Remediation strategies for pharmaceutical contaminants of emerging concern - quo vadis?

The growing presence of contaminants of emerging concern, particularly pharmaceuticals, in aquatic environments poses significant risks to ecosystems and human health due to their persistence, ecotoxicity, and links to antimicrobial resistance and endocrine disruption. With pharmaceutical consumption rising and wastewater treatment plants unable to remove these compounds, the need for effective, sustainable, and scalable remediation strategies is urgent. This perspective reviews the sources, environmental fate, and health impacts of pharmaceuticals, as well as their physicochemical properties influencing mobility and toxicity. Beyond a conventional review, this work critically connects the performance and limitations of current and emerging water treatment technologies - including adsorption, bioremediation, advanced oxidation processes, and hybrid technologies - with their future challenges and opportunities. A distinct feature is the outlining of strategic roadmaps aligned with the European Union's target for 90 % pharmaceutical removal by 2027. Four forward-looking routes are proposed, each prioritizing performance, sustainability, digitalization, or cost-efficiency. By integrating treatment methods, monitoring, and nature-based solutions, these roadmaps aim to align technological innovation with environmental and economic goals to ensure sustainable water management. A robust emphasis on large-scale implementation is placed, highlighting key adjustments between efficiency, energy demand, and economic viability. In addition, local mitigation strategies at pharmaceutical hotspots are discussed as essential complements to centralized treatment systems. Altogether, these insights provide a suitable transition to safer, cleaner, and more sustainable water treatment paradigms in the scope of emerging pharmaceuticals.