This study aims to contribute to the risk management of pharmaceuticals in the environment, illustrating risk perceptions of lay people and experts from Southwestern Europe (Portugal, Spain, and France). The psychometric paradigm was applied to assess risk regarding four hazards: pharmaceuticals in the environment (i.e., broadly framed), pharmaceuticals in treated wastewater, pharmaceuticals in drinking water, and pharmaceuticals in crops. Two factors explained most of the variance of risk assessments: dread and unknown. The dread factor combined immediacy and severity of effects, and the old nature of hazards. Pharmaceuticals in crops and drinking water scored higher in this factor, as did experts and French respondents. The unknown factor differentiated between the assessments of lay people and experts. Lay people assessed the hazards as being more known by those who were exposed but less known by science; and exposure was perceived as more voluntary and the risk as more controllable. Even though pharmaceutical residues are present in much higher concentrations in treated wastewater, risk assessments were overall higher for drinking water and crops. Moreover, data also revealed risk management preferences: whereas lay people preferred technological and awareness-type measures, experts preferred measures to improve the disposal of pharmaceutical waste and health-type measures.