8.8.1. Destruction of Controlled Drugs

All Ward stock CDs under safe custody which are no longer required (have reached their expiry date or patient’s own) must not be returned to Pharmacy but should be destroyed at Ward / Department level by two registered healthcare professionals, where one must be a Pharmacist or Pharmacy Technician.

Please refer to local SOPs for the destruction of CDs which are not under safe custody restrictions. Please note, that these CDs can be destroyed by two registered healthcare professionals, where one must be a Pharmacist or Pharmacy Technician at Ward / Department level.

The Controlled Drug Register (where applicable) should be completed accordingly with the date, time, reason for destruction and the quantity destroyed. Each entry should be signed by the two members of staff involved. Ensure that the register balance matches physical balance. The CD team must be notified of any discrepancy and a DATIX entry submitted.

Please note that Schedule 2 Controlled Drugs are all subject to restrictions on possession and supply and require secure storage (alongside Schedule 3 Burpenorphine and Temazepam).  It is the responsibility of the Ward / Department to ensure they have appropriately sized / quantity of CD Destruction Kits for destruction.

All Controlled Drugs must be rendered irretrievable prior to disposal using a denaturing kit (see Section 8.8.4.).

For destruction of Controlled Drugs (all schedules), see table for guidance (see Section 8.8.2.).

8.8.2. CD Destruction within NHS Tayside Hospital Wards and Community Hospitals ONLY

8.8.3. CD Destruction within NHS Tayside GP Practices and Community Pharmacies

In Hospital Pharmacy, Community Pharmacy and General Practice CDs can only be destroyed in the presence of an Authorised Witness (person who has signed authorisation from Controlled Drugs Accountable Officer). For the destruction of Schedule 2 Controlled Drugs (within Community Pharmacy and General Practitioner settings), please contact tay.cdteam@nhs.scot to arrange a destruction. It is the responsibility of the Community Pharmacy / GP Practice to ensure they have appropriately sized / quantity of CD Destruction Kits for destruction.

8.8.4. Controlled Drugs Types and their Destruction Process

·         Aerosols: Remove the metal collar from around the top of the bottle using appropriate equipment. Remove the bottle cap which includes the entire pump assembly. Use a pipette or syringe to remove the contents into a denaturing kit. Double rinse the container and pour into the destruction kit. Following double rinsing the bottles can have their labels removed and placed into appropriate waste streams for uplift. Or blue lidded pharmaceutical waste container.

·         Ampoules: Remove ampoule from packaging, ensure no liquid in the top of the vial by flicking the top and ensure it falls to the base of the ampoule. Break the ampoule at the weak point and aspirate its contents using a syringe or pipette before dispensing into the destruction kit. Place the empty ampoule into the destruction kit. If this is not possible, the empty ampoule must go into a blue lidded pharmaceutical waste container. The syringe or pipette must be disposed of appropriately, either into the destruction kit (size dependant) or into the blue lidded pharmaceutical waste container.

·         Capsules: Pull apart both ends of the capsule and empty its contents into the destruction kit. Place both ends of the capsule shell in the destruction kit.

·         Concerta: Remove the tablet from its packaging and fully submerge the tablets in boiling water (in a suitable container) until it has fully melted. Add all of the liquid and the remaining part of the tablet to the denaturing kit.

·         Liquids: Measure the volume in a measuring cylinder (if bottle is opened, if the bottle is sealed, use manufacturer volume). Remove the lid from the bottle and pour its contents into the destruction kit. Double rinse the container and measuring cylinder and pour into the destruction kit. Following double rinsing the bottles can have their name and signage deleted and placed into appropriate waste streams for uplift. Or Pharmaceutical waste bin.

·         Lozenges: Remove the lozenge from its packaging and fully submerge in boiling water (in a suitable receptacle) and melt. Add all of the liquid to the denaturing kit.

·         Patches: Remove the patch from its packaging and peel off the protective coating. Fold the patch onto itself several times ensuring no drug is exposed. Place the folded patch into the destruction kit.

·         Powdered injections: Reconstitute with water to dissolve powder. Aspirate its contents using a syringe or pipette before dispensing into the destruction kit. Place the empty vial into the destruction kit. If this is not possible, the empty vial must go into a Pharmaceutical waste bin.

·         Sachets: Hold the sachet and flick the packet to ensure the powder falls to the base of the sachet. Carefully open over the destruction kit and then empty its contents into the destruction kit, ensuring that all contents have been emptied. Place the empty packaging into the destruction kit. If this is not possible, the packaging must go into a Pharmaceutical waste bin.

·         Suppositories: Remove the suppository from its packaging and place into boiling water (in a suitable receptacle) and melt. Add all of the liquid to the denaturing kit.

·         Tablets: All must be crushed. Remove tablet (s) from packaging and place in a tablet crusher or Mortar. Use the Pestle to crush the tablet if using a Mortar. All tablets must be completely crushed into a fine powder in which no larger pieces can be retrieved. Pour the crushed contents into a destruction kit. Remove as much of the powder which may be stubborn and remain on the bottom of the Mortar using a spatula. Rinse the Mortar with water and dispose that water into the destruction kit.

·         After all CD’s have been appropriately destroyed and placed into the denaturing kit, water should then be added. Place the lid on securely and shake vigorously (over a sink), therefore, activating the solution and rendering the drugs irretrievable. Once the contents have congealed, the destruction kit should be placed into a blue lidded pharmaceutical waste container and then sealed to avoid any diversion of the kit.

All Controlled Drugs must be rendered irretrievable prior to disposal. This will require the use of a Pestle and Mortar, syringe/pipette or boiling water to destroy each before being placed into a destruction kit. Please ensure appropriate PPE is worn during the destruction. The sequence in which items should be destroyed is:

·         Tablets

·         Capsules

·         Patches

·         Sachets

·         Ampoules

·         Aerosol

·         Lozenges

·         Suppositories

·         Liquids

8.8.5. Destruction of Patient’s Own CDs in a Hospital Ward or Department

Where patients have brought their own CDs into Hospital with them and they are no longer required, or if a labelled ‘Patient’s Own’ supply has been made by Pharmacy and is no longer required, these CDs can be destroyed by 2 registered healthcare professionals, where one must be a Pharmacist or Pharmacy Technician at Ward level (with patient’s consent):

CDs which have not left the Dispensary but have been labelled for patient and remain uncollected remains as Pharmacy stock, therefore, must be destroyed in the presence of an Authorised Witness. Patient’s Own CDs on the Ward do not need to be destroyed in the presence of an Authorised Witness (see Section 8.8.2.).

·         CDs must be rendered irretrievable before disposal using a CD Destruction kit (see Section 8.8.4.)

·         A record of the quantities destroyed must be made in the appropriate page of the CD Register or ‘Patient’s Own’ CD Record Book of the CDs destroyed and must be signed by both parties

·         The used CD Destruction kit must be placed in a blue-topped medicines waste bin.

·         It is safer for patients prescribed CDs, who are dealing with many medicines, to go home with only medicines they currently require to manage their symptoms.

The Patient’s Own Controlled Drug Register should be retained for a period of seven years.

There is no legal requirement for patient returned Controlled Drugs requiring safe custody to be destroyed in the presence of an Authorised Witness.

8.8.6. Destruction of Remainders of Continuous Infusions Containing CDs

When a continuous infusion containing a CD is commenced, the total amount in the prepared infusion is considered as “administered” as far as the entry in the CD Register is concerned.

If the infusion is discontinued before all of the solution has been infused, the amount remaining must be checked by two registered healthcare practitioners where one must be a Pharmacist or Pharmacy Technician, or a registered healthcare professional and a suitably trained competent witness if available against the TPAR, and must then be discarded into a pharmaceutical waste bin containing a Vernagel sachet.  

It is recognised that there may only be one registered professional available and therefore, local policies must be referred to. The destruction must be witnessed, and both staff involved must sign on the designated part of the infusion record chart. Complete the CD Register and annotate clearly.

8.8.7. Disposal of Unused Part of CD Doses

This applies only to CD doses that are to be discarded after being prepared for administration to a patient.

Discarded part of CD doses should be rendered irretrievable on disposal (the contents of the ampoule must be expelled on top of the Vernagel in the blue lidded pharmaceutical waste container. Placing a full ampoule into the blue lidded pharmaceutical waste container containing CDs is not acceptable) (see Section 8.8.4.).

Liquids up to a maximum volume of 5mL, including part-used ampoules, syringes etc, should be dispensed into a blue lidded pharmaceutical waste container following the addition of Vernagel. Vernagel is an absorbent polymer which solidifies liquids. The Vernagel sachet should be placed into the bottom of the blue lidded pharmaceutical waste and any medicines to be disposed of should then be added. 

Larger volumes require the use of a CD Destruction Kit. One kit can be used for several discards during a session.