In a comprehensive literature review measured environmental concentrations of human and veterinary pharmaceutical substances reported worldwide were compiled in a systematic database. Pharmaceuticals or their transformation products have been detected in the environment of 71 countries covering all five UN regions. 631 different pharmaceuticals have been found above the detection limits of the analytical methods employed. We conclude that pharmaceuticals in the environment are a global challenge calling for approaches to prevent, reduce, and manage pharmaceuticals entering the environment, such as the recently adopted new emerging policy issue under the Strategic Approach to International Chemicals Management (SAICM). An overview of strategies for action proposed in the literature is provided.