Ten acidic and two neutral pharmaceuticals were detected in the effluents of eight sewage treatment plants (STPs) from across Atlantic Canada. Concentrations varied between nondetectable and 35 μg/L. The analgesic, nonsteroidal anti-inflammatory drugs ibuprofen and naproxen were predominant. Carbamazepine, a neutral compound used as an antiepileptic drug, was observed consistently at a median concentration of 79 ng/L. Acetaminophen was found in the effluents of the three largest mechanical STPs at a median concentration of 1.9 μg/L, but not in the lagoon treatment systems. The substantially longer hydraulic retention times may have contributed to more effective removal of acetaminophen in the lagoon treatment systems. Drugs generally were not detected at significant concentrations in the larger bodies of receiving water (Saint John River, Hillsborough River, and Bedford Bay, Canada). However, drug residues in the small receiving streams were 15 to 30% of the effluent median concentrations. Six compounds (caffeine, naproxen, salicylic acid, carbamazepine, metoprolol, and sotolol) were found to persist in a small stream for a distance of at least 17 km, suggesting that small stream exposure to pharmaceutically active residues may be relatively greater than that in large bodies of water. Bioassays assessing acute and chronic effects on four organisms were conducted on four high-use drugs: Acetaminophen, ibuprofen, naproxen, and salicylic acid (metabolite of acetyl salicylic acid). Results indicated no negative effects except for the chronic algal (Selanastrum capricornutum) growth test on ibuprofen (no-observed-effect concentration, 10 μg/L; lowest-observed-effect concentration, 32 μg/L). Effects of these four compounds on invertebrates and plants in the receiving environments are unlikely based on the concentrations measured.