Chemotherapy & Hazardous Drugs

Drugs are classified as hazardous if they may cause cancer, developmental or reproductive toxicity or harm to organs at low doses. They include drugs used for cancer chemotherapy (also called antineoplastics), antiviral drugs, hormones, some bioengineered drugs and other various drugs.

Check the NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings (2014) to determine if a drug is classified as hazardous.

Safe use and handling

Follow safety precautions when working with hazardous drugs. These include use of exhausted enclosures, procedures to avoid personal exposure and contaminating surfaces, personal protective equipment (PPE) and training of personnel in hazard awareness and safe work practices.

Federal and state regulations and guidelines exist for the use, handling, storage, treatment and disposal of hazardous drugs in clinical and research settings. Environmental Health & Safety (EH&S) has developed guidance that includes procedures for safety, compliance and best practices. For research involving hazardous drugs at UW, follow these guidelines:

For veterinary clinical care, use the Veterinary Hazardous Drug Program Guide from Washington State Labor & Industries.

Waste: Trace vs Non-Trace

Manage chemotherapy (chemo) and hazardous drug waste separately from other waste streams such as biohazardous waste. Chemo/hazardous drug waste should not be autoclaved. Collect chemo/hazardous drug waste as either trace or non-trace waste as defined below.

Trace Waste

"Trace" refers to empty containers or containers that have less than 3% of the original quantity of drug remaining, such as sharps, empty syringes and vials. An "empty" container is one in which all contents have been removed by normal means such as aspiration, pouring or flushing.

Non-Trace Waste and P-Listed Drugs

Non-trace chemo/hazardous drug waste refers to unused or expired drugs, containers with more than trace amounts of chemo/hazardous drug, contaminated PPE and contaminated items from preparation, use, and clean-up. Dispose of non-contaminated PPE and other items in the trash.

Environmental Protection Agency (EPA) P-listed drugs are acutely hazardous drugs regulated by federal law. Handle all P-listed drug waste (including empty containers and trace amounts) as non-trace chemo/hazardous drug waste. P-listed chemo/hazardous drugs include:

Waste Code Constituent of Concern Product Name Examples
P001 Warfarin and salts (>0.3%) Coumadin, Warfarin
P012 Arsenic trioxide Trisenox
P042 Epinephrine Adrenaline, EpiPen, Eppy/N, Epifrin, Epinal, Anaphylaxis kit, Epinephrine, Racepinephrine, Racord, Primatene inhaler
P046 Phentermine Phentermine (CIV)
P075 Nicotine and salts Nicotine patches, Habitrol, Nicoderm, Nicorette, Nicotrol, Tetrahydronicotyrine
P188 Physostigmine salicylate Eserine salicylate
P204 Physostigmine Eserine

Source: WA State Dept. of Ecology RCRA list

Trace Chemo/Hazardous Drug Waste

Non-Trace Chemo/Hazardous Drug Waste

What you can do to stay safe

  • Follow the guidelines for safe use and handling.
  • Learn to identify trace vs non-trace waste.
  • Do not autoclave chemotherapy or hazardous drug waste.
  • Take the required and recommended safety training courses.

Services available

Environmental Health & Safety can assist with training, consultation and help with any questions about chemotherapy and hazardous drugs.

Frequently asked question

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