Nowadays pharmaceutical water contamination is a worldwide problem. Resulting from an absence of appropriate legislation, policies, and efficient treatment technologies, especially those developed to remove pharmaceuticals from wastewater, has led to the further contamination of soil and natural water bodies. The adverse impact this has on wildlife/human species reinforces the need to develop proper monitoring and detection techniques for pharmaceutical water contamination. This article focuses on the sources, fate, monitoring, and negative effects of pharmaceuticals globally and compares it with data from Kazakhstan and the bordering Commonwealth of Independent States (CIS) countries. In general, Kazakhstan/CIS countries are demonstrating similar trends with other developed comparison countries in terms of types and concentrations of pharmaceuticals found. The major difference between Kazakhstan/CIS and developed countries is the absence of matured monitoring and legislation systems. On the other hand, the removal of pharmaceuticals at wastewater treatment plants, which precede most sources of soil and natural water way pollution, is intensified by the development of the pharmaceutical industry and approval of novel drug types. This work shows that proper disposal, monitoring and legislation, efficient wastewater treatment, and development of accurate drug determination methods have significant potential in controlling pollution of the environment, including the water–soil nexus.