Environmental contamination by pharmaceuticals is reaching alarming levels (see, for example, Nature 476, 265; 2011) and is set to rise. New partnerships between drug companies, the public-health sector and those who deliver environmental sustainability are urgently needed to tackle the issue.

Low-cost pharmaceuticals are increasingly accessible to the global population, which is predicted to exceed 8 billion by 2050. Rising drug use is also driven by ageing populations. Widely used preventative medication — such as statins and anti-hypertensives — and cheap generic drugs add to the problem. The UK Office of National Statistics predicts that the country's medicine usage will more than double by 2050.

Agricultural soils and rivers are contaminated with a range of pharmaceuticals, including antibiotics, antidepressants, analgesics and cancer-chemotherapy agents (see http://go.nature.com/lr2vfy).

The effects are already evident: they include the feminization of fish by residues of the contraceptive pill, and the deaths of millions of vultures on the Indian subcontinent following ingestion of the anti-inflammatory drug diclofenac. Antibiotic overuse has led to the emergence of resistant pathogenic bacteria in the wider environment, and not just in medical settings.

Current practices remain unchanged. However, attempts are being made to provoke action. The European Environment Agency has recommended that improvements be made in pharmaceutical-waste management, and that more guidance be provided for the public and for policy-makers. The UK Royal Commission on Environmental Pollution in March highlighted links between demographic change and pharmaceutical releases, and the UK government's Advisory Committee on Hazardous Substances will conduct an investigation.