Pharmaceuticals are designed to be bioactive and therefore are among the most important chemical compounds manufactured. In recent years pharmaceuticals have been detected in a range of environment compartments, with concerns raised that they may impose a risk to both humans and environmental organisms. To support informed management of any associated risks, knowledge about their substance flows is indispensable. However, little is known about sources and attributable substance flows with regard to the use of human pharmaceuticals. Often data available on a national level are used to judge local or regional situations and to calculate expected concentrations. In this paper, computations on the use of active pharmaceutical ingredients (APIs) of drugs used in human medicine at the local, regional and national levels were conducted. Different data sources were used and raw-data were scaled up- or downwards and compared. Results of this analysis indicated that hospitals are, by far, minor sources of pharmaceuticals to the aquatic environment in comparison to non-point emissions from households. Differences in flows at the local, regional and national scales are also identified. © 2008 Springer Science+Business Media B.V.