title: Outcomes of the California ban on pharmaceutical lindane: clinical and ecologic impacts.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
authors.affiliation: University 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.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Humphreys
authors.forename: Sarah
authors.initials: S
authors.lastname: Janssen
authors.forename: Ann
authors.initials: A
authors.lastname: Heil
authors.forename: Patricia
authors.initials: P
authors.lastname: Hiatt
authors.forename: Gina
authors.initials: G
authors.lastname: Solomon
authors.forename: Mark D
authors.initials: MD
authors.lastname: Miller
mesh_terms: D000977:Antiparasitic Agents / Q000032:analysis* / Q000506:poisoning / Q000627:therapeutic use; D002140:California; D004781:Environmental Exposure; D004784:Environmental Monitoring; D001556:Hexachlorocyclohexane / Q000032:analysis* / Q000506:poisoning / Q000627:therapeutic use; D006801:Humans; D007306:Insecticides / Q000032:analysis* / Q000506:poisoning / Q000627:therapeutic use; D007880:Legislation, Drug; D010373:Lice Infestations / Q000188:drug therapy; D012722:Sewage / Q000032:analysis*; D014874:Water Pollutants, Chemical / Q000032:analysis* / Q000506:poisoning
chemical_list: D000977:Antiparasitic Agents; D007306:Insecticides; D012722:Sewage; D014874:Water Pollutants, Chemical; D001556:Hexachlorocyclohexane