Plastic pipes are increasingly used in drinking water distribution systems, yet their impact on water quality remains insufficiently understood. Here, we systematically investigate the dual outcomes posed by plastic pipes─chemical leaching and cascaded microbial exposure risks─by integrating Fourier Transform Ion Cyclotron Resonance Mass Spectrometry and metagenomic analysis. Our results reveal that plastic pipes continuously release dissolved organic matter (DOM), including organic additives such as bisphenols (BPs) and organophosphate esters (OPEs), which profoundly reshape microbial communities. Under chlorinated conditions, leached DOM alters microbial diversity, promoting chlorine-resistant bacteria and opportunistic pathogens (OPs), while under nonchlorinated conditions, it accelerates microbial growth and enriches antibiotic resistance genes (ARGs), OPs, and virulence factors (VFs). Among plastic materials, polyethylene (PE) exhibited the highest chemical risk, releasing high concentrations of TCPP (700 ng/L) and BPF (200 ng/L) along with 207–227 unique DOM molecules. In contrast, polyvinyl chloride (PVC) supported the highest OP abundance, while polypropylene random copolymer (PPR) fostered the greatest OP diversity. These findings challenge conventional drinking water safety assessments that separate chemical contamination from microbial risk, underscoring the urgent need for an integrated risk assessment framework. Furthermore, they highlight the necessity of paying greater attention to the chemical and cascading microbial issues arising from the leaching of plastic pipes into drinking water, and of conducting a more comprehensive assessment of the associated potential health risks.