Trace amounts of pharmaceuticals have been detected in surface waters in the nano- to microgram per liter range, and in drinking water in the nanogram/L range. The environmental risks of pharmaceuticals in surface waters have been evaluated and generally found to be low if the wastewater is treated before release to the environment. The human health risks of trace amounts of pharmaceuticals in drinking water have however not been evaluated in any great depth. Preliminary screening level assessments suggest risk to be low – but the public and decision-makers are concerned and would like the matter investigated more thoroughly, especially with regards to mixture effects, chronic long-term effects and sensitive sub-populations. The World Health Organization is currently evaluating the need for credible health based guidance associated with low concentrations of pharmaceuticals in drinking water. The aim of this paper is to summarize the state-of-the-science and the ongoing international debate on the topic.