By analysing the pharmaceutical waste produced by eight operating rooms, an anaesthetist in New York found that discarded or wasted propofol made up 45% of all the drug waste.

Future wastage was reduced by removing 50 ml and 100 ml vials of propofol from the pharmacy, and retaining only the smallest size – 20 ml. This waste reduction matters – propofol does not degrade in nature, accumulates in body fat, and is toxic to aquatic life.

Anesthesia and Analgesia 2012;114:1091-2, doi:10.1213/ANE.0b013e31824ea491

 This is a simple, direct and obviously very effective approach to reducing drug waste and reducing the environmental impact of drug wastes in outflows from hospitals.

Propofol is a dangerous drug that reduces anxiety and tension, and promotes relaxation and sleep or loss of consciousness. Propofol provides loss of awareness for short diagnostic tests and surgical procedures, sleep at the beginning of surgery, and supplements other types of general anesthetics. It is often used with a number of controlled drugs by anaesthetists, with each drug drawn up in excess in marked syringes; the patient is then maintained with small additional drug volumes as required during their operation in circumstances where there is no time to draw up additional volumes from a fresh vial.

That creates an additional problem. Unused drugs in their syringes are often discarded intact directly into a sharps bin making those bins a target for scavengers. This was not uncommon 30 years ago in London and may happen again. Safe disposal practice developed to ensure no risk of illicit salvage of these drug wastes but as this entailed emptying the syringes into a drain the environmental impact makes this no longer acceptable.

Waste security should be adequate to prevent scavengers having access to any clinical wastes but this is rarely in place. Better are the various drug disposal kits that are available to mix liquid drug residues with an inert gel or absorbent granule – wallpaper paste or cat litter are useful – but these must be rendered unpalatable by the addition of Bitrex to make it impossible for even the most desperate individuals to consider any attempt at recovery. Without delay, this denatured drug waste must be incinerated.