From Policy to Practice: Community Pharmacists’ Self-Reported Counseling Role in Pharmaceutical Waste Management

<b>Background/Objectives</b>: Safe disposal of unused medicines represents an increasing public health and environmental concern. Until 2024, Romanian community pharmacies collected expired medicines from the public, though implementation was inconsistent. Using a knowledge-attitude-practice (KAP) framework, this study assessed community pharmacists' self-reported involvement in pharmaceutical waste prevention in Bihor County, Romania, one year after new legislation transferred collection responsibilities to hospital-based centers. <b>Methods</b>: A cross-sectional survey was conducted in May 2025 using a self-administered questionnaire comprising 22 items covering socio-demographics, professional practices, knowledge, and attitudes. Eligible participants were community pharmacists (N = 285). <b>Results</b>: Respondents reported high awareness and favourable attitudes toward pharmaceutical waste management: 98.2% indicated awareness of current legislation, 94.4% reported receiving training on the new regulations, 99.6% acknowledged health and environmental risks, and 98.9% expressed agreement that patient education is important. However, 55.4% reported providing disposal information only when patients requested it, while 89.8% indicated that patients rarely asked about medicine disposal. Self-reported proactive counseling increased with patient request frequency (χ²(3) = 7.914, <i>p</i> = 0.048), with pharmacists in the high-request group reporting substantially higher proactive counseling than those in the low-request group (83.3% vs. 42.9%). In an adjusted logistic regression, low request frequency was associated with lower odds of proactive counseling (aOR = 0.21, 95% CI: 0.05-0.98, <i>p</i> = 0.047). Most respondents (94.6%) perceived waste-related responsibilities, though these perceptions were only weakly related to reported counseling behaviors. <b>Conclusions</b>: Pharmacists reported high awareness and positive attitudes toward pharmaceutical waste management, but counseling remained reactive. Patient demand was a key correlate of counseling proactivity, underscoring the need for structured education within Romania's hospital-based take-back system.