From medicine cabinets to ecosystems: a Europe-wide assessment of household pharmaceutical waste disposal practices

Background: Unused and expired household medicines contribute to environmental pollution, avoidable healthcare costs, and public health risks, including antimicrobial resistance. Although regulatory frameworks for pharmaceutical waste disposal exist across Europe, real-world practices remain poorly characterised and unevenly implemented. Comprehensive, contemporary evidence on how household medication disposal systems operate across European countries is lacking. Methods: A Europe-wide, cross-sectional online expert survey was conducted from 17 March to 15 October 2025. Experts in healthcare, pharmacy, regulation, and health policy provided structured information on national legislation, collection systems, disposal practices, public awareness activities, and economic arrangements for unused or expired household medicines. Data were consolidated at the country level and analysed descriptively. Results: Forty valid responses were received from experts across 35 European countries. Dedicated legislation for household pharmaceutical waste was reported in 30 countries, while five lacked specific legal provisions and three reported no formal collection system. Pharmacy-based take-back schemes operated in 31 countries, yet their organisation, funding, and effectiveness varied widely. In eight countries, unused medicines were commonly discarded in household waste. Annual collection rates varied from 12.4 to over 200 g/capita. Extended producer responsibility schemes were reported in six countries and were associated with higher collection volumes and comprehensive national coverage. Public awareness campaigns were reported in 22 countries, but their scope, visibility, and evaluation were inconsistent. Systematic monitoring data were unavailable in most countries, and only seven reported reimbursement mechanisms for pharmacies collecting medicines. Conclusion: Household medication disposal practices across Europe remain highly heterogeneous, reflecting persistent gaps between policy intent and implementation. Inconsistent legislation, limited financing, variable public awareness, and weak monitoring undermine system performance. Coordinated European action is needed to harmonise standards, strengthen financing, and promote environmentally safe disposal of unused and expired household medicines.