It is almost invariable that, in the anaesthetic room, the operating theatre, in the Intensive Care and Neonatal Units, in A&E and occasionally in the Imaging Department, controlled drugs and other pharmaceuticals are drawn up in 10ml or 20ml syringes, labelled, and then discarded with a substantial volume of residual product. The remaining volume may be 1, 2 5 or 10ml or more since the ability to give drugs immediately requires prefilled syringes in circumstances where even a few seconds delay while fresh drug is drawn from a new ampule may be critical.

How are these drugs discarded? Safety requires that the drugs, once drawn into a syringe, are not stored for use with the next patient. The syringes, which are commonly labelled with their content, are often discarded by flushing down the sink. This complies with Controlled Drug safety requirements that puts waste fractions beyond recovery or use. Unfortunately, this is now contraindicated by reason of environmental protection and some alternative is required. In most centres, these syringes are now discarded intact into a sharps bin but there are many cases of salvage of this drug waste for illicit re-use. Much of this occurs in hospitals, by staff addicts and others who may seek these prized syringes from an insecure waste score. Perhaps it happens also as wastes are uplifted and pass along the disposal chain but these is little evidence for this.

Another case has appeared in US, where “Jim Kaju had been fired from his job at the University of Minnesota’s hospital, wasn’t going to let that stop his addiction.

“On a spring afternoon in 2008, he donned scrubs, strolled through the main entrance and went straight for a storage room to find narcotics.

“The former nursing aide and onetime cop had the guile to pass as a nurse and the savvy to find a restricted area where he would likely find leftover painkillers.

“Inside a storage bin was a vial of Fentanyl, a synthetic opioid more powerful than morphine and normally reserved for surgery. He slipped it into his pocket and went home to feed his blinding addiction to painkillers. Kaju isn’t surprised at the recent rash of painkiller thefts by employees of Minnesota hospitals. He knows the desperation and ingenuity of a prescription-drug junkie inside a medical facility.

http://www.startribune.com/local/133752113.html

Waste security is essential, though this is often overlooked and there is no policing of this by the appropriate regulatory bodies who seem to have abrogated responsibility for this issue. Consigning these syringes into sharps bins intended for treatment by incineration may be futile since this merely identifies those bins as targets for pilfering while security is poor. Better to discharge the syringe content to a simple DOOM (disposal of old medicines) kit or equivalent. It’s a simple option that will ensure that all drug wastes, and particularly those Controlled Drugs, are put beyond use.

However, there is a fly in the ointment. DOOM kits, DOOP pots and equivalent are nothing more that a pot of dried flakes of wallpaper paste with a poster paint powder additive to comply with ‘corporate colour’. Though I was asked to evaluate the very first of these drug disposal pots and was impressed by this simple and low-cost but practical solution I did make one absolutely strict proposal, that the kits were prepared with a Bitrex™ additive. This was not done, though the recommendation stil stands.

Bitrex™ is one of, or possibly the most bitter substance known and even the smallest amount make the product impossible to swallow. However, though the addition of CDs to wallpaper paste results in a thick gel that is impossible to inject there is presently no Bitrex™ additive. It is irresponsible to suspect that those who scavenge discarded pharmaceuticals will not eat those discard gels that they find.

Users should demand that suppliers confirm the addition of Bitrex™ to all DOOM kits and equivalent.