Achieving environmentally safe and just pharmacy: a global roadmap to address the global challenge of pharmaceutical pollution

Global pharmaceutical pollution is harming ecosystems, driving antimicrobial resistance, and disproportionately affecting low- and middle-income countries. This Review proposes nine management solutions, spanning drug design, regulation, manufacturing, prescribing, agriculture, and waste and wastewater treatment, and six cross-cutting actions needed to implement them. A roadmap is presented, with measurable milestones for 2030, 2040, and 2050, whose delivery would support achievement of an environmentally safe and just (equitable) pharmaceutical lifecycle.