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This review examines the impact of pulp and paper mill effluents by comparing effects from Canada's east and west coasts at a time when revisions to the federal Fisheries Act (Pulp and Paper Effluent Regulations) are being finalized. Pulp and paper mill effluents from Canadian coastal mills were usually acutely toxic at source, and in many cases had marked deleterious effects on receiving waters due to toxicity, high biochemical oxygen demand (BOD), and total suspended solids (TSS) loadings. Extreme reductions in ambient dissolved oxygen, impacts on benthic and intertidal organisms, changes in water colour and primary productivity, have been demonstrated over the years and continue to cause environmental damage. Contamination of biota by a wide range of chlorinated organic compounds has been more recently the focus of investigations.While sublethal effects of lowered dissolved oxygen levels and suspended solids on the water column and bottom communities are well known, the potential effects of major organochlorine contamination of water (measured as Adsorbable Organic Halogens = AOX), sediments, and biota are not fully understood, especially under natural and perturbated conditions. The findings of recent North American and Scandinavian studies which describe liver enzyme activation, histological damage, reproductive and population level changes in fish, are a major concern as they are a sign of ecosystem stress and pathology.The environmental effects described herein are long-term impacts which will not respond quickly to changes in pollutant loading. Integrated site-specific assessments need to be undertaken to document ecosystem response to process and treatment improvements at mill sites. Current biomonitoring techniques including measures of population structure and ecosystem function are needed in addition to sensitive biochemical indicators of contaminant exposure.