Ethical approval

This study was performed in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the School of Biomedical Sciences Ethics Filter Committee (FCBMS) at Ulster University (Approval No: FCBMS-24–167-A). All participants completed a written informed consent prior to taking part in the study. Anonymity and confidentiality were maintained throughout.

Study design

This study adopted a qualitative descriptive design, guided by an inductive thematic analysis approach as outlined by Braun and Clarke [17]. The design was selected to address the research aim of exploring community pharmacists’ perspectives and experiences regarding medicine returns, medicine wastage, and safe disposal in Northern Ireland, and to identify context-specific recommendations for improved practice. The qualitative descriptive approach was considered appropriate as it provides a straightforward means of capturing and presenting participants’ views in their own words, particularly in areas where little prior research exists. Thematic analysis offered a flexible yet rigorous method for identifying, analysing, and reporting patterns within the data, allowing the researchers to develop a rich understanding of pharmacists’ operational realities without imposing pre-existing theoretical frameworks.

Participant recruitment

A purposive sampling strategy was used to ensure the inclusion of pharmacists from a range of ages, workplace settings (independent and chain pharmacies), geographical locations (urban, semi-urban, and rural), and professional backgrounds (varying years of experience and both managerial and non-managerial roles). To be eligible, participants had to be registered pharmacists working in community pharmacy in Northern Ireland, have at least one year of post-registration experience, and be directly involved in the handling of returned medicines and disposal processes. Recruitment was carried out through professional pharmacy networks, email invitations distributed via representative bodies, and direct contact with known pharmacy leads. No financial incentives were offered for participation. In total, 15 pharmacists took part in the study. Thematic saturation, defined as the point at which no new codes were identified during analysis, was reached by the thirteenth interview. Two further interviews were conducted to confirm the stability of the themes. Participant demographic information, including age, gender, years of experience, and type of pharmacy, is provided in Table 1 to aid interpretation and transferability.

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Table 1. Demographics of participants.

https://doi.org/10.1371/journal.pone.0346163.t001

Data collection

Data were gathered through semi-structured, in-depth interviews conducted online using Zoom or Microsoft Teams, depending on participant preference. This approach offered flexibility and accessibility for participants based in rural areas. The interview guide was developed following a review of literature on pharmaceutical waste, environmental sustainability, and public health practice. It covered eight broad areas, including current medicine return procedures, staff training and guidance, public engagement, regulatory awareness, environmental concerns, operational barriers, and suggestions for policy improvement. The guide was piloted with two pharmacists, resulting in refinements to improve clarity and flow, including the simplification of technical terms and reordering of questions to support a more natural conversation. Field notes were made immediately after each interview to capture contextual details such as tone, emphasis, and non-verbal cues where visible. Interviews lasted between 30 and 45 minutes, were audio-recorded with the participant’s informed consent, and were transcribed verbatim. All transcripts were anonymised during transcription to protect participant confidentiality. Interviews were conducted between January and May 2025.

Data analysis

Thematic analysis was undertaken following Braun and Clarke’s six-phase framework, adopting an inductive and semantic approach [17]. This meant that coding was driven by the data itself rather than a pre-existing theory, and that codes reflected the explicit meanings expressed by participants. Analysis began with familiarisation, where all transcripts were read multiple times by one of the researchers (EM), accompanied by reflective note-taking to record early impressions and potential patterns. Initial coding was conducted independently by the researcher (EM), working line-by-line through the transcripts to identify meaningful segments of data. Each segment was assigned a short descriptive label, forming the basis of a shared codebook. This codebook was updated iteratively through weekly meetings, where the research team (EM and KR) discussed, refined, merged, or split codes as necessary. Codes that did not initially fit with emerging patterns were set aside for later review. Once coding was complete, related codes were grouped into themes through an iterative clustering process. Visual mapping techniques were used to explore relationships between codes, and related concepts were brought together into broader categories (refer to Fig 2). For example, codes relating to “lack of formal training” and “No standardised protocols” were eventually combined under the theme “Work skills and support.” Themes were reviewed by EM and KR for internal consistency and distinctiveness, with sub-themes identified to highlight the different layers of meaning within the data. We (EM and KR) also looked for examples that did not fit the main patterns and used these to refine themes, broaden their scope, or highlight contrasting viewpoints in the findings. Each theme was then defined and named in a way that captured its core meaning and scope. Saturation was assessed during coding, with no new codes emerging after the thirteenth interview. The remaining two interviews were used to confirm thematic stability. In the write-up, we (EM and KR) combined our interpretation of the data with direct quotes from participants, choosing examples that showed views and opinions. All coding was done manually using Microsoft Word, without the use of qualitative software. Any differences in coding were resolved through consensus, and peer debriefing with the research team (EM and KR) took place every two weeks to challenge interpretations and maintain reflexivity.

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Fig 2. Visual mapping to explore relationships between codes and related concepts.

https://doi.org/10.1371/journal.pone.0346163.g002

Trustworthiness and rigour

The study adhered to Lincoln and Guba’s four criteria for trustworthiness: credibility, transferability, dependability, and confirmability [18]. Credibility was supported through investigator triangulation, regular peer debriefing, and the use of direct participant quotations to ground the analysis. Transferability was facilitated by providing a detailed description of the research setting, participant demographics, and study context. Dependability was ensured by maintaining an audit trail of coding decisions, codebook iterations, and theme refinement. Confirmability was enhanced through reflexive journaling, the use of negative case analysis, and secure retention of anonymised raw data for verification purposes. Member checking was considered but not undertaken, as the ethics committee advised it could compromise participant confidentiality in a small professional community and place additional time burdens on participants already under significant workload pressures. However, the research team engaged in repeated discussions to ensure that the final themes accurately reflected the data.

Reflexivity

The chief researcher (KR) is a pharmacy professional with experience in public health, pharmacy practice, and qualitative research. Another researcher (EM) brought expertise in environmental health, pharmacy education, and qualitative methodology. While these professional backgrounds provided valuable contextual insight, they also carried the risk of bias in interpreting participants’ accounts. To address this, the researcher (EM) maintained a reflexive journal to record assumptions, decisions, and reflections after each interview. This diversity of professional perspectives helped challenge individual interpretations and reduce the risk of bias. Team discussions (EM and KR) actively considered how personal and professional experiences might influence the analysis, and a conscious effort was made to ensure that participants’ voices were prioritised in the reporting of findings.

This manuscript adheres to the Standards for Reporting Qualitative Research (SRQR) checklist to ensure methodological transparency and rigour. The completed SRQR checklist is included as an S1 Checklist SRQR.

Participant characteristics

The demographic details of the participants are shown in Table 1. A total of 15 community pharmacists participated in the study. The age of participants ranged from 18 to over 40 years, with the majority aged between 31–40 years (40.00%), followed by those aged 41 and above (33.33%), and 18–30 years (26.67%). The sample comprised more female (60.00%) than male (40.00%) participants. Regarding professional experience, the largest group had 11–20 years of experience (40.00%), followed by 1–5 years (26.67%), 6–10 years (20.00%), and above 20 years (13.33%). In terms of job roles, 60.00% were practising pharmacists and 40.00% held pharmacist manager positions. Slightly more participants were based in rural settings (53.33%) than in urban locations (46.67%). This demographic diversity provided a broad perspective on medicine return and disposal practices across different levels of experience, roles, and geographical contexts. The seven key themes and their definitions are shown in Table 2.

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Table 2. Key themes and their definitions.

https://doi.org/10.1371/journal.pone.0346163.t002

Theme 1: Equitable access to return services

Participants described a lack of consistency in public knowledge and use of medicine return services. Participants reported that while some patients regularly return unused or expired medicines, others, particularly those from rural areas or with limited health literacy, may remain unaware of appropriate disposal options. This uneven awareness was viewed as a barrier to both environmental safety and effective waste reduction.

“Some people still don’t realise that you can return the medicines back to the chemist.” (P5)

“Posters don’t really work; people respond better to a quick chat.” (P14)

Some pharmacists observed increasing public engagement in recent years but agreed that further education is needed to reach vulnerable groups.

“There’s definitely more awareness now… but there’s still a long way to go.” (P9)

While efforts such as brief conversations and in-store reminders were mentioned, participants highlighted that there is no structured role or system for pharmacists to actively raise public literacy around medicine disposal.

Theme 2: Safe pharmacy disposal practices

Participants described procedures for the disposal of returned medicines, including the use of designated containers, waste segregation, and licensed third-party disposal services. These processes were particularly strict when dealing with controlled drugs, which require denaturing before disposal.

“We have dedicated bins… a licensed waste company comes and collects.” (P3)

“Controlled drugs need to be denatured… there’s a strict process.” (P2)

Despite these procedures, pharmacists expressed concern about the environmental implications of improper public disposal, such as flushing medicines down sinks or toilets.

“Improper disposal can contaminate water supplies or end up in landfills.” (P8)

This theme highlights both the professionalism within pharmacy waste handling and the need for stronger public messaging around environmental risks.

Theme 3: Waste reduction through supply control

Participants reported that medicine waste often originates from overprescribing, automatic repeat dispensing, or patient non-adherence. Many described active strategies to mitigate such waste, including engaging patients in medication reviews and collaborating with prescribers to minimise unnecessary supply.

“We check if patients really need everything before dispensing.” (P6)

“We try to work with GPs to reduce overprescribing.” (P4)

Participants expressed frustration that once medicines leave the pharmacy, even if unopened, they cannot legally be reused, which adds to the perception of wastefulness.

“Once medicines leave the pharmacy, we can’t reuse them… it feels wasteful.” (P2)

This theme reflects pharmacists’ desire to contribute more directly to sustainable prescribing and dispensing practices, while also acknowledging regulatory limitations.

Theme 4: Collaborative waste management

Participants spoke about informal collaborations with GPs, care homes, and local charities to manage medicine waste more efficiently. Some took proactive steps to highlight recurring medicine returns or to support patients who were at risk of medication accumulation.

“We sometimes flag things to GPs if a patient is constantly returning meds.” (P7)

Others described wider community engagement efforts but noted the lack of structured systems or shared accountability.

“We work with local GP practices, nursing homes, and nonprofit organisations.” (P8)

“There isn’t much structured collaboration on this issue.” (P5)

This theme highlights opportunities for more formalised, multi-agency partnerships aimed at reducing medicine wastage and supporting safe disposal.

Theme 5: Financial/operational burden of disposal services

Participants emphasised that medicine disposal is financially and operationally burdensome for pharmacies. Disposal bins, secure storage, and licensed contractor collections incur costs that must be absorbed by the business. In addition to these direct costs, participants described the significant time and staff resources required to sort, log, and prepare medicines for disposal.

“Safe disposal isn’t cheap… we have to factor it into our budget.” (P11)

“It’s time-consuming… someone has to check everything and fill out forms.” (P1)

This theme reflects the economic and operational impact of pharmaceutical waste at the pharmacy level.

Theme 6: Workforce skills and support

Finally, participants highlighted a need for clearer guidance and greater support in managing medicine waste. Many found existing protocols confusing or inconsistent, particularly when dealing with controlled substances or interpreting new policies.

“The guidelines can be confusing… I have to double-check them.” (P12)

“There’s a lot of paperwork… and the rules keep changing.” (P7)

The reliance on informal knowledge and experience, rather than formal training, was noted as a vulnerability in maintaining safe and sustainable disposal practices.

“We mostly rely on experience and common sense.” (P5)

This theme suggests that targeted workforce development, including training and standardised protocols, is essential to ensure safe and efficient medicine return systems.

Theme 7: Legal tensions in medicine reuse

This theme captures pharmacists’ recurring frustration with the legal restrictions that prohibit the reuse of returned, unopened, and unexpired medicines. Participants expressed a strong ethical concern over the destruction of perfectly viable medication, especially high-cost or short-supply items. While acknowledging the importance of patient safety, many pharmacists questioned whether current rules sufficiently balance risk with the growing economic and environmental cost of medicine waste.

“Once medicines leave the pharmacy, we can’t reuse them… it feels wasteful.” (P2)

“Unopened packs are destroyed… it’s a waste of resources.” (P10)

“It would be great to safely redistribute returned unopened medicines.” (P6)

These views reflect an apprehension between regulatory precaution and professional judgement.

Strengths of the study

A key strength of this study lies in its focus on community pharmacists in Northern Ireland, a region with a distinctive healthcare system and limited prior research on pharmaceutical waste practices. By adopting a qualitative approach, the study captured the real-world perspectives of pharmacists directly involved in medicine returns and disposal. The use of semi-structured, in-depth interviews allowed participants to reflect freely on their experiences, challenges, and ideas for improvement, generating rich and contextually grounded data. Furthermore, the study used Braun and Clarke’s thematic analysis framework to ensure a systematic and rigorous interpretation of the data, with independent coding and collaborative theme development enhancing the credibility of findings.

Limitations of the study

Despite these strengths, several limitations should be acknowledged. First, the sample size, while adequate for thematic saturation, may not fully capture the diversity of pharmacy practice across all regions or organisational types. Second, participation was voluntary and may have attracted pharmacists with stronger opinions or interest in sustainability, introducing potential self-selection bias. Third, while online interviews via Zoom or Microsoft Teams enabled participation across geographical areas, they may have limited observation of non-verbal cues and introduced technical constraints. Additionally, the study did not include perspectives from other stakeholders (e.g., GPs, waste contractors, or regulators), which could have enriched the data and provided a more holistic view of the medicine waste ecosystem.

Implications for policy and practice

This study has several important implications for healthcare policy and pharmacy practice. First, the findings reinforce the need for nationally standardised protocols and clear guidance for managing returned and expired medicines in community pharmacies. Regulatory bodies such as the PSNI and Department of Health should collaborate with frontline pharmacists to co-develop practical, enforceable SOPs tailored to pharmacy settings. Second, efforts to reduce medicine waste must be coupled with public education campaigns that are community-specific and pharmacist-led, emphasising not just safety but environmental responsibility. Pharmacies should be supported to fulfil their role as educators through appropriate training and resourcing. Third, there is a strong case for integrating pharmacists more formally into repeat prescribing and medication optimisation pathways, allowing them to intervene earlier in the medicines use cycle. This could reduce unnecessary dispensing and support safer disposal practices. Lastly, the study highlights the importance of investing in pharmacy workforce development. Sustainability in medicine use should be embedded into CPD, undergraduate training, and operational planning across pharmacy sectors.

Recommendations for future research

Further research is needed to evaluate the effectiveness of medicine reuse models under controlled conditions, especially in light of resource constraints and environmental goals. There is also a need to explore multi-stakeholder perspectives, including general practitioners, patients, care home staff, and policymakers, to develop a coordinated waste management strategy. Quantitative studies estimating the carbon and financial footprint of pharmaceutical waste in community settings would provide valuable data for cost-benefit analyses. Lastly, implementation research evaluating the rollout of pharmacist-led waste reduction interventions, such as enhanced medication reviews or return counselling, could inform future practice and policy.