The agricultural use of good quality sludge represents a value-added route to ensure growth sustainability in Europe, where raw material availability, for example, for phosphorus, is insufficient to meet demand. However, the possible presence of pathogens, pharmaceuticals and heavy metals requires specific regulations to minimize sludge-related health issues and environmental risks. The current regulation on sludge agricultural use applied by many EU countries is here presented and compared, highlighting scarce harmonization of the legislative framework among Member States. Actual issues, such as the fate of emerging micropollutants and microplastics in sludge-amended soils, and public health concerns regarding sludge spreading during the COVID-19 epidemic, are considered, too.