Introduction

In Latin America, it is common for households to store left-over medications from previous treatments or non-prescribed drugs for minor ailments in family medicine cabinets.^1-3 Studies show that incorrect disposal practices are also widespread, with medicines being mostly discarded in household waste (66-83%) or flushed down the toilet (11-30%).^1,2 This behaviour is related to limited environmental awareness and a lack of knowledge.^2,3 In general, safe disposal strategies in this region are still in the initial stages of implementation.¹ Current procedures, including wastewater treatment, are not equipped to degrade the active pharmaceutical ingredients that may pollute the environment.^4,5

In line with the significance of this issue, the European Union (EU) has made substantial progress in regulating and managing pharmaceutical waste. Its intersectoral strategies include not only control and safe disposal but also educational programs, rational use of medicines, and stricter control of over-the-counter sales.⁵ In addition, the EU maintains surveillance of highly hazardous pharmaceutical and chemical compounds, has set concentration limits for some of them in receiving water bodies, and promotes improvements in wastewater treatment.⁵

Concerning the same environmental problem, the Ibero- American Network of Post-Consumer Medication Programs (RIPPM, by its Spanish acronym) was established in 2015, composed of Blue Point Corporation (CPA) in Colombia, the National System for the Management of Medication and Packaging Waste (SINGREM) in Mexico, the Integrated System for the Management of Medication Waste (SIGRE) in Spain, and Valormed in Portugal. All of them are national entities responsible for collecting and disposing of expired and leftover medications from households.⁶

The objective of this study is to analyze the structure, procedures, strategies, and key indicators of the programs that comprise the RIPPM through a comparative analysis aimed at identifying challenges, opportunities for improvement, and best practices that other countries could replicate.

Method

We carried out a documentary review, collecting and analyzing data available through official sources and direct communication with the RIPPM programs, covering the period from 2017 to 2023. The procedures followed are detailed below.

Collection of publicly available data

Information was gathered from the websites of the four programs,^7-10 following a framework specifically designed for this study, which includes structural characteristics (program origin, legal framework, financing, and stated strategies), operational processes (mechanisms for collection, transportation, storage, classification, statistical data recorded, and final disposal procedures), and performance indicators:

When relevant data searched were unavailable publicly, we sent direct requests for information via email to the operational and public service areas of each program. For SINGREM, the data on indicators, operations, and waste management included in this study were provided by the General Directorate of the program, updated to 2022. SIGRE also shared its historical collection data (2014-2023). No direct response was received from CPA regarding information on its budget, updated collection data, and final waste disposal.

Data analysis

We created comparative tables in accordance with the logical sequence of the data collection and analysis framework described above. As the information from the four programs differed in format and presentation, units of measurement were standardized to ensure that percentages, rates, and ratios were comparable. The information was processed using Microsoft Office 365.

Results

Structural and operational differences among RIPPM programs (Table 1)

Environmental authorities oversee the operation of RIPPM pro- grams in compliance with national regulations that vary from country to country. In Portugal, Spain, and Colombia, pharmaceutical companies are required to contribute with resources and/or actively participate in the program management processes. In contrast, in Mexico, participation is voluntary, and members contribute only with funding. All four programs have implemented a common mechanism whereby each pharmaceutical company pays a fee proportional to the volume of medications sold.

European strategies encompass primary source prevention, ecodesign, responsible waste management, and public awareness initiatives. In contrast, programs in America prioritize collection coverage and financing.

In Europe, pharmacies collect medications and provide informational support to guide the public on proper disposal. In Mexico and Colombia, collection points have been expanded to public spaces without providing guidance for users.

European distributors collect waste in addition to supplying medications to pharmacies (reverse logistics) and temporarily store it before sending it to a sorting plant. In America, this task is performed by internal or external personnel utilizing proprietary warehouses. The final treatment depends on the type of waste and includes elimination or reuse, recycling, and energy recovery. In Mexico, all collected waste is incinerated, with no recovery.

In addition to funding, European pharmaceutical companies also supervise waste management and promote new packaging technologies to facilitate recovery. These programs have successfully integrated the entire pharmaceutical sector into the program’s processes.

Performance indicator disparities

Table 2 shows that SINGREM has the lowest territorial coverage, with only 7.5% of pharmacies in Mexico with collection containers, and the lowest pharmaceutical sector participation (35% of pharmaceutical firms). In contrast, the other three programs exceed 98% coverage and 97% participation.

Spain has 45.6 containers per 100,000 inhabitants, followed by Portugal with 32.4, while Mexico and Colombia have approximately 4 units each. Regarding collection volume, European programs collect slightly more than 100 grams of medication per inhabitant, compared to 5 grams in Latin America. In absolute terms, SIGRE leads the way with an annual average of nearly 5,000 tons of expired medications. In 2022, its budget was four times that of its Mexican counterpart despite serving a population 2.6 times smaller and collecting eight times more. Additionally, the Spanish program excels in waste recovery, achieving a recycling rate close to 70%.

Discussion

Public policy and regulation should be improved

It is essential to have laws regulating the consumption, disposal, and reverse logistics of medications. The current situation remains deficient. Other countries in the region, such as Brazil, regulate manufacturing, distribution, and dispensing but do not address household disposal.³ Currently, there is no international standard for managing this problem.¹¹ Mexico is the only RIPPM country where pharmaceutical companies’ participation is voluntary.

Moreover, even where regulation exists, enforcement and compliance are often weak and inconsistently applied.¹² It is necessary to design public policies that approach the problem comprehensively,¹³ involving pharmaceutical companies and consumers, and incorporating environmental monitoring actions, as implemented in the EU.⁵

Organization, financing, and operational capacity must be strengthened

The safe disposal of pharmaceuticals is often costly, and not all countries have the necessary resources. Diverse socioeconomic realities and heterogeneous levels of infrastructure and technology affect the scope of the initiatives.⁴ Big countries like Mexico and Brazil have not yet achieved complete coverage.^1,11

Spain and Portugal have established strong alliances among the three key sectors in the pharmaceutical supply chain: pharmaceutical companies, distributors, and pharmacies. This scheme avoids the investment of public resources in transportation, storage, or specialized staff. Additional strategies worth noticing are investment in new technologies, improving processes’ efficiency (SIGRE), and providing waste management services to private companies, generating additional revenue (CPA).

While Colombia and Mexico have made notable progress com- pared to other Latin American countries, their efforts still fall short. Their limited resources are reflected in low performance and coverage.⁴ Strengthening technical capacities in coordination with the pharmaceutical industry is essential. Increased funding, government support, and corporate commitment could boost their development.

To reduce the environmental impact, programs must transition toward a circular economy and promote waste recovery. Although Spain has a smaller population than Mexico, it collects consider- ably more pharmaceutical waste, achieving high levels of recycling and energy recovery. This may be explained by four key factors:

Community participation is a crucial factor in the success of any program. It should be a strategic axis in the design of public policies and health interventions, as well as in enhancing transparency.¹⁵ Educational programs, awareness campaigns, and pharmacy-based guidance have strengthened public awareness in Europe.

Ibero-American and regional collaboration is possible and desirable

The lack of harmonized regulation across the Latin American region hinders coordination and proper management of pharmaceutical waste. Within RIPPM, there is no single operational model due to socioeconomic, infrastructural, and awareness-level differences.⁴

RIPPM was created with clear objectives: to exchange experiences in pharmaceutical waste management, coordinate and innovate in the best disposal practices, and adapt programs to diverse cultural, geographic, social, economic, and regulatory contexts. Both regions can benefit from experience-sharing, especially as new members join.⁶

There is a global and RIPPM-level commitment to the 2030 Sustainable Development Goals. This alignment promotes responsible resource use, access to funding, and international support.⁴ The challenge now is to ensure these goals are effectively fulfilled.

Conclusions

Beyond legal compliance, various strategies have been implemented to mitigate the environmental impact of expired and leftover medications. Programs in Spain, Portugal, and Colombia have progressed toward circular models that incorporate ecodesign, innovation, process efficiency, and waste recovery, albeit to different extents. Mexico, on the other hand, is most in need of effective interventions.

The RIPPM represents an opportunity to promote comprehensive solutions, share best practices, and transition toward a sustainable circular economy in Latin America. Harmonizing regional regulations could enhance international cooperation. Promoting environmental awareness, community engagement, and full, non-voluntary participation by the pharmaceutical industry is essential to reducing environmental impact.