Abstract
INTRODUCTION: Awareness of planetary health has grown across healthcare professions, and the pharmacy sector, responsible for the lifecycle of medicines from production to disposal, plays a significant role in both perpetuating and mitigating environmental harm. However, pharmacy education omits environmental sustainability as a structured component. AIM: To explore pharmacy students' perceptions of environmental sustainability within their education and future professional roles, focusing on their awareness, attitudes, and perceived barriers or enablers to integrating sustainability in pharmacy education and practice. METHOD: A qualitative study was conducted at a university in Northern Ireland, utilising semi-structured interviews with pharmacy students across all four years of their studies. Purposive sampling was used. Interviews were transcribed verbatim and analysed inductively using Braun and Clarke's six-phase approach to thematic analysis. RESULTS: Sixteen students were interviewed, with data saturation reached at the 14th interview and confirmed through researcher consensus and transcript review. Six themes emerged (mean interview length = 45 ± 10 min): (1) Sustainability as an overlooked area - limited or fragmented curricular coverage; (2) Narrow understanding of waste - awareness focused on disposal and packaging, with little recognition of wider pharmaceutical impacts; (3) Pharmacy as both waste generator and sustainability site - examples included medicines returns, digitalisation, and hospital "green teams"; (4) Integrating sustainability into education - preference for interactive, experiential learning (e.g., guest speakers, placements); (5) Barriers to change - patient resistance, behavioural inertia, and competing curricular demands; (6) Policy, incentives, and leadership as enablers - systemic and financial support deemed essential for sustainable practice. CONCLUSION: Pharmacy students recognise the importance of environmental sustainability but perceive significant gaps in both education and practice. While they value opportunities for experiential learning and see potential for pharmacy to contribute positively, systemic barriers and limited curricular integration hinder progress. Embedding sustainability into pharmacy education, supported by leadership, policy, and incentives, will be critical to preparing future pharmacists as both healthcare providers and environmental stewards.