The detection and monitoring of illicit drug concentrations in environmental waters is of increasing interest. This study aimed to determine if illicit and regulated compounds, their potential pre-cursors, and metabolites varied in amount discharged into the environment from treated wastewater at different facilities. Water samples were taken from discharge points of four different tertiary wastewater treatment plants discharging directly into the Hawkesbury-Nepean River (Australia) on two different occasions and analysed to determine the concentrations of compounds including: ephedrine, pseudoephedrine, amphetamine, 3,4-methylenedioxyamphetamine, 3,4-methylenedioxymethamphetamine, methamphetamine, cocaine, and benzoylecgonine. Here, we show that detectable levels of illicit drug and metabolites are being emitted on a consistent basis after having persisted through the wastewater treatment process. The concentrations of methamphetamine are in excess of previously reported surface water concentrations. The estimated total load of compounds being discharged on a daily basis is greater than similar sized catchment areas. The results presented here are of concern from both an ecological and human health perspective.