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Background and Importance Improper disposal of unused or expired medicines is a global concern as it contaminates water systems and landfills and contributes to antimicrobial resistance. Numerous reports highlight the scale of pharmaceutical waste and link it, among other factors, to medication non-adherence. However, limited evidence exists on how healthcare professionals—particularly clinical pharmacists—can support interventions to reduce waste, improve adherence, and promote safe disposal.Aim and Objectives This study aimed to investigate real-world practices across Europe related to the management and disposal of unused or expired household medicines. The objective was to identify areas in which clinical pharmacists can contribute to reducing medication waste, fostering proper disposal practices, and minimising environmental impacts.Material and Methods Stemming from the IHI ENKORE Project, this European online expert survey assessed national legislation, awareness campaigns, and disposal practices for unused household medicines. The survey examined the volume of pharmaceutical waste generated, as well as economic aspects, including costs and financial responsibilities for disposal. Data were analysed to identify cross-country differences and define priority areas where clinical pharmacists can play a significant role.Results Valid responses were collected from 33 European countries. In most of them, neither medication packaging nor public campaigns provided patients with information on how to manage unused medicines. On the other hand, most national collection systems for unused drugs involved pharmacists—obligatory collection in pharmacies was reported in 16 countries, while voluntary in 7. Similarly, in real-world settings, the most common disposal practice was returning unused medicines to community pharmacies (21 countries). However, in 7 countries, the most common method was discarding them in household waste. Consequently, a large proportion of unused medicines were disposed of improperly, leading to environmental pollution.Conclusion and Relevance Unused and expired medicines remain a persistent and costly problem with serious implications for health systems and the environment. With their expertise in medication management, clinical pharmacists are well positioned to address this challenge by counselling patients on proper use, adherence, and—where appropriate—safe disposal of unused medicines. Their more frequent involvement can help reduce pharmaceutical waste, limit environmental harm, and strengthen healthcare sustainability. This provides a strong incentive to broaden the scope and availability of clinical pharmacy services across Europe.Conflict of Interest Corporate sponsored research or other substantive relationships:I (PK) received speaker’s honoraria from Procter & Gamble Company for a presentation over which the paying company had no influence. Additionally, my university received funding from the European Union’s Horizon 2020 for the ODIN Project (Grant Agreement N° 101017331) and from IHI for the ENKORE Project (Project Number: 101166707), and CAREPATH Project (Project Number: 101192133) outside this work.