Controlled drugs or sharps
Refer to the following guidance when the pharmaceutical waste incudes a controlled drug and/or a sharp:
Any outer packaging and Patient Information Leaflets may be placed into ordinary paper or cardboard waste containers for recycling. Patient-sensitive Information must be obliterated with permanent black marker pen before disposal. Whilst there is no obligation to remove the cardboard outer packaging for recycling, doing so will reduce the volume of pharmaceutical waste.
Blister strips and medicines compliance aids (MCAs)
Where a manufacturer’s blister strips have been completely used, this primary packaging can be recycled in certain facilities. Contact your local waste manger for further information.
Medicines should not be removed from blister strips or single-use medicines compliance aids (MCAs). These should be disposed of intact without removing the medicines, in the appropriate pharmaceutical waste container.
Hazardous (cytotoxic and cytostatic) waste
Cytotoxic and cytostatic medicines are classed as clinical hazardous waste and include any medicine that has one or more of the hazardous properties:
- acute toxicity
- toxic for reproduction
Note that “toxic for reproduction” should not be confused with “contraindicated for use in pregnancy”.
Cytotoxic and cytostatic includes some hormone-based preparations such as hormonal contraceptives, antimicrobial substances such as chloramphenicol, as well as cancer-treating agents.
Organisations need to be able to identify the hazardous (cytotoxic and cytostatic) waste used within their organisation.
Antineoplastic and Other Hazardous Drugs in Healthcare is an American resource from the Centers for Disease Control and Prevention (CDC) and has a useful list of medicines classified as cytotoxic and cytostatic (antineoplastic). The list previously included in HTM 07-01 is no longer in the current published document.
A purple-lidded waste container must be used and should be clearly labelled with the following information using a black permanent marker pen, before filling the container:
- Pharmaceutical Hazardous Waste for incineration
- Cytotoxic and Cytostatic. Mixed Form
- EWC 18 01 08*
If the waste includes any patient’s own medicines it should additionally be coded as EWC 20 01 31*.
Non-hazardous (medicinal) waste
This is the largest group of pharmaceutical waste and includes medicines which are considered non-hazardous by the organisation (not cytotoxic or cytostatic). This group is also known as medicinal waste.
A blue-lidded waste container must be used and should be clearly labelled with the following information using a black permanent marker pen, before filling the container:
- Pharmaceutical Non-Hazardous Waste for incineration
- Non-Cytotoxic and Non-Cytostatic. Mixed Form
- EWC 18 01 09
If the waste includes any patient’s own medicines it should additionally be coded as EWC 20 01 32.
Non-pharmaceutically active waste
Some licensed medicinal products are not pharmaceutically active and possess no hazardous properties.
Non-pharmaceutically active intravenous fluids in small quantities, with no other hazards (such as infectious due to contamination with body fluids or the addition of pharmaceutically active substances), can be disposed of by:
- placing in the offensive waste stream for Energy for Waste (EfW) or another permitted process. Organisations should discuss this with their waste manager
- discharging to the foul sewer (if less than 1 litre) and the empty containers placed in the offensive/hygiene waste stream
- placing in the medicinal waste stream
Examples include sodium chloride 0.9% and dextrose solutions. Intravenous fluid containing a pharmaceutically active ingredient e.g. potassium, must be placed in the appropriate pharmaceutical waste container.
Nutritional supplements are classified as nutritional borderline substances. These are not pharmaceuticals and can be classified as a food stuff for disposal purposes (source: British Specialist Nutrition Association Ltd). Food waste can be sent for anaerobic digestion or composting and more information should be sought from your local waste manager.
Liquid feeds and supplements
Liquid nutritional feeds and supplements in small quantities (less than 1 litre) can be discharged to the foul sewer, if they present no other hazard. This has been agreed across the UK and Northern Ireland in the National Guidance for Healthcare Waste Water Discharges with the following requirements:
- containers must be opened individually and emptied
- the containers themselves should be appropriately disposed of
If larger quantities need to be disposed of, the manufacturer or supplier may be able to arrange collection.
Bulk quantities of more than 1 litre should not be discharged into the foul sewer without prior discussion with the local sewerage undertaker.
Alcohol hand gels
Alcohol hand gels that do not contain siloxanes (which cause significant damage to plant and equipment used in the sewage treatment process) and whose safety data sheet (SDS) does not prohibit discharge to the sewer, can be disposed of by:
- rinsing out the packaging
- recycling the packaging or placing into the domestic waste stream
The local waste manger should be contacted for advice where products contain siloxanes.
Flammable and other substances
Other waste medicines may possess a range of hazardous properties that need to be notified to the waste contractor for duty of care purposes and may require segregation to keep chemically-incompatible substances apart. These include medicines that are:
Flammable liquids must not be placed in the waste container. A separate consignment will be required and arranged on an ad-hoc basis with the waste contractor.
Homecare contracts should have provision for the collection of waste medication and sharps for injectable medicines.
- Additional information on nutritional supplements