Proper Handling of Propofol Waste: Disposal in Anesthesia Setting

April 18, 2022 | Pharmaceutical Waste Disposal

 

 

Propofol, also known under the brand name of Diprivan, is a non-barbiturate sedative used primarily by trained anesthetists in operating rooms to relax and sedate patients prior to invasive, surgical procedures. The drug causes loss of consciousness within forty seconds of injection, though with a short half-life.

Because the drug has been known to induce concentrations of dopamine in the brain and promote a ‘brain-reward’ feeling, it is important to properly handle and dispose of Propofol. Such processes not only reduce the risk of drug diversion by medical healthcare staff but the potential of the drug finding its way into the wrong hands and being used for recreational purposes.

Propofol is used as a supplement to general anesthetics, although is not currently listed as a controlled substance under the Controlled Substances Act. In 2010, a proposed rule was submitted to the Drug Enforcement Administration (DEA) to place the drug into the Schedule IV (low potential for abuse or dependency) drug listings, but as of 2021, the drug is not listed on the DEA’s Controlled Substances list.

Despite this, and the fact that Propofol does not fall under the same DEA regulations for drug disposal as controlled substances, the risks and dangers associated with recreational use of the drug require careful handling and disposal.

While proper handling of Propofol waste may be falling through the cracks, some states have taken the approach to treat Propofol as a controlled substance. Healthcare organizations, hospitals, and veterinary facilities have created their own drug disposal and drug diversion plans over the years. Safeguard your organization and your healthcare workers and patients by knowing the risks associated with Propofol use and implementing proper control and drug disposal systems.

The Risks of Misuse and Improper Disposal

The American Association of Nurse Anesthetists (AANA), reports in Volume 85, No. 6, the December 2017 issue of the AANA Journal, that propofol makes up 41% of reported cases of substance abuse among anesthesia providers. Health organizations are taking notice of the risks associated with the misuse and improper handling of propofol waste, which include:

Although propofol is a pharmaceutical drug that is most commonly wasted in the OR, many hospitals do not have a secure disposal container as they do for controlled substances.  The AANA reports that implementing a drug disposal system with an easily accessible pharmaceutical waste container significantly decreased the instance of propofol misuse and improper disposal.

Risks of Misuse and Improper Disposal

Research and studies over the years have shown the potential of Propofol to not only be abused but that its use can also come with a high mortality rate. In recent years the DEA and the American Society of Anesthesiologists have suggested safety recommendations for its use, per a 2018 article in Brain Science “Neurobiology of Propofol Addiction and Supportive Evidence: What is the New Development?

The American Association of Nurse Anesthetists (AANA), reports in a December 2017 article, “Propofol Disposal in the Anesthesia Setting: Overcoming Barriers” that Propofol makes up 41% of reported cases of substance abuse among anesthesia providers.

As a result, health organizations are taking notice of the risks associated with the misuse and improper handling and disposal of Propofol waste, which have the potential to lead to drug diversion practices and environmental harm.

Drug diversion and an increase in the instances of Propofol addiction were noted at an alarming rate between 1990 and 2010, with a 25% increase of individuals seeking drug addiction programs, with anesthesia professionals making up a majority of those cases. According to a position statement by the American Association of Nurse Anesthesiology, Propofol is listed among the most commonly abused drugs by anesthesia professionals. As such, easy access by health care workers makes them more prone to drug diversion and addiction.

Environmental Concerns of Improper Propofol Disposal 

Certified Registered Nurse Anesthetists (CRNAs) have environmental concerns regarding discarding unused Propofol into sinks or other drains, in addition to the fact that many CRNAs have limited access to sinks in operating room. However, disposal practices are changing to decrease not only environmental risk and negative impact of medicines flushed or poured down sinks, but to safely and securely dispose of such drugs.

Propofol has been shown to be toxic to aquatic life and does not degrade in nature. It can only be destroyed through incineration following proper collection in secure storage containers.

https://journals.lww.com/anesthesia-analgesia/Fulltext/2012/05000/Propofol_Wastage_in_Anesthesia.26.aspx#:~:text=Propofol%20is%20an%20environmental%20hazard%20because%20it%20does,20%2C%2050%2C%20and%20100%20mL%20vials%20of%20propofol.

Improving Proper Handling of Propofol Waste 

Although Propofol is a pharmaceutical drug that is most commonly wasted in the OR, many hospitals do not have a secure disposal container for this drug as they do for controlled substances. The AANA reports that implementing a drug disposal system with an easily accessible pharmaceutical waste container significantly decreased the instances of Propofol misuse and improper disposal.

The AANA conducted an evidence based practice project at a large, Midwestern teaching facility to address the proper handling of Propofol waste. By implementing a fast-acting disposal container in each operating room, the practice of sink disposal decreased significantly and the percentage of unemptied vials of Propofol that remained in unsecured bins decreased to 3.4% from 25.8%. The new method replaced sink disposal and provided a more convenient method of Propofol disposal. 

Rx Destroyer Provides Disposal Solutions

Rx Destroyer™ drug disposal works with hospitals and healthcare facilities to establish safe and easy system-wide drug disposal solutions, including in operating rooms.

Our chemical drug destruction meets DEA “non-retrievable” standards and exceeds pharmaceutical waste disposal regulations in most states. We work with many hospitals, pharmacies, long term care facilities, veterinarian professionals, and other institutions for quick and seamless facility implementation.

Our patented* drug disposal formula is available in a wide range of convenient containers for safe, easy and affordable drug disposal. With Rx Destroyer, there is no need to add water. Simply load unused medication into the bottle and gently shake. We are dedicated to saving water and saving lives, one prescription at a time.

Our experts provide seamless facility implementation with drug disposal solutions meeting EPA and DEA regulations. Contact us to learn more about our easy-to-use, eco-friendly drug disposal solutions and the proper handling of Propofol waste.