Microplastics (MPs) in aquatic environments can be associated with various substances, including persistent organic pollutants, which add to the problem of plastic ecotoxicity. The abundance of 1–5 mm microplastics and concentrations of particle-adsorbed organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs) in sandy sediments from three beaches in recreational areas along the upper Ob River in Western Siberia were assessed. MP pollution levels in the Ob River beach sands ranged from 24 ± 20.7 to 104 ± 46.2 items m⁻² or, in terms of mass concentration, from 0.26 ± 0.21 to 1.22 ± 0.39 mg m⁻². The average abundance of MP particles reached 0.67 ± 0.58 items kg⁻¹ or 8.22 ± 6.13 μg kg⁻¹ in the studied sediments. MP concentrations were significantly higher in number (p < 0.05) and mass (p < 0.01) at the riverbank site downstream of the Novosibirsk wastewater treatment plant (WWTP) outfall compared to these at the upstream and more distant beaches. Most MPs (70–100%) were represented by irregularly shaped fragments. The polymer composition of MPs varied between sites, with a general predominance of polyethylene (PE). The study revealed associations of MPs with PCBs and OCPs not previously detected in the riverbed and beach sediments, suggesting that these substances are circulating in the Ob River basin. Although MP concentrations were higher downstream of the WWTP, the maximum levels of particle-associated OCPs were observed in the beach sands of the site farthest from the urban agglomeration. The pesticides γ-HCH, 4,4-DDT, and 4,4-DDE were detected on MPs at relatively low concentrations. PCBs were more abundant in the studied samples, including 118 dioxin-like congener. The results obtained indicate that the Ob River is susceptible to plastic and persistent organic pollutant (POP) contamination and serve as a starting point for further studies and practical solutions to the problem.