at large. (3) a. Any officer, employee, or agent of, or volunteer for, the Department of Public Health or a local health authority or a program, profit or nonprofit, including, but not limited to, any licensed physician or other health care provider or health care facility, participating in, contributing funds or other assistance to, conducting activities in conjunction with, providing consultations, emergency care, referrals, education, needles, hypodermic syringes, other injection supplies, or any other materials, in accordance with the program shall be immune from criminal prosecution and liability, as a result of participation, affiliation, association, contribution, assistance, conduct, consultation, or provision of emergency care, referrals, education, needles, hypodermic syringes, other injection supplies, or any other materials. b. The immunity from criminal liability, including vicarious liability, provided in this act shall also extend to the members of any local health authority establishing, sponsoring, operating, or administering a program. It is the express intention of this act that the employees, officers and agents of the state be provided immunity for personal injury, damage to or loss of property, or other civil liability caused or arising out of, or in relation to, an actual or alleged act, error or omission that occurred in relation to or in conjunction with the program in accordance with Section 36-1-12 of the Code of Alabama 1975. This section expressly incorporates Section 36-1-12 of the Code of Alabama 1975, and neither expands nor limits the protections provided under that section. Nothing in this section shall be deemed to impair, derogate, or otherwise limit any other immunity of any person or entity under constitutional, statutory, or common law. (f) Not later than one year after commencing operations of a program established pursuant to this section, and every 12 months thereafter, each local health authority operating such a program, either directly or through agreement with an outside organization, shall report the following information to the Department of Public Health: (1) The number of individuals served by the program. (2) The number of needles, hypodermic syringes, and other injection supplies dispensed by the program, and a weight-based estimate of those returned to the program. (3) The number of naloxone kits, or equivalent, distributed by the program or the number of referrals made to programs that provide access to naloxone kits, or equivalent. (4) The number and type of substance abuse treatment referrals, including referrals for medication assisted treatment, provided for individuals served by the program. (5) The number and type of medical, mental health, and social services referrals provided to individuals served by the program. (g) Program operations may extend beyond an initial three-year pilot stage if the Department of Public Health or local health authority determines there to be continued demonstrated need. (h) Nothing in this act shall be construed to establish a standard of care for physicians or otherwise modify, amend, or supersede any provision of the Alabama Medical Liability Act of 1987 or the Alabama Medical Liability Act of 1996, commencing with Section 6-5-540, et seq., Code of Alabama 1975, or any amendment thereto, or any judicial interpretation thereof.

Section 6

This act shall become effective immediately following its passage and approval by the Governor, or its otherwise becoming law.