Attitude-Practice Gap in Ecopharmacology: A Cross-Sectional Study of Healthcare Professionals in Western Maharashtra, India.

Introduction The accumulation of active pharmaceutical ingredients (APIs) in the environment poses a serious global threat, accelerating antimicrobial resistance and disrupting ecosystems. Since standard wastewater treatment plants cannot fully degrade these pollutants, mitigating pharmaceutical wastes must begin at the source. Consequently, healthcare professionals play a critical role in prescribing sustainably and guiding patients in disposing of their medication. Given this responsibility, this study assesses and compares the knowledge, attitudes, and practices regarding ecopharmacology among different tiers of healthcare professionals and identifies specific barriers preventing sustainable clinical action. Materials and methods An analytical cross-sectional, observational study was conducted at a tertiary care hospital in western Maharashtra, India. The study analyzed 493 participants, including medical interns, residents, consultants, and nurses, using descriptive statistics, one-way ANOVA, a chi-square test, and multivariable logistic regression models. Results Despite 88.8% (n=438) of professionals recognizing pharmaceutical pollution as a severe risk, a distinct attitude-practice gap emerged. Personally, 61.0% (n=301) of participants discard leftover drugs into regular household trash. Clinically, only 22.3% (n=110) consider environmental impacts when prescribing, and only 29.0% (n=143) routinely counsel their patients on disposal. Logistic regression revealed that textbook knowledge did not predict proactive counseling. Instead, personal communication confidence is the strongest driver, explaining why experienced consultants counsel significantly more than recent graduates despite lower theoretical scores. To overcome these barriers, participants demanded systemic interventions: 91.5% (n=451) requested hospital take-back centers, 88.2% (n=435) demanded extended producer responsibility (EPR) from manufacturers, and 73.0% (n=360) requested practical continuing medical education training. Conclusion High environmental awareness does not organically translate into sustainable medical practice. Bridging this gap requires a systemic shift, modernizing medical education to focus on patient communication skills and establishing an accessible medication take-back infrastructure supported by industry EPR mandates.