[HISTORY: Adopted by the Department of Health of Allegheny County 5-2-2007 as Rule and Regulation Article II; approved and adopted by the County Council 2-5-2008 by Ord. No. 4-08. Amendments noted where applicable.]
The Allegheny County Health Department finds the sharing of intravenous injection apparatus among injecting drug users a threat to public health. Sharing injection apparatus is a significant factor in the transmission of infectious diseases, including HIV and Hepatitis B and C. Providing clean injection apparatus and biohazard containers through a sanctioned needle exchange program, educating injecting drug users as to the dangers of sharing injection apparatus and continued drug abuse, and providing condoms to prevent sexual transmission of infectious diseases have been shown to reduce the incidence of infectious disease transmission among injecting drug users. Repeated offerings of drug rehabilitation services have also been demonstrated to increase the likelihood that injecting drug users will enter treatment and, through one or more attempts, become drug-free.
The regulation of needle exchange programs is necessary to assure that the distribution of clean injection apparatus and biohazard containers is carried out in a manner consistent with the goal of preventing infectious disease transmission among injecting drug users, and to encourage the provision of the greatest number of treatment and prevention strategies possible, with the ultimate goal of reducing the incidence of HIV and Hepatitis B and C among injecting drug users, their sexual partners, and their offspring. Such prevention will promote the health, safety and welfare of the community.
The provisions of this chapter will become effective 10 days after the enactment date of an ordinance of Allegheny County approving its provisions.
The following terms, when used in this chapter, have the meanings indicated in this section, except where the context indicates a clearly different meaning:
- BIOHAZARD CONTAINERS
- Approved, limited-access, puncture-proof receptacles to be used for the safe storage of used needles or sharps.
- BOARD OF HEALTH
- The Allegheny County Board of Health.
- The Allegheny County Health Department.
- The Director of the Allegheny County Health Department or his or her authorized representative.
- INFECTIOUS DISEASE SCREENING or IDS
- Testing blood or other tissue for HIV and Hepatitis B and C, by a Clinical Laboratory Improvement Amendments (CLIA) approved method.
- INJECTION APPARATUS
- Syringes, needles, and alcohol wipes.
- KEY INDIVIDUALS
- Individuals with actual authority over the day-to-day operations of needle exchange programs.
- NEEDLE EXCHANGE PROGRAM
- A public or private enterprise with the goal of reducing the incidence of infectious disease transmission among program participants, their sexual partners, and their offspring, approved by the Board of Health, through the provision of education on safe practices, counseling opportunities, clean injection apparatus, biohazard containers, and condoms or other barrier methods of preventing sexually transmitted diseases.
- Any natural person, corporation, partnership or association.
- PROGRAM LOCATION
- The specific address at which a needle exchange program provides any materials or services to any program participant(s), whether inside a building or at a temporary facility, including but not limited to tents, outdoor tables, or mobile facilities.
- PROGRAM PARTICIPANT
- Any individual receiving services, materials, or referrals from a needle exchange program.
The Department shall, subject to the approval of the Board of Health, devise operating procedures of needle exchange programs in Allegheny County, Pennsylvania. The Board shall not approve or alter any operating procedure without providing written notice of the new procedure(s) to the Allegheny County Council and Chief Executive at least 30 days prior to the Board's vote.
The Board of Health shall review each proposal for a needle exchange program and, upon approval, shall forward written copies of all materials pertaining to approved proposals to the County Chief Executive and Council, and to the Mayor and Council or, if applicable, Commissioners of each municipality where a needle exchange program is proposed at least 90 days before the program proposes to begin operations.
Persons wishing to create and operate needle exchange programs shall submit to the Board of Health written statements of their intent to promulgate such a program, with the names, addresses, and social security numbers of key individuals. Each statement shall include a rationale for the necessity for the program, the intended program location(s), days and hours of operations, and the proposed method for tracking program users. Any changes in this identifying information or the identity of key individuals shall be sent to the Board of Health within 30 days. All needle exchange programs shall maintain continuously updated records of the full names, addresses and telephone numbers of all individuals providing services to or having contact with program participants at any program location.
No needle exchange program shall operate in any location until the address of the program location is specifically approved by the Board of Health and the proposed site's municipality through legislative action.
Program locations in operation with the approval of the Allegheny County Health Department as of January 1, 2007, shall not require additional approval by the Department or the municipality in which they are located, although all such program locations shall be disclosed to the Mayor, Council, and/or Commissioners of all municipalities in which they are located in writing within 10 days of the effective date of this regulation.
Under no circumstances shall the Department approve any future program location proposed to be within 1,500 feet of any elementary school, primary school, secondary school, licensed day-care facility, or drug treatment facility.
The Department shall not approve any temporary facility, including but not limited to tents, outdoor tables, or mobile units, as a program location unless such location is first identified by address and in writing by the needle exchange program, and the municipality in which the temporary facility is to be located is notified in writing of the address of the temporary program location in accordance with the requirements of Subsection C.
Needle exchange programs shall enroll each program participant with a unique identifier, and shall not provide services before attempting to elicit the program participant's age, gender, self-reported race, zip code, and disease status (HIV, Hepatitis B or C).
Each needle exchange encounter shall be documented with the unique identifier and the date and time of the encounter. The person documenting the encounter and all individuals providing materials or services to any program participant shall provide his or her initials. Documentation shall be retained by the needle exchange program for at least three years.
IDUs not known to be infected with HIV or Hepatitis B or C infections at first screening shall be offered testing at the first visit that is at least six months from the date of first screening.
IDUs presenting with one or more symptoms of HIV or Hepatitis B or C shall be informed that they should follow up immediately with their primary care provider or the Department.
IDUs shall be counseled on safe sex practices.
Needle exchange programs shall be primarily for the use of Allegheny County residents, but nonresidents may participate if there are available resources.
The number of injection apparatus and biohazard containers dispensed shall be no more than are reasonably necessary for one month's worth of injections at an IDU's first interaction with the needle exchange program.
Each IDU shall be offered a referral to drug treatment and counseling services at each needle exchange encounter. Such referral shall be documented with the initials of the person who made the referral and the IDU's response.
Whenever possible, the Department shall provide infectious disease testing materials as requested by needle exchange programs.
Community laboratory facilities processing needle exchange program specimens shall report positive infectious disease tests not conducted by the Department shall be reported to the Department within 72 hours.
Department funds shall not be used to support any activity of any needle exchange program without prior approval as required by law.
Needle exchange programs shall submit to the Director semi-annual reports of the disease status of all enrolled IDUs on or before December 31 and July 1 of each calendar year, in a form to be determined by the Board of Health, but which shall include at least: the number of encounters; the number of individual participants; the total number of injection apparatuses; the number of treatment referrals made; the number of infectious disease tests performed.
Any needle exchange program approved by the Board of Health that violates any of the sections contained herein shall lose its authorization to continue to operate as a needle exchange program, subject to the discretion of the Department or upon the repeal of the legislative program location approval required under the terms of § 851-5D by the host municipality.