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The motivation of this paper stems from the growing concern of heavy pesticide use in developing countries such as Sri Lanka. Its excessive use affects the environment, the economy and farmers’ health and yet farmers still seem unaware of its ill-effects. More worrying is the lack of appropriate government efforts to address this problem. If neglected, heavy use of pesticide eventually renders land useless, reduces future farm output and productivity and can severely affect farmers’ health. This paper investigates pesticide use in agriculture and its impact on farm level technical efficiency using a metafrontier framework with stochastic frontier analysis. Data are collected through surveys of two groups of farmers in Sri Lanka. The first (described as the ‘non-hospitalized farmers’) are farmers who perceive that their ill-health is due to exposure to pesticides and obtained treatment but are not hospitalized. The second group (described as the ‘hospitalized farmers’) are farmers whose ill-health has been diagnosed by doctors and have been treated in hospital for exposure to pesticides. The results show that farmers overuse pesticides because of higher expectations of future returns which has led to an increase in inefficiency and remains unknown to the farmers. Determinants of inefficiency supports the argument that pesticide induced health problems reduce the health capital, while increasing farm level inefficiency.