The Pharmaceutical Use of Lindane and its Legislative Ban in California Eliza H. Humphreys, MD, MPH...
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The Pharmaceutical Use of Lindane and its Legislative Ban in California Eliza H. Humphreys, MD, MPH ACPM Conference February 24, 2007
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Transcript of The Pharmaceutical Use of Lindane and its Legislative Ban in California Eliza H. Humphreys, MD, MPH...
The Pharmaceutical Use of Lindane and its Legislative Ban in
CaliforniaEliza H. Humphreys, MD, MPH
ACPM Conference
February 24, 2007
Objectives
• Chemical information on lindane
• Lindane uses
• CA experience with lindane ban
• Environmental issues
• International regulations on lindane
Lindane HCH
Concentration of Lindane into a Los Angeles County Wastewater Treatment Plant
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70
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
Co
nce
ntr
atio
n,
pp
t
Source: Ann Heil, P.E. Supervising Engineer, Los Angeles County Sanitation District
Outreach begins
Ban takes effect
Lindane Leaving LACSD Water Reclamation Plants
40
2
30
0
40
0
40
0
40
00
5
10
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Med
ian
Lin
dan
e,
pp
t
San Jose Creek Pomona Whitter Narrows Long Beach Los Coyotes
Before After
CTRLimit, MUN
California Lindane Ban Impact
19 ppt
Source: Ann Heil, P.E. Supervising Engineer, Los Angeles County Sanitation District
First and Second Line Treatments For Head Lice in California
86
11 93
10
05
0
115
148
37
0 1 4 4
61
0102030405060708090
100
Drug
Fre
qu
en
cy
First line treatment
Second line treatment
Source: American Academy of Pediatrics/UCSF/PEHSU Survey, 2005
What are the difficulties you have noticed since the ban of Lindane?
0
20
40
60
80
100
120
140
No Yes NoResponse
Total
Have you noticed an increase in the number of scabies cases?
Frequency
Source: American Academy of Pediatrics/UCSF/PEHSU Survey, 2005
First and second line drug choices for treatment of scabies in California
0
20
40
60
80
100
120
140
Drug
Fre
qu
ency Scabies first
line tx
Scabiessecond line tx
Source: American Academy of Pediatrics/UCSF/PEHSU Survey, 2005
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
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
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
0
1020
30
4050
60
7080
90
No Yes Noresponse
Frequency
Have you changed your prescribing practice for the treatment of lice and scabies as a result of the ban in 2000?
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.
Life cycle concerns
Photo courtesy of John Vijgen.
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
