RELATING TO HARM REDUCTION.

HB1114

HOUSE OF REPRESENTATIVES

H.B. NO.

1114

THIRTY-THIRD LEGISLATURE, 2025

STATE OF HAWAII

A BILL FOR AN ACT

RELATING TO HARM REDUCTION.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

����
SECTION 1.
�
The legislature finds that sharing injection equipment
among individuals who use drugs is a major contribution to the spread of human immunodeficiency
viruses, hepatitis B, hepatitis C, and other serious bloodborne infections.
�
Act 152, Session Laws of Hawaii 1992, authorized
the establishment of the first state-funded sterile needle and syringe exchange
program in the United States.
�
The program
has aimed to prevent the transmission of bloodborne pathogens and to provide individuals
who inject drugs with services such as referrals to appropriate health and social
services, thereby reducing overall disease burden in Hawaii.

����
Over
the past thirty years, extensive scientific research has confirmed that syringe
exchange programs nationwide effectively reduce disease transmission, increase access
to addiction treatment, improve public safety, lower healthcare costs, and do not
lead to an increase in drug use or crime.
�

Research has also helped identify the most effective approaches in what are
now commonly referred to as
"
syringe services programs.
"

����
A 2020 report
by the Centers for Disease Control and Prevention, United States Department of Health
and Human Services, concluded that syringe programs that restrict syringe distribution
to one-to-one exchange are less effective than needs-based distribution programs
that provide sterile needles and syringes to syringe exchange participants in quantities
sufficient to reduce the likelihood of needles and syringes being shared or reused.
�
The Centers for Disease Control and Prevention
supports needs-based approaches to syringe distribution based on evidence that it
is the best practice for reducing new HIV and viral hepatitis infections.
�
The Centers for Disease Control and Prevention
concludes that, compared to one-to-one exchanges, needs-based syringe distribution
results in less syringe sharing and reuse, lower risk of infection, and is not associated
with increased unsafe syringe disposal.
�
Research
shows that syringe distribution programs are safe, effective, cost-saving, do not
increase drug use or crime, and do not cause people to begin injecting drugs.
�
However, Hawaii and Florida remain the only states
that impose a strict one-to-one sterile needle and syringe exchange limit.
�
This Act will authorize the
State
'
s
syringe exchange program to transition from a one-to-one exchange
model to a needs-based distribution system.

����
Syringes
and needles are not the only injection equipment that contribute to the spread of
infection.
�
Any materials used in the preparation
or administration of drugs may potentially transmit pathogens or cause injury when
shared or reused.

����
The
Model Syringe Services Program Act, released by the White House Office of National
Drug Control Policy in December 2021, recommends extending protection from criminal
liability under drug paraphernalia statutes to syringe program staff, volunteers,
and participants while implementing or accessing program services intended to reduce
transmission of bloodborne infections.
�
This
Act makes amendments consistent with those recommendations.

����
In
alignment with recommendations for improving effectiveness, the State
'
s
sterile needle and syringe exchange program also facilitates access to critical
health services necessary for participants.
�

These include educating participants about the dangers of contracting human
immunodeficiency virus through sharing drug injection equipment and offering counseling
services and referrals for treatment of substance use disorders.
�
Furthermore, individuals who do not inject drugs
but are marginalized often seek harm reduction information, supplies, and referrals
to other services through the program.
�
This
Act will remove the requirement that the program exclude non-injection drug users,
ensuring the program can assist individuals in need when resources are available.

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Syringe
services programs also play a crucial role in collecting and safely disposing of
used injection equipment.
�
Safe disposal occurs
most effectively if program participants batch all used injection equipment for
safe disposal by syringe services programs.
�

However, participants may be reluctant to batch used injection equipment
for safe disposal if they risk criminal penalties for drug residue found on used
equipment.
�
Extending protection to program
participants from arrest and prosecution for possession of drug residue on used
syringes and needles will increase the likelihood of proper disposal, thereby reducing
public health risk.
�
Program staff regularly
encourage participants to batch and return all used injection equipment to the syringe
exchange program, not only for the safety of the community, but also to assist in
ensuring the program
'
s continuity.
�
For these reasons, the Model Syringe Services
Program Act recommends providing immunity from criminal penalties for possession
of a controlled substance or other illicit drug due to the presence of residue in
a hypodermic needle or syringe or other supplies.

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The purpose
of this Act is to improve the safety, effectiveness, and cost savings of the State
'
s sterile needle and syringe exchange program by amending it based
on current
recommendations
from the Centers for Disease
Control and Prevention and the White House Office of National Drug Control Policy
'
s model legislation.

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SECTION
2.
�
Section 325-111,
Hawaii Revised Statutes, is amended as follows:

����
1.
�
By adding five new definitions to be appropriately
inserted and to read as follows:

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"
"Authorized
objects" means objects authorized by the department, by rule, for dissemination
to syringe exchange participants for the purpose of reducing infection or injury.
�
"Authorized objects" may include, but
are not limited to, cookers, cottons, or ties.

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"Needs-based distribution" means

a syringe distribution
practice that provides sterile needles and syringes to syringe exchange participants
in quantities sufficient to reduce the likelihood of needles and syringes being
shared or reused.

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"Program staff" means an employee
of the department or its designee who is specifically tasked with procuring, handling,
transporting, and providing sterile needles, syringes, and authorized objects and
services to syringe exchange participants.

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"Residue"
means any controlled substance, as the term is defined in section 329-1, in an amount
less than 0.05 milliliter.

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"Syringe
exchange participant" means an injection drug user who receives a sterile needle
and syringe pursuant to the program.
"

����
2.
�
By repealing the definition of "participant".

["
"Participant" means
an injection drug user who exchanges a sterile needle and syringe unit pursuant
to the program.
"]

����
SECTION
3.
�
Section 325-113, Hawaii Revised Statutes,
is amended to read as follows:

����
"[
[
]
�325-113
[
]
]
�
Operation of the program.
�
(a)
�
The
program shall be operated for the purpose of:

����
(1)
�
Preventing the transmission of the human
immunodeficiency virus, the hepatitis B virus,
the hepatitis C virus,
and
other [
blood borne diseases;
]
bloodborne infections;
and

����
(2)
�
Providing [
injection
] drug users
with referrals to appropriate health and social services.

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(b)
�
The program shall provide for maximum security
of exchange sites and equipment, including a full accounting of the number of needles
and syringes [
in use,
]
distributed,
the number in storage,
the
number of used needles and syringes collected,
and any other measure that may
be required to control the use and dispersal of sterile needles and syringes; provided
that a
syringe exchange
participant may exchange used needles and syringes
at any exchange site if more than one site is available.

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(c)
�
The
program
shall provide [
for a one-to-one exchange, whereby the participant shall receive
one sterile needle and syringe unit in exchange for each used one.
]
needs-based
distribution of sterile needles and syringes.

����
(d)
�
The program [
shall provide procedures for the
screening of participants to prevent non-injection drug users from participating
in the programs.
]
may provide screening procedures to allow non-injection
drug users to safely and effectively receive services, exclusive of syringes and
needles, from the program.

����
(e)
�
The department
and its designees
shall
keep records to identify and authorize [
persons employed by the department or
its designees
]
program staff
to have access to needles, syringes,
or
authorized objects, and
the program's records.

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(f)
�
The program shall include services to:

����
(1)
�
Educate the
syringe exchange
participant
about the dangers of contracting [
HIV infection
]
bloodborne pathogens

through [
needle-sharing
]
needle- and other materials-sharing
practices;
and

����
(2)
�
Offer
substance [
abuse
]
use
disorder
treatment referral and counseling services to all
non-injection
drug users and syringe exchange
participants.

����
(g)
�
The program shall compile research data on behavioral
changes, enrollment in [
drug abuse
]
substance use disorder
treatment,
counseling, and education programs,
service provision,
disease transmission,
and other information that may be relevant and useful to assist in the planning
and evaluation of efforts to
combat
the spread
of [
blood borne diseases.
]
bloodborne infections.
"

����
SECTION
4.
�
Section 325-114, Hawaii Revised Statutes,
is amended to read as follows:

����
"[
[
]
�325-114
[
]
]
�
[
Criminal liability.
]
�
Liability.

(a)
�
[
Exchanges under the sterile needle and syringe
exchange program
]
Possession or delivery of needles or syringes
shall
not constitute an offense under section 329-43.5 for [
the participant or for
the employees of the department or its designees.
]
program staff acting in
the course and scope of official duties; provided that delivery is limited to other
program staff or to syringe exchange participants pursuant to this part.
�
Possession of needles or syringes shall not constitute
an offense under section 329-43.5 for syringe exchange participants participating
in a program visit.

����
(b)
�
Possession or delivery of authorized objects shall
not constitute an offense under section 329-43.5 for program staff acting in the
course and scope of official duties; provided that delivery is limited to other
program staff or to syringe exchange participants pursuant to this part.
�
Possession of authorized objects shall not constitute
an offense under section 329-43.5 for syringe exchange participants participating
in a program visit.
�
The department shall
establish, by rule, a specific list of authorized objects, which may be updated
from time to time as needed.

����
(c)
�
Possession or delivery of used needles or syringes
containing residue shall not constitute a drug possession offense under section
712-1242(1)(c), 712-1243, 712-1245(1)(c), 712-1246.5, 712-1248(d), or 712-1249,
for syringe exchange participants within

month after their last participation in a program visit; and shall
not constitute such an offense for program staff acting in the course and scope
of official duties; provided that any delivery, whether by syringe exchange participants
or by program staff, shall be made only to program staff pursuant to this part.

����
(d)
�
Subsections (a), (b), and (c) shall only apply
to needles, syringes, or authorized objects possessed by syringe exchange participants
or program staff; or to needles, syringes, or authorized objects delivered between
program staff, or between a syringe exchange participant and program staff.
�
Subsection (a), (b), or (c) shall not apply to
any needles, syringes, or authorized objects possessed by anyone other than syringe
exchange participants or program staff, nor shall these exceptions apply to any
needles, syringes, or authorized objects delivered between syringe exchange participants,
between a syringe exchange participant and an individual who is neither a syringe
exchange participant nor program staff, between individuals who are neither syringe
exchange participants nor program staff, or between such an individual and program
staff.

����
(e)
�
A law enforcement officer who, acting in good
faith, arrests or charges a person who is thereafter determined to be exempt from
an offense pursuant to this section shall not be subject to civil liability for
the mere arrest or filing of charges.

����
[
(b)
Nothing
]
(f)
�
Except as specifically
provided in this section, nothing
in this part provides immunity from prosecution
to any person for violation of any law prohibiting or regulating the use, possession,
dispensing, distribution, or promotion of controlled substances, dangerous drugs,
detrimental drugs, or harmful drugs.
�
[
Nothing
]

Except as specifically provided in this section, nothing
in this part provides
immunity from prosecution to any person for violation of [
sections
]
section

329-41, 329-42, or 712-1241 through [
712-1249.6.
]
712-1249.7.
"

����
SECTION
5.
�
Section 325-116, Hawaii Revised Statutes,
is amended to read as follows:

����
"[
[
]
�325-116
[
]
]
�
Reports.
�

The department, on or before January 1 of each year, shall submit a report
to the oversight committee.
�
The report shall
include:

����
(1)
�
Information
as to the number of
syringe exchange

participants
served [
and
], the number
of needles and syringes distributed[
;
]
, and the number of used needles
and syringes collected;

����
(2)
�
A
demographic

profile of the
syringe exchange
participants served, including but not limited
to:
�
age, sex, ethnicity, area of residence,
occupation, types of drugs used, length of drug use, and frequency of injection;

����
(3)
�
Impact of the program on needle and syringe sharing
and other high risk behavior;

����
(4)
�
Data on
syringe exchange
participants regarding
HIV
testing
, counseling, drug treatment, and other
social services, including referrals for HIV testing and counseling and for [
drug
abuse
]
substance use disorder
treatment;

����
(5)
�
Impact
on the transmission
of HIV infection among injection drug users;

����
(6)
�
Impact on behaviors that caused
syringe exchange

participants
to be at risk for HIV transmission such
as frequency of drug use and needle sharing;

����
(7)
�
An assessment of the cost-effectiveness of the
program versus direct and indirect costs of HIV infection; and

����
(8)
�
Information

on the percentage of persons served through treatment programs for injection drug
users funded through the department that were attributed to needle exchange referrals.

����
The
report shall address the strengths and weaknesses of the program, the advisability
of its continuation, amendments to the law, if appropriate, and other matters that
may be helpful to the oversight committee in evaluating the program's efficacy."

����
SECTION
6.
�
Statutory material to be repealed is bracketed
and stricken.
�
New statutory material is underscored.

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SECTION
7.
�
This Act shall take effect upon its approval.

INTRODUCED BY:

_____________________________

BY REQUEST

Report Title:

Department of Health; Sterile Needle and Syringe Exchange Program;
Needs-Based Distribution; Non-Injection Drug User Participation; Liability

Description:

Repeals the one-to-one syringe limit for the needle exchange
program.
�
Authorizes the Sterile Needle and
Syringe Exchange Program to provide needs-based distribution.
�
Authorizes non-injection drug user participation
in the Program.
�
Modifies liability for exchange
program participants, staff, and law enforcement officers.

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not legislation or evidence of legislative intent.