Drug waste poses a real threat to human health and the environment. Therefore, recycling and sustainability scholars have recently sought practical solutions to the drug waste problem. Furthermore, several governments have made significant efforts to reduce the negative effects of waste, such as establishing programs to take back unwanted drugs (expired and unused) for recycling (i.e., drug reuse or drug redispersing). However, many of these programs have failed to achieve their goals. In this context, it is expected that creating green start-ups to collect unwanted drugs will contribute to solving this problem. Accordingly, this study aims to investigate the antecedents of intentions to create green start-ups for collecting unwanted drugs. To this end, the authors integrate start-up self-efficacy and drug waste collection-related knowledge constructs into the theory of planned behavior (TPB). Using a self-administered paper questionnaire and relying on a convenience sample, data were collected from 328 students in six Algerian universities. A hierarchical multiple regression was conducted to test the proposed study model. Theresults revealed that perceived behavioral control (PBC)(β = 0.187, p< 0.001), attitudes (β = 0.182, p = 0.002), start-up self-efficacy (β = 0.169, p = 0.001), drug waste collection-related knowledge (β = 0.161, p< 0.001), and subjective norms (β = 0.088, p< 0.05) have a positive significant effect on the intention to create a start-up to collect unwanted drugs. In conclusion, this paper contributes to reducing drug waste by investigating the drivers of intention to create green start-ups for collecting unwanted drugs. Therefore, our study is expected to provide valuable insights for hospitals, pharmacies, pharmaceutical manufacturers, environmental protection associations, and stakeholders interested in reverse logistics.