| Outcomes of the California Ban on Pharmaceutical Lindane: Clinical and Ecologic Impacts Elizabeth H. Humphreys,1 Sarah Janssen,2,3 Ann Heil,4 Patricia Hiatt,5,6 Gina Solomon,2,3,6 and Mark D. Miller3,6,7 1University of California San Francisco–University of California Berkeley Joint Residency Program in General Preventive Medicine and Public Health, Institute for Global Health, San Francisco, California, USA; 2Health and Environment Program, Natural Resources Defense Council, San Francisco, California, USA; 3School of Medicine, University of California San Francisco, San Francisco, California, USA; 4County Sanitation Districts of Los Angeles County, Whittier, California, USA; 5California Poison Control System, San Francisco Division, Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA; 6Pediatric Environmental Health Specialty Unit, California Poison Control System-San Francisco, University of California San Francisco, San Francisco, California, USA; 7Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, California, USA Abstract
Introduction: There are increasing concerns over the presence and implications of pharmaceutical agents in water. In 2002, California banned pharmaceutical use of lindane because of concerns about water quality, as lindane treatment for head lice and scabies was found to be a significant factor adversely affecting wastewater quality. Objectives: In this article we describe the effects the ban has had on wastewater quality, unintentional exposures, and clinical practice. This is the first time that a pharmaceutical has been outlawed to protect water quality. As such, this ban provides a rare opportunity to evaluate the possible or potential outcomes of future public health interventions aimed at reducing pharmaceutical water contamination. Methods: We compiled data on lindane in wastewater treatment plant effluent for several large plants in California and one outside of California. Data on exposures to lindane were obtained from records of the California Poison Control System. We assessed the impact on clinical practice via a survey of 400 pediatricians. Results: Wastewater treatment plant monitoring showed that lindane declined in California after the ban. Similarly, unintentional exposure calls declined. Most physicians were aware of the ban (81%) and had used lindane previously (61%) , but they did not notice any difficulties with the ban (78%) . Conclusions: The California experience suggests that elimination of pharmaceutical lindane produced environmental benefits, was associated with a reduction in reported unintentional exposures, and did not adversely affect head lice and scabies treatment. This ban serves as a model for governing bodies considering limits on the use of lindane or other pharmaceuticals. Key words: contamination, head lice, lindane, persistent organic pollutant, pharmaceutical, physician survey, scabies, unintentional ingestions, wastewater. Environ Health Perspect 116:297–302 (2008) . doi:10.1289/ehp.10668 available via http://dx.doi.org/ [Online 11 December 2007]
Address correspondence to M.D. Miller, Pediatric Environmental Health Specialty Unit, c/o California Poison Control System-SF, U.C. San Francisco, Box 1369, San Francisco, CA 94143 USA. Telephone: (510) 622-3159. Fax (510) 622-3210. E-mail: mmiller@oehha.ca.gov We thank S. Husted (California Department of Public Health, Vector-Borne Disease Section) ; V. Walker (California Department of Health Care Services) ; J. Kapusnik-Uner (First DataBank) ; and the California District of the American Academy of Pediatrics and Marianne Hockenberry for their assistance. The University of California San Francisco, Pediatric Environmental Health Specialty Unit (UCSF PEHSU) receives funding from the U.S. Agency for Toxic Substances Disease Registry and the U.S. Environmental Protection Agency administered by the Association of Occupational and Environmental Clinics. Funding for this project was provided by the UCSF PEHSU. The views expressed by M.D. Miller are his and do not necessarily represent those of the Office of Environmental Health Hazard Assessment, the California Environmental Protection Agency, or the State of California. G. Solomon and S. Janssen are employed by the Natural Resources Defense Council. The remaining authors declare they have no competing financial interests. Received 13 July 2007 ; accepted 10 December 2007.
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