The safe management of pharmaceutical items and their associated waste is an everyday task for the dental practice. This is especially the case for the sedatives used in the treatment of anxious patients, as well as some surgical procedures.
All members of the dental team will be responsible for the safe management of pharmaceutical items in some way. Each team member must have appropriate knowledge of intravenous sedation (IV), how to store associated controlled drugs, and how to safely dispose of all the disposable items used in the procedure.
Indications for use
Dental sedation is an alternative to general anaesthesia, where a patient retains consciousness but is more relaxed during treatment, without feeling pain. Despite being awake throughout, most patients will remember very little of the treatment, and may feel as though they have slept.[i] Using conscious sedation in place of general anaesthesia assures patient safety whilst reducing the time needed before patient discharge.[ii]
IV sedation uses a thin needle to access a vein, usually in the back of the hand or arm, which is then replaced with a cannula to deliver the chosen sedative. A benzodiazepine, midazolam, is the most commonly used solution outside of hospital settings;1 it is indicated for conscious sedation for adults and the elderly by slow IV injection, applied shortly before the procedure begins.[iii]
The application must be carried out by an appropriately trained professional who should also know how to store, handle and dispose of the pharmaceutical, as well as all associated equipment.
Pharmaceutical waste
Midazolam is a Schedule 3 pharmaceutical, which is of note as most other benzodiazepines fall under Schedule 4.[iv] This is defined in the latest versions of the Misuse of Drugs Regulations 2001, which set the framework for safe management of controlled drugs, including in healthcare environments.[v]
As a Schedule 3 pharmaceutical, midazolam does not require storage in a controlled drug cupboard or a register for its presence on site.[vi] Invoices for the solution, on the other hand, must be kept for up to two years.[vii]
Some of the biggest restraints around management come with the disposal of the material. As a Schedule 3 drug, midazolam must be denatured before disposal, and therefore rendered irretrievable.[viii] Current guidance explicitly states that it is not acceptable to simply put used or partly used midazolam ampoules and syringes into pharmaceutical waste or sharps containers, or to empty them into the waste stream.7 Denaturing kits are available from trusted waste management suppliers, and dental teams should use these wherever practical. This step is vital for protecting the dental team, patients, waste handlers, and the wider environment, in case the waste container is mismanaged and the contaminated items inside are exposed prior to the final steps of disposal.
The used drug denaturing kit should be disposed of in a blue-lidded pharmaceutical bin, where it will be destroyed via incineration. Other contaminated items used throughout intravenous application, including the controlled drug container, IV bags and syringes, will still require safe management. Unlike denatured midazolam itself, however, the blue pharmaceutical waste container will not be their destination.
Disposing of contaminated material
To understand the correct destination for waste types, Health Technical Memorandum 07-01 (HTM 07-01) is considered the gold standard for current guidance. In its explanation of the clinical waste colour coding and storage guide, IV bags (and by extension similarly contaminated material) are an example of waste for the yellow stream, which is used for infectious waste that is contaminated with medicinal or chemical properties, that requires incineration or alternative treatment.[1]
Similarly, any contaminated sharp items, including needles, should be disposed of in a yellow unit. A dedicated sharps container will be needed to minimise puncture risk.9 Excess liquid material in a syringe should not be discharged into the drains, and instead should be kept inside the syringe before being placed in a yellow container.
To protect patients and the dental team when disposing of IV waste, and midazolam in particular, it’s important to have reliable waste containers at points of use. Initial Medical, a leading waste management specialist in the UK, provides Controlled Drug Denaturing Kits and environmentally friendly Eco Sharps Bins to suit your everyday needs. The latter are made with 40% recycled plastic, and are puncture-resistant, as well as colour-coded following current guidelines – meaning they are a safe, seamless fit into your workflow.
Supporting patients with IV sedation is a key part of modern dentistry and ensures more individuals can receive the care they need. Knowledge of safe storage, application, and disposal of controlled drugs and contaminated items is vital and helps to keep every attendee of the practice safe.
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Author: Rebecca Waters – Rentokil Initial
[1] NHS England, (2022). Health Technical Memorandum 07-01: Safe and sustainable management of healthcare waste. (Online) Available at: https://www.england.nhs.uk/wp-content/uploads/2021/05/B2159iii-health-technical-memorandum-07-01.pdf [Accessed January 2026]
[i] Oxfordshire Community Dental Service, (N.D.). Intravenous sedation information leaflet. (Online) Available at: https://www.oxfordhealth.nhs.uk/wp-content/uploads/2020/03/OH-046.19-IV-sedation-dental-info-leaflet.pdf [Accessed January 2026]
[ii] Melini, M., Forni, A., Cavallin, F., Parotto, M., & Zanette, G. (2020). Conscious sedation for the management of dental anxiety in third molar extraction surgery: a systematic review. BMC oral health, 20(1), 155.
[iii] National Institute for Health and Care Excellence, (N.D.). Midazolam. (Online) Available at: https://bnf.nice.org.uk/drugs/midazolam/ [Accessed January 2026]
[iv] National Institute for Health and Care Excellence, (N.D.). Controlled drugs and drug dependence. (Online) Available at: https://bnf.nice.org.uk/medicines-guidance/controlled-drugs-and-drug-dependence/ [Accessed January 2026]
[v] The Misuse of Drugs Regulations 2001, (15/01/2025). Available at: https://www.legislation.gov.uk/uksi/2001/3998 [Accessed January 2026]
[vi] Care Quality Commission, (2024). GP mythbuster 28: Management of controlled drugs. (Online) Available at: https://www.cqc.org.uk/guidance-providers/gps/gp-mythbusters/gp-mythbuster-28-management-controlled-drugs [Accessed January 2026]
[vii] NHS, UK Medicines Information, (2016). How should dentists prescribe, store, order and dispose of controlled drugs? (Online) Available at: https://www.sps.nhs.uk/wp-content/uploads/2016/06/NW-QA178.4-Controlled-drugs-for-dentists-1-1.pdf [Accessed January 2026]
[viii] Specialist Pharmacy Service, NHS, (2025). Managing Controlled Drugs (CD) Waste. (Online) Available at: https://www.sps.nhs.uk/articles/managing-controlled-drugs-cd-waste/ [Accessed January 2026]
About Initial Medical
Initial Medical set the standard in healthcare and infectious waste management in the UK, providing a reliable, effective and fully compliant service built around customer needs and delivered by our highly trained local teams. We are ISO 9001:2015 accredited, with technology fully integrated into our operations, providing full traceability of service delivery, electronic waste documentation and the best customer experience possible. We also offer innovative healthcare waste management services and infection control products to help break the chain of transmission and prevent cross contamination.
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