June 22, 2021

A Hidden Risk: Tackling the Challenges of Propofol Disposal

Although healthcare organizations are committed to safe drug disposal to protect staff and patients and prevent negative environmental impacts, much of their attention is focused on hazardous drugs such as warfarin and chemotherapeutic agents and controlled substances like prescription opioids. However, propofol is a potentially dangerous drug that may be overlooked, possibly putting organizations and their staff at risk.

What Is Propofol?

Propofol (also known as Diprivan) is a short-acting sedative primarily used in the operating room (OR) to relax and sedate patients before surgical procedures and to supplement general anesthetics. It is also

used for long-term sedation in intensive care units (ICUs), such as for critically ill patients who require a breathing tube connected to a ventilator. When used in sub-anesthetic doses, propofol induces psychotropic effects similar to other addictive drugs.

Is Propofol Dangerous?

When used inappropriately, propofol can cause life-threatening side effects and lead to addiction and overdose. Substance abuse among medical professionals is about the same as it is for the general population, however certain disciplines are disproportionally affected by propofol. According to one source, propofol accounts for 41% of reported substance abuse cases among anesthesia providers and is one of the most commonly diverted drugs by anesthesia nurses. Nurses and technicians have also been found to abuse the drug, although at lesser rates. While recent data is limited, past studies suggest that propofol addiction rates are on the rise. Despite the drug’s risks, it is not included on the Drug Enforcement Administration’s (DEA) list of controlled substances. This means all licensed physicians can access the drug without being a DEA registrant, and it is readily available in certain settings, including ORs and ICUs.

What Are the Challenges Associated with Propofol Disposal?

Propofol is often leftover or wasted in hospital settings. In fact, propofol is the most commonly wasted pharmaceutical in the operating room by volume. Despite this, many hospitals do not have secure processes or designated containers for its disposal, which presents environmental and staff health risks.

Regarding the ecological impact, the lack of appropriate containers can lead to sewering—where staff is forced to flush or pour the leftover medication down the sink. This situation makes many healthcare workers uncomfortable and violates the intent and spirit of the Environmental Protection Agency (EPA) guidance. Although scientists do not fully understand the effects of trace pharmaceuticals on humans, there is enough evidence that drugs in waterways may cause harm. It is critical that organizations avoid flushing drugs—both hazardous and non-hazardous ones—down the sink. This is especially important for propofol, which does not degrade in nature and is toxic to the aquatic environment.

From a staff health perspective, the opportunity for drug diversion—where people steal pharmaceuticals to use for recreational purposes—is a concern. Because propofol is not controlled by the DEA, staff can potentially access it more easily than other addictive substances like opioids. If there are not appropriate drug disposal containers in ORs and ICUs, the risk of diversion can increase and ratchet up the chances for abuse. 

What Are Best Practices to Encourage Safe Propofol Disposal?

One best practice is to include propofol in current controlled substance disposal strategies to safeguard staff and the environment. Although the drug is not currently regulated by the DEA, it was recommended by the DEA to be added as a schedule IV drug in 2010.

If a hospital opts to dispose of propofol as a controlled substance, it will need to incorporate the drug into current policies, emphasizing the need for equipment that facilitates secure disposal and comprehensive training to ensure staff understand the risks associated with the drug and proper disposal.

What Type of Disposal Solutions Are Appropriate for Propofol?

Organizations may opt to use specially designed containers that immediately deactivate the drug on contact and ensure it cannot be retrieved once discarded. Not only does this prevent the drug from entering the waste stream, but it also limits the opportunity for drug diversion. Organizations should consider placing these receptacles in their ORs and ICUs where propofol is used, so staff can reach them easily without having to leave the patient care area. Hospitals and health systems should also partner with a licensed waste management vendor to remove the containers at predefined times and replace them with new, empty ones. This reduces the burden on staff to empty the containers, and it also maintains worker safety by limiting contact with the waste. The waste management vendor can then properly treat the waste, rendering it safe for disposal in a landfill.

What Should Staff Training about Propofol Entail?

As with other drug disposal training, staff should learn about the risks of propofol and how to safely handle the drug. Trainings should occur during orientation and annually as part of refreshers. Periodically mentioning the topic in employee newsletters and staff meetings is also valuable to build awareness. Weaving the topic into online training can also be beneficial as these are easy to access and are kept current with the latest regulatory information. Using real-world examples to underscore the seriousness of the topic and the need to follow defined processes can be especially helpful.

Although the risks associated with propofol are relatively low as compared to other controlled substances, the drug still represents a hazard that hospitals and health systems should address. Learn more about how Stericycle can help ensure proper propofol and other controlled substance waste disposal and prevent drug diversion.

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