More food and energy allow for more people who then require more food and energy, and so it has gone for centuries. At the same time, economic progress leads to a different lifestyle with an increasing demand for energy and food, also accelerating food waste. Fueling this food-energy-population dynamic is an ever-increasing conversion of unreactive dinitrogen (N2) to reactive N (Nr), which then results in a cascade of positive (food and energy for people) and negative (damage to people, climate, biodiversity, and environment) impacts as Nr is distributed throughout Earth systems. The most important step in reducing the environmental impacts of Nr is limiting its human-based creation. In this article, therefore, we focus on this most important first step: the conversion of N2 to Nr by human activities. Specifically, we examine Nr creation and use (they are different!) on a global and regional basis and Nr use on a global and regional per capita basis. In addition, we introduce the metric Nr Use Index (NUI), which can be used to track and project Nr use relative to a fixed point in time. We then assess the progress in Nr management over the past 20 years. Our article presents a case study of the Netherlands to show what one country, beset by Nr-related problems that have led to an N crisis, did to address those problems and what worked and what didn't work. The article concludes with an assessment of what the future might hold with respect to Nr creation and use, including a review of other projections. We expect that NUI will increase especially in Asia, Latin America, and Africa. The other parts of the world are consolidating or even decreasing NUI. In Latin America and Asia, there is limited agricultural land, and by increasing NUI for food the risk of Nr pollution is very high. The Netherlands has shown not only what effects can be expected with increasing NUI but also what successful policies can be introduced to limit environmental losses. Our assessment shows that Nr creation needs to be limited to prevent local to global environmental impacts. Expected final online publication date for the Annual Review of Environment and Resources, Volume 46 is October 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.