Regulations · 4 min read · Updated 6 November 2026
Disposing of dental medicines and controlled drugs: a UK guide
Medicines a dental practice typically holds
Even a small practice keeps a range of medicines: local anaesthetic cartridges, the emergency drug kit, topical anaesthetics, fluoride varnish and high-fluoride toothpaste, and sometimes antibiotics, analgesics or sedation drugs. All of them eventually go out of date, and the emergency kit in particular has to be checked and replaced regularly, so pharmaceutical waste is a steady stream rather than an occasional one.
Pharmaceutical waste is usually treated by high-temperature incineration, which is why it must be kept separate from offensive waste and general rubbish. Putting medicines in the wrong stream can lead to rejected loads and extra charges from your contractor.
Which container for which medicine
| Item | Container or route |
|---|---|
| Expired tablets, capsules, gels and creams | Pharmaceutical waste container, usually blue-lidded |
| Part-used local anaesthetic cartridges | Yellow-lidded sharps container |
| Adrenaline ampoules and auto-injectors | Yellow-lidded sharps container |
| Glucagon kits | Yellow-lidded sharps container if a needle is attached, otherwise pharmaceutical waste |
| Salbutamol inhalers and GTN sprays | Pharmaceutical waste, never punctured or crushed |
| Midazolam and other controlled drugs | Denature first, then pharmaceutical waste |
| Cytotoxic or cytostatic medicines, rarely used in dentistry | Purple-lidded container |
| Medical oxygen cylinders | Return to the supplier |
Check your contractor's container list, as some supply a single pharmaceutical container for mixed non-cytotoxic medicines and others separate liquids and solids.
Controlled drugs: midazolam and denaturing
Midazolam, used for sedation and for treating prolonged seizures in the emergency kit, is a Schedule 3 controlled drug. Home Office advice is that Schedule 2, 3 and 4 part 1 controlled drugs should be denatured before disposal, which means making them irretrievable so they cannot be reused or diverted.
- Use a commercial controlled drug denaturing kit for liquids and solids
- For very small liquid residues, an absorbent such as cat litter can be used if a kit is not practical, but not paper towel or cotton wool
- Witness the destruction, ideally by a registered healthcare professional
- Record the destruction in line with your controlled drugs procedures
- Put the denatured kit into the pharmaceutical waste stream
- Return patients' own controlled drugs, such as prescribed buccal midazolam, to a community pharmacy
In England, sites that sort and denature controlled drugs need a T28 waste exemption from the Environment Agency, which is free and site-specific. Wales has an equivalent position from Natural Resources Wales, and practices in Scotland and Northern Ireland should check their own regulator's requirements.
Never down the drain
Medicines must not be poured down sinks or toilets, even in small amounts. They pass through sewage treatment and into rivers, and discharging them is not allowed. Liquids from part-used vials and syringes go into denaturing kits or the pharmaceutical waste container, not the sink.
Checking the emergency drug kit
Most practices check their emergency drugs and equipment at least weekly. Building waste into that check makes disposal routine rather than a scramble when stock expires.
- Keep a list of every emergency drug with its expiry date
- Order replacements before items expire
- Put expired items straight into the right container on the day they are removed
- Denature expired midazolam with a witness and record it
- Keep the pharmaceutical waste container near where the kit is checked
- Record what was disposed of and when
Storing pharmaceutical waste before collection
Pharmaceutical waste is attractive to anyone looking for drugs, so it needs the same care as stock. Keep the container in a staff-only area, close the lid between uses and do not leave it in reception or corridors. Once a container is full, seal it, label it with the practice details and date, and store it securely with your other clinical waste until collection.
- Use a container sized for your volumes so it is collected before it becomes cluttered
- Keep it away from heat and direct sunlight
- Never store medicines waste loose in bags
- Keep denatured controlled drug kits in the container until collection, not in a drawer
- Check the container is on the consignment note when it leaves the practice
Empty packaging and paperwork
Empty, clean medicine packaging such as outer cartons and leaflets can go in recycling, but blister packs with tablets left in them and bottles with residue are pharmaceutical waste. Remove or obscure patient labels before recycling anything with personal data. Pharmaceutical waste is usually collected as hazardous waste, so each collection should come with a consignment note in England and Wales.
Frequently asked questions
What colour bin do expired medicines go in?
Non-cytotoxic and non-cytostatic medicines go in a pharmaceutical waste container, normally with a blue lid, for incineration. Cytotoxic and cytostatic medicines, which are rare in dentistry, go in purple-lidded containers. Medicines in sharps, such as part-used cartridges and adrenaline, go in yellow-lidded sharps containers. Your contractor's container guide should confirm what goes where.
How should a dental practice dispose of expired midazolam?
Midazolam is a Schedule 3 controlled drug, so it should be denatured using a controlled drug destruction kit before disposal, ideally witnessed by a registered healthcare professional and recorded. The denatured kit then goes in the pharmaceutical waste stream. In England the site needs a T28 exemption to denature controlled drugs. Never pour midazolam down the sink or put it in the general waste, even in small amounts.
Can old oxygen cylinders go in the waste?
No. Medical oxygen cylinders remain the property of the supplier in most cases and should be returned to them when empty, out of date or no longer needed. Pressurised cylinders must never be put in general, clinical or pharmaceutical waste, as they can explode if crushed or incinerated. Check your supplier's collection arrangements, and keep cylinders stored securely and upright until they are collected.
pharmaceutical waste midazolam controlled drugs emergency drugs
