Global water quantity and quality are anticipated to decrease in the coming decades, as a result of both increasing global populations and the effects of climate change. Reusing and recycling water is a key part of reducing the pressure on our existing water supplies and the aquatic environment. However, the occurrence of non-steroidal anti-inflammatory drugs (NSAIDs) in secondary, and in some tertiary, treated effluents and sewage impacted water bodies is one of the major obstacles for the implementation of water reuse. For several decades, NSAIDs have been extensively used for therapeutic purposes in both humans and domestic livestock. The negative effects of NSAIDs on aquatic biota are just beginning to be realised. Currently, intensive treatments are required to remove effectively NSAIDs from recycled treated effluent in order to minimize, or eliminate risks to human health and aquatic environment. In this chapter, we focus the discussion on contemporary methods for NSAID removal including biological, physical, chemical and combined process that may provide a more effective and efficient alternative.