Each year, 7,675 tonnes of unused medicines (UNM) are returned to pharmacies in France and then collected by the eco-organization Cyclamed to be incinerated or reused. To better understand behaviors and act more effectively, the National Agency for the Safety of Medicines and Health Products (ANSM) and Health Insurance, in partnership with Cyclamed, conducted the PERIMED study (PERIMES and MEDicamenteux waste), the first statistical analysis focusing on the nature, composition and supposed causes of non-use of medicines in France. The results observed open up avenues for concrete action, serving the proper use of medicines, the sustainability of the health system and the ecological transition. Press release.
For several years, the volume of unused medicines collected by Cyclamed (1) has been in constant decline (almost -30% between 2022 and 2024). This volume, however, remains high: 7,675 tonnes in 2024. Furthermore, according to the report “Decarbonize health industries” published in 2025 by the Shift Project (2), the production of medicines consumed in France would generate in absolute value 9.1 million tonnes of CO2 per year, making the health sector a significant contributor to total greenhouse gas emissions.
In this context and as part of the roadmap for ecological planning of the health system (PESS), Health Insurance, ANSM and Cyclamed have conducted a unique study, called PERIMED (OUT-of-date and MEDicamentous waste), with the objective of identifying the therapeutic classes most concerned, analyzing the factors which lead to non-use and proposing targeted action levers for manufacturers, prescribers, pharmacists and patients. Based on the analysis of 32,840 units collected between April and July 2025, i.e. 85 kg representing 1125 different pharmaceutical specialties, it draws up for the first time a detailed and representative map of unused medicines collected by French pharmacies.
What the study reveals
• Four therapeutic classes account for 80% of returns
Almost all therapeutic classes are represented among the drugs collected, but with unequal volumes. 80% of the units studied belong to four therapeutic classes: drugs for the respiratory system (25%), those for the digestive system and metabolism (21%), those for the nervous system (21%) and those for the cardiovascular system (13%). In more detail, the most frequently found medications are analgesics (paracetamol, tramadol), laxatives (macrogol, lactulose) and antibiotics (amoxicillin, amoxicillin/clavulanic acid).
• 4 boxes of medicines collected out of 10 are not expired
Around 60% of the medicines collected are expired by the time they are returned to the pharmacy (although there may be a delay between when a medicine is no longer used and when it is actually reported). This proportion illustrates the follow-up of ANSM recommendations aimed at returning valid medications at the end of treatment rather than storing them over the long term; but it also highlights the possible room for improvement, particularly on packaging, in order to reduce the destruction of products that can still be used.
• A majority of prescription medications
Medicines with compulsory prescription represent almost 70% of the units collected.
– Even if medicines with compulsory medical prescription (PMO) are the most consumed in France, their presence among the medicines reported in the Cyclamed sector raises questions, given a particularly regulated pharmaceutical circuit.
– These returns seem to result from several factors that can combine: unsuitable size of packaging, unsuitability of certain prescriptions, ineffectiveness or intolerance of treatments, but also difficulties in compliance.
– This also reflects the good level of adherence of French patients to public health recommendations: prescription medications must be returned to the pharmacy at the end of treatment, rather than keeping them at home.
– The study also highlights that these medications are also more often reported unexpired (44%) than optional prescription medications (dispensable without a prescription, over the counter) (31%), which suggests differences in behavior between the two categories, particularly in terms of storage and use.
• A significant annual cost for Health Insurance and therefore the community
The study sought to analyze and estimate the financial amount linked to the waste of medicines: the economic analysis associated with the study estimates, in projection, at 517 million euros the annual amount covered by compulsory health insurance for medicines ultimately not used (including €278 million estimated for medicines that have not expired).
What are the causes of non-use of medications?
The study highlights the multifactorial nature of non-use of medications, highlighting multiple findings that concern the entire medication chain:
• Compliance: premature termination of a treatment due to adverse effects, insufficient effectiveness or improvement in symptoms before the end of treatment
• Dispensing methods: certain medications dispensed “if necessary” (painkillers in particular) may not ultimately be consumed
• Packaging: boxes containing more tablets than necessary for the actual duration of treatment mechanically contribute to non-use
• Shelf life: sometimes short expiry dates for certain medications (painkillers, antidiarrheals, antihistamines) lead to destruction before use.
LThis report proposes concrete courses of action at all levels for the proper use of medicines :
• Adapt storage times
– The Perimed study highlights that shelf life, sometimes short for certain common medications, probably plays an important role in non-use. This is the case for paracetamol, ibuprofen or even antidiarrheals (loperamide and racecadotril) which are among the medications that are most often collected already expired. An extension of these expiry dates, when the maintenance of the quality of the medicine has been demonstrated, would make it possible to limit this waste. With this in mind, the ANSM launched an experiment in November 2025 for five years aimed at encouraging laboratories to extend the shelf life of certain drugs.
– The study suggests that certain packaging is not always suitable for use. Offering more suitable packaging could limit the volume of unused medicines. This is already the case for certain hypnotic benzodiazepines, offered in small packages suitable for short-term treatment, thus limiting the risk of dependence or waste in the event of early cessation of taking the medication.
– Reflections around the delivery to the unit must also be carried out at the same time for certain very specific products, since existing packaging does not meet health needs (e.g. certain antibiotics).
The ANSM has launched actions to encourage the eco-design of packaging or eco-production, so that they are more sustainable, while reducing their environmental impact.
The central role of health professionals
Health professionals are essential players in reducing non-use. The levers for action can be to help them: prescribe as accurately as possible by promoting non-drug alternatives when they exist, ensure before any renewal that patients do not yet have the same medications at home, frequently reassess the relevance of treatments and deprescribe (see n°291 of Mental Health Deprescribing?, October 2024) to limit the iatrogenic risk, with careful monitoring of the patients concerned, support patients in respecting proper use and the storage of their treatments, or even relying on existing systems for certain categories of population such as shared medication assessments. Thus, the 2024-2029 medical convention includes commitments from private doctors in favor of the relevance and sobriety of prescriptions, with in particular a deprescription consultation for hyperpolymedicated patients which came into force on January 1, 2026 and a relevance program which targets in particular health products (antibiotics, proton pump inhibitors, analgesics, etc.).
Patients also have a role to playthis is why awareness campaigns are carried out by the ANSM and Health Insurance to encourage good practices: checking the medicines in your medicine cabinet, avoiding excessive storage, returning unused medicines at the end of a treatment or expired medicines to the pharmacy are all practices which can reduce the volume of unused medicines and improve proper use.
Health Insurance and representatives of independent nurses have already experimented, in several departments, with a so-called “anti-waste” approach.relying on the intervention of nurses in their patients’ homes to reduce the waste of health products, and in particular medicines. In France, the Directorate General of Health is also considering an experiment with a secure circuit allowing certain unused anticancer drugs to be redispensed in hospitals, from September 2026. An initiative fully supported by Health Insurance.
1– Since 1993, the eco-organization Cyclamed, approved by the public authorities, has piloted the national system for the collection and recovery of Unused Medicines (UNM) for human use.
2– The Shift Project is a French association created in 2010 and a laboratory of ideas which aims to mitigate climate change and reduce the economy’s dependence on fossil fuels, particularly oil.
To find out more:
• PERIMED 2025 study report, National Agency for the Safety of Medicines and Health Products, Health Insurance, June 24, 2026.
• Recycling medicines: why and how to return them to the pharmacy?, Health Insurance, August 11, 2025.
