Ecopharmacovigilance in Urban Households: Assessing Pharmaceutical Waste Accumulation and Environmental Risk to Advance Sustainable Healthcare

Household medication hoarding is an emerging public and environmental health concern linked to inadequate pharmaceutical waste management and the lack of ecopharmacovigilance programs. This study analyzed the reasons for medication accumulation and associated environmental health risks in urban Mexico using synthetic indicators and risk assessment tools. A cross-sectional survey was conducted in 633 households, and indicators such as the household hoarding index, informal circulation index, and environmental risk index ( ERI ) were calculated. Multivariate analysis (NMDS) and risk matrices were applied to identify priority therapeutic groups. Results showed that 83.1% of households (95% CI: 79.6–86.0) accumulated medications, with 72.6% engaging in informal circulation practices. Antibiotics, antidiabetics, and antihypertensives accounted for over 70% of the estimated environmental risk, with antibiotics presenting the highest ERI (0.17). Continuous prescriptions and leftover treatments were the main hoarding reasons. It is concluded that pharmaceutical hoarding represents a critical challenge for sustainable waste management and ecopharmacovigilance. The combined use of synthetic indicators and risk matrices enables evidence-based prioritization for public policies, community education, and environmentally sound pharmaceutical disposal programs.