Compared to pharmaceutical manufacturing, hazardous drugs have a narrow definition in the world of pharmacy. This article will compare and contrast the differences in the approach and knowledge base that exists in both worlds, in terms of defining and coping with the hazards these drugs represent.

Typically, pharmacy considers a hazardous drug to be an antineoplastic or cancer drug, while pharmaceutical manufacturers understand that all drugs have a potential hazard to those working with them. Changing the paradigm for pharmacy will occur with the increased understanding that exposure risk is based on both amount and form (liquid or powder) of the drug, as well as the route of entry into the body. The routes of entry are inhalation (through the nose or mouth), dermal (contact with the skin), or ingestion. Ingestion occurs when items such as food or drink come into contact with a drug and are then swallowed.

Pharmacists have been conditioned by information contained in a number of articles^1,2 appearing in the American Journal of Health System Pharmacy. These articles identified the presence of several cancer drugs on floors and counters outside of biological safety cabinets used for compounding the drugs. This created a deep concern among pharmacists that the mere detection of any antineoplastic in the workplace put them at risk. The articles did not consider several factors, which are incorporated into a risk assessment approach, for evaluating the impact exposure to the drug. These factors include the quantity present, the form of the drug, and potential routes of exposure for the health care worker.

The conditioning of pharmacists continued into 2004 when NIOSH released a hazardous drug alert.³ NIOSH recognized that they had no data, nor had they done any form of risk assessment. The alert depended heavily on anecdotal experiences to create a heightened concern by healthcare workers, including individuals working in pharmacies.

The paradigm was established that any detectable amount of an antineoplastic drug was hazardous.