Successful decommissioning of subsea oil and gas infrastructure requires a safe and effective approach to assess and manage waste products. These products, often present as scale on internals of pipelines, include naturally occurring radioactive materials (NORM) and trace metals. Understanding the potential effects of these contaminants on marine fauna is crucial to managing global decommissioning. This review is composed of two aspects: 1) a systematic review was conducted to synthesize literature on all contaminants associated with decommissioned offshore structures and the effects of NORM contaminants on marine organisms; 2) a critical review of current environmental regulations for decommissioning and characterization of petroleum scale and NORM components. Studies defining the chemical and radiological contaminants associated with decommissioned structures were very limited. The main source of contaminants was identified from offshore platforms, with none from subsea structures. Only three studies measured variable chemical effects of radium to organisms from scale materials in subsea oil and gas infrastructure. No studies measured effects on organisms from other NORM, such as lead-210 and polonium-210. Currently, there are no international regulations on subsea pipeline closure, with NORM being underreported and not addressed in environmental impact assessments. This review highlights research gaps from environmental monitoring and characterization of NORM associated with decommissioned structures. Key recommendations for future research include characterizing NORM scale and assessing effects of scale to marine organisms through direct organism exposure experiments. This review emphasizes the need to incorporate ecotoxicology into environmental risk assessment for offshore petroleum decommissioning.