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:

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  Valormed (Portugal) publishes annual activity reports and biannual indicators, general program descriptions, operating licenses, management processes, campaigns, and current news (sections: “About Us”, “How We Operate”, “Campaigns” and “News”).

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  CPA's web page (Colombia) contains the 2017 sustainability, social responsibility, and transparency report, the human medication post-consumer plan, public campaigns from 2017 to 2020, and a program history (sections: “About Us”, “Our Services” and “A Happy Planet”).

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  SIGRE (Spain), the 2023 sustainability report, the Pharmaceutical Industry Prevention and Ecodesign Business Plan (PEPE 2024–2028), and information on its organization, operations, ecodesign, sustainability, campaigns, and past reports were consulted (sections: “Who We Are”, “Sustainability” and “Communication”).

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  SINGREM (Mexico), yearly cumulative collection data (available until 2017), legal framework, operational model, and information on safe containers (sections: “Who We Are” and “Safe Containers”).

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.

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.

Environmental authorities oversee the operation of RIPPM programs 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, eco-design, 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.

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%.

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

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 compared 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 considerably more pharmaceutical waste, achieving high levels of recycling and energy recovery. This may be explained by four key factors: 1) a more comprehensive and effectively implemented regulation; 2) complete territorial coverage; 3) informative resources available to users in pharmacies; and 4) higher public environmental awareness. Reports indicate that 91% of Spaniards consider disposing of medications in the trash or down the toilet to be harmful to the environment.14

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.

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.