1. The Pharmaceutical Use of Lindane and its Legislative Ban in California Eliza H. Humphreys, MD, MPH ACPM Conference February 24, 2007

2. Objectives Chemical information on lindane Lindane uses CA experience with lindane ban Environmental issues International regulations on lindane

3. Lindane HCH

4. Source: Ann Heil, P.E. Supervising Engineer, Los Angeles County Sanitation District Outreach begins Ban takes effect

5. Lindane Leaving LACSD Water Reclamation Plants CTR Limit, MUN California Lindane Ban Impact 19 ppt Source: Ann Heil, P.E. Supervising Engineer, Los Angeles County Sanitation District

6. Source: American Academy of Pediatrics/UCSF/PEHSU Survey, 2005

7. What are the difficulties you have noticed since the ban of Lindane? Source: American Academy of Pediatrics/UCSF/PEHSU Survey, 2005

9. Comments from California Pediatricians on Scabies Treatment “Haven’t had Elimite fail” “I have seen improved response to Elimite for scabies..” “I’ve had scabies myself (about 5 times volunteering in many orphanages). I prefer Elimite.” Source: American Academy of Pediatrics/UCSF/PEHSU Survey, 2005

10. California Summary Even before the ban (since 1987) we strongly recommended against lindane because it was not effective and posed potential health risks. 1% permethrin remains the drug of choice for head lice For lice treatment failures, 0.5% malathion is the drug of choice 5% permethrin is the #1 choice for scabies

11. Results of a 2005 California random survey of 400 actively practicing pediatricians by the Pediatric Environmental Health Specialty Unit/University of California, San Francisco/American Academy of Pediatrics Have you changed your prescribing practice for the treatment of lice and scabies as a result of the ban in 2000?

12. HEAD LICE TREATMENT Medical Board of California Action Report is a monthly publication sent to all physicians January 2000 “California Program to Prevent and Control Head Lice” written by CDHS If there is treatment failure with permethrin or pyrethrins, CONSIDER 0.5% malathion, not lindane.

13. Life cycle concerns Photo courtesy of John Vijgen.

14. Lindane Toxicity Endocrine disruptor Neurotoxicity in children, elderly, immunocompromised Changes in circulating antibody levels Possible carcinogen Not the most effective treatment for lice/scabies - 17% killing rate