Pharmaceutical waste in South Korea: a socio-technical analysis of prescription practices, disposal barriers, and collection infrastructure

Pharmaceutical waste has emerged as a public health and sustainability concern as South Korea transitions to a super-aged society. However, studies integrating economic, infrastructural, and behavioral dimensions of pharmaceutical waste remain limited. This study investigates pharmaceutical waste in South Korea as a socio-technical public health challenge by estimating its potential economic burden and identifying barriers to effective management. National Health Insurance claims data (2018–2023) were integrated with an exploratory behavioral survey ( n = 237) and spatial infrastructure analysis to evaluate relationships among pharmaceutical expenditure, disposal accessibility, and public disposal practices. Pharmaceutical expenditures increased by 33.6% between 2018 and 2023 despite minimal growth in the patient population. A conservative estimate based on Drug Utilization Review data suggested potential economic losses from unused medicines at 301.6 billion KRW ($223.41 million) in 2023. Older adults aged ≥ 65 years accounted for 45.7% of pharmaceutical expenditure, but spatial analysis indicated uneven accessibility to collection infrastructure, particularly in lower-density regions. Regional collection patterns also suggested variation in operational continuity across local governance systems. Survey findings showed high recognition of environmental risk (82.3%) and willingness to participate in disposal programs (94.1%), but low use of official return systems (21.1%), suggesting that logistical and accessibility barriers may constrain participation. Pharmaceutical waste in South Korea appears to reflect disposal-stage limitations and broader structural imbalance between prescribing practices, medication use, and recovery systems. Strategies that combine prescription optimization, accessible return infrastructure, and coordinated public-sector governance may improve pharmaceutical waste management and support health-system sustainability in aging societies.