April 15, 2014 The Honorable Richard Pan Chairman, Assembly Committee on Health State Capitol, Room 6005 P.O. Box 942849 Sacramento, CA 95249-0009 RE: AB 1893 Oppose Dear Chairman Pan: I’m writing as the founder and executive director of an organization called “Students With Diabetes” and our chapters in California in San Diego, the University of Southern California (NVDLC) and in Newport Beach, as well as our members in the San Francisco and Los Angeles areas. The entire national organization and our California chapters and members have great concerns with the current draft of AB 1893 and encourage you and members of your committee to oppose the bill unless it is significantly amended to resolve our concerns. Our primary reason for writing relates to an Internet search which identified the legislation, picked up supporting materials authored by the legislation’s sponsors, and also found materials of concern published by the entity identified as the primary sponsoring organization known as the California Product Stewardship Council. Our review of the documents identified inflammatory language directed towards people with diabetes, in some cases “diabetics,” and others with chronic diseases by the bill author’s office and the sponsoring organization. The words are so troublesome we are left with no choice but to comment directly to the committee and ask for some form of relief. By way of background, Students With Diabetes aims to create a community and connection point for young adults with diabetes ages 18-30 on college campuses and in local communities across the country. We want to simplify life for young adults with diabetes. Young adult life presents new situations and experiences which can prove daunting. Students With Diabetes equips young adults with the tools and information they need to succeed, as well as providing professional and social opportunities to create individual networks. Our group also supports a strong advocacy network to help protect the rights of students with diabetes whenever issues of concern such as those related to AB 1893 arise. Our role as

the voice for young adults with diabetes progressing with education as a means to further future careers provides Students With Diabetes with a unique voice which I hope the committee will hear loud and clear. While on its surface AB 1893 appears innocuous in reality it is built on a series of half-truths and myths and a few completely deceitful statements. Consider the fact sheet claiming most people who use needles, syringes and lancets lack the skills and knowledge about proper disposal methods so they callously flush these items down the toilet or throw them in the trash. Members of the committee, I’ve personally had diabetes for several decades and can attest to never ever flushing sharps down a toilet. I’m also comfortable saying such behavior is nowhere near the norm among our members and in all my studies in obtaining my Doctoral degree in Public Health I’ve never run across a study suggesting this behavior is common except possibly in illicit drug injecting populations. On behalf of our membership, I’d greatly appreciate an apology for printing this statement and for furthering a bias that people with chronic conditions aren’t inclined to do the right thing. A similar apology from the California Product Stewardship Council is welcome and expected too for similar language contained on its website and within various advertisements placed. An equal concern besides the unfortunate rhetoric is how unworkable this bill is. The legislation overlooks promoting what are at times free or much cheaper means of sharps disposal that are equally if not more effective. Some of these disposal means, all of which are supported by the FDA, EPA and state and local health agencies include empty detergent containers, old bleach containers and tools which clip a sharp from a needle or syringe. These clippers alone often retail for much less than a sharps container and have a capacity that lasts years. The clippers are also designed for use while traveling which is something a container is not designed to do well. Cost issues are especially important to consider for young adults with diabetes. Many times our young people struggle to make ends meet. An obligation to pay several dollars a month for a sharps container may not seem like much to you but trust me it is a lot to a student trying to stretch every available dollar. This is especially true when they already have an expensive chronic condition like diabetes. I’m at a loss from a public health perspective, as to why the legislature is focused on mandating the purchase of a sharps container when cheaper more effective options are available. Further complicating this legislation is the insurance framework. Since some private insurers cover disposal systems for patients wouldn’t a smarter approach for this legislation consist of requiring all insurers, Medi-Cal and petitioning the federal government to direct Medicare to cover sharps containers and other disposal options for sharps? Obtaining this coverage would resolve the cost issue facing young adults with chronic diseases and spread the risk among many in the insured population. It seems to me this is the smartest path forward.

The education mandate contained in the legislation is an interesting approach but I fear it is at odds with existing FDA directives in place related to product labeling and packaging. How are national and international manufacturers of FDA cleared products supposed to provide information on state and local options for disposal? This suggestion is unworkable from a regulatory perspective. However, the FDA does require manufacturers include messaging in their product inserts about proper disposal. As a person with diabetes myself I can attest to frequently seeing this messaging. I’m sympathetic to the issues identified by waste handlers and others documented in the background related to this legislation. However, relying on a review or prescribing trends and patient interaction with pharmacists conducted in the late 90s to suggest there are 3 billion sharps and 900 million lancets in use in the United States today is flawed an inaccurate. I would suggest we take a step back and determine a better path forward. Given the impact this legislation will have on young people and the language used to date to support this flawed bill I hope the committee will strongly consider holding the bill over for further consideration. At a minimum, the mandates requiring the purchase of sharps container whenever syringes, needles or lancets are purchased should no longer appear in the bill given the information shared. Let me again close by reminding those responsible for developing the materials associated with promoting this legislation that including information that is patently false furthers the bias and discrimination that people living with diabetes face. I sincerely hope a correction to the variety of documents in circulation coupled with an apology for the language utilized and the factual errors relied upon arrives soon. Sincerely,

Nicole Johnson, DrPH, MPH, MA Founder, Students With Diabetes cc: Asm. Matt Stone

Asm. Susan Talamantes Eggman Committee Staff