Pharmaceutical residues resulting from patient excretion, incorrect disposal and manufacturing of medicines contribute to environmental pollution and related risks. Designing active pharmaceutical ingredients of inherently lower environmental risk (‘greener APIs’) is one potential solution to this issue. To assess the current level of preparedness to adopt potentially greener APIs as a part of more sustainable medical care, the perspectives of healthcare professionals on greener APIs were evaluated by investigating related opportunities, barriers and the needs to overcome these barriers. Semi-structured interviews were conducted with professionals working in the healthcare sector in European countries between February and April 2024 (n = 16). The interviewees included doctors (3), pharmacists (3), experts in procurement (3), reimbursement (1), market authorisation (2), healthcare provision (2) and industry’s sustainability reporting (1), as well as a professional working for an environmental NGO (1). Data was evaluated using qualitative content analysis. Interviewees’ answers showed that some strategies already exist to account for environmental aspects in decision-making, e.g. by adding environmental criteria to the tenders of procurement agencies. Criteria on environmental properties of APIs can be expected to play a more significant role in the decision-making of HC professionals in future. Balancing molecular properties related to patient benefit and risk against environmental properties could be product specific. Frequently expressed needs to enable this include: access to reliable scientific data and evidence of environmental impacts of APIs, legislative and regulatory frameworks and guidance to ensure environmental properties are assessed and weighed in a centralised and harmonised manner. The evident interest among HC professionals to consider environmental properties in their decision-making may stimulate data sharing by pharmaceutical companies in the short-term and efforts to design greener APIs in the long-term. The marketing authorisation process is viewed as the main intervention point in the life cycle of pharmaceuticals to strengthen considerations of environmental risks. The authors conclude that future research should target the identified barriers and their solutions. The study evaluates on the preparedness to adopt greener APIs into use. Qualitative interview study with 16 European healthcare (HC) professionals. Findings show interest by HC professionals to minimise environmental impacts. Barriers and needs to consider environmental criteria were identified.
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