Release of small plastic items, known as Acute Plastic Pollution (APP) in the environment. What is it and what can it cause? For understanding, the Nordic Council of Ministers commissioned an assessment which is described in this report including the problems, causes and solutions to address APP at multiple levels. It is a serious problem for which there are no legal frameworks nor coordinated response. Research on the magnitude and locations of APP emphasizing pellet loss is needed. Recommendations include adoption of an internationally accepted definition, reclassification of pellets as hazardous goods, inclusion in legislation, awareness-raising and incorporation of APP in a legal framework with actions for preparedness and a standardized disaster response protocol. Prevention is key, hence, technical and legal measures should be applied to achieve this.