Prevention Guide - Safe Handling of Hazardous Drugs - Irsst

2. RISKS RELATED TO THE USE OF HAZARDOUS DRUGS
2 RISKS RELATED TO THE USE OF HAZARDOUS DRUGS
2.1 Hazardous Drugs
2.1.1 Definition of a Drug
In Quebec, a drug is defined as any substance or mixture of substances that can be used:
‣ for the diagnosis, treatment, alleviation or prevention of an illness, disorder, abnormal physical or
psychological condition, or their symptoms, in people or animals; or
‣ to restore, correct or modify the physiological functions of people or animals.
There are two widely-used international classifications of drugs. The World Health Organization suggests the use
of the anatomical, therapeutic and chemical (ATC) classification, while the American Hospital Formulary Service
(AHFS) has a similar classification system. The Régie de l’assurance-maladie du Québec (Quebec Health
Insurance Board) uses the AHFS classification as the Quebec frame of reference. The list of hazardous drugs
proposed by NIOSH (Appendix 2) also uses this classification.
This therapeutic classification groups the drugs according to their primary pharmacological effects (e.g., class
10:00 – antineoplastic agents, class 68:00 - hormones and substitutes, etc.).
For the purposes of this guide, antineoplastic drug includes such terms as anticancer drug and chemotherapy, as
well as the drugs classified as such in the AHFS classification.
2.1.2 Definition of a Hazardous Drug
NIOSH considers a drug to be hazardous if studies involving humans or animals show that it has one or more of
the following six characteristics.
Characteristics
according to NIOSH
Carcinogenic (GDT)*
Teratogenic (GDT)*
Genotoxic (ASHP)
Reproductive
Toxicity (ASHP)
Organ Toxicity at Low
Dose (ASHP)
Similar Drugs (ASHP)
Definitions
Applies to any substance or agent capable of promoting or causing the development of
a cancer or a lesion which could be the starting point of a cancer.
Quasi-synonym: carcinogen, cancerogen
The terms “carcinogenic” and “oncogenic” should not be confused. “Carcinogenic” is
used to refer solely to malignant tumours, while “oncogenic” is used to refer to both
benign and malignant tumours.
Applies to substances capable of causing congenital malformations due to an action on
the embryo.
Applies to substances with the ability to damage the genetic material (DNA) and cause
mutations.
Applies to substances affecting fertility (e.g., miscarriages, late fetal death, infertility).
Applies to substances with a toxic effect on an organ or on health at a low dose (e.g.
liver damage, local necrosis of exposed tissue, etc.).
Applies to substances whose structure and toxicity are similar to those of a drug
declared hazardous based on one of the above criteria.
* GDT: Grand dictionnaire terminologique (French/English terminology database)
PREVENTION GUIDE – SAFE HANDLING OF HAZARDOUS DRUGS ASSTSAS 2-1