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Disposal of Medicines in Hospitals and Nursing Homes

28 July, 2015

In the past, it was common for medicinal waste to be disposed of along with normal waste, or down sink plugholes. However, legislation has meant that these practises are now illegal and require that waste is not only disposed of safely but is separated into different kinds of waste so it can be processed in the most appropriate manner. Each type of waste has its own code, which should be marked on the container containing the waste.

  • Cytotoxic or cytostatic medicines – 18 01 08*
  • Other medicines – 18 01 09
  • Used sharps contaminated with medicines – 18 01 03* and 18 01 08
  • Used sharps uncontaminated with medicines – 18 01 03*
  • Unused sharps – 18 01 01

Most medicines are classed as non-hazardous waste; the exception being drugs classed as cytotoxic or cytostatic. Legislation requires that medicinal waste is kept separate from other waste, and separated as either hazardous (yellow bin, purple lid) or non-hazardous (yellow bin, blue lid).

Common non-chemotherapy cytotoxic or cytostatic medicines, which may be encountered including the following:

  • Oestrogen or Progesterone containing products (e.g. contraceptives or HRT)
  • Anastrozole
  • Leflunomide
  • Chloramphenicol
  • Raloxifene
  • Finasteride
  • Tamoxifen

The law does not allow waste to be processed without a licence, so tablets should be disposed of without deblistering or decanting liquids.
However, outer packaging, such as cardboard boxes, should be removed first. The one exception the Environment Agency allows is for controlled drugs, where an exemption (T28) must be registered to allow these drugs to be denatured using a CD destruction kit before disposal.

Department of Health guidelines states that no medicinal product at all should be washed down the sink and so recommend that any packaging which contains a residue of a medicinal product (e.g. an empty bottle) should also be disposed of as medicinal waste instead of being rinsed out. Some waste contractors will provide a separate larger bin for this purpose on request.

Sharps which have been contaminated with medicines (such as those used to give injections) also need to be separated from those which have not. A yellow container with a yellow lid is used for those with possible medicinal contamination, whereas a yellow container with an orange lid is reserved for those that have not been used for medicines. Department of Health guidance also allows for small quantities of controlled drugs to be disposed in the yellow sharps bin in order to render them irretrievable, such as the unused portion of an ampoule or the unused half of a tablet.

Although the legislation around medicinal waste is becoming more complicated, it is relatively easy to be compliant as long as waste is sorted correctly at the time it is disposed of.

The T28 exemption is available from-