Prescription Drug Misuse in Pakistan: Understanding the Growing Risk of Opioids and Sedatives

Walk into almost any pharmacy in Pakistan, and there is a great chance you can buy a dose of tramadol, alprazolam, or any syrup without ever showing a prescription. For many families, this feels harmless, even though helpful, when a doctor's appointment becomes too expensive. But behind the scenes, this convenience lies in a quietly expanding public health problem: prescription drug misuse. Opioids and sedatives are a class of medicines designed to relieve pain and anxiety under medical supervision and are increasingly being used without medical guidance, without a prescription, in higher doses, or for longer than intended. The result is a rising tide of dependence, overdose, and long-term health damage that is only beginning to receive the attention it deserves.

What Counts as Prescription Drug Misuse?

Prescription drug misuse refers to using medication in a way other than how it was prescribed to the patient. Two categories of medicines that are central to this discussion in Pakistan are opioids and sedatives.Opioids include both classic painkillers such as morphine and codeine, as well as newer analgesics like tramadol and atypical opioids such as nalbuphine, buprenorphine, and pentazocine, which are apparently misused more frequently in Pakistan than hydrocodone or oxycodone, which are commonly discussed. Sedatives, most commonly benzodiazepines such as alprazolam and diazepam, are prescribed for anxiety, insomnia, and acute stress but carry a risk of dependence, particularly with long-term use.

How Big Is the Problem in Pakistan?

Pakistan has never carried out a comprehensive drug use survey since 2013.

• An estimated 6.7 million Pakistanis were found to have used opioids of some form in the preceding year, placing the country among those with the highest opioid burden globally.

• Around 1.6 to 1.7 million people reported non-medical use of prescription painkillers specifically, distinct from illegal heroin use.

• The report noted that women, who are far less likely to use illegal street drugs, were disproportionately misusing prescription opioids, tranquilizers, and sedatives obtained legally through pharmacies.

Why Is Misuse of Drugs Rising?Key Drivers.

Easy, Unregulated Access.

Both opioids and benzodiazepines are legally classified as controlled medicines in Pakistan. Many pharmacies and general stores sell these medicines OTC without insisting on a valid prescription, and patients can often obtain repeat supplies from multiple prescribers without any prescription-tracking system.

Self-Medication and Limited Access to Care.

For a large portion of the population, visiting a physician, particularly a pain specialist, is neither affordable nor easily accessible. With chronic pain, anxiety, and insomnia, many people turn to pharmacists or informal advice for a quick solution, often receiving a sedative or painkiller with little discussion of dosage limits or dependence risk.

Health Consequences of Opioid and Sedative Misuse.

The health impact of prescription drug misuse extends well beyond disasters. Long-term opioid misuse can cause constipation, receptor dependence, and respiratory depression at higher doses or when combined with central nervous system depressants, potentially leading to overdose. Combining opioids with benzodiazepines is a lot more dangerous, as both classes suppress breathing, and their combined effect effectively raises the risk of respiratory failure.Sedative misuse has its own risks, including memory problems, daytime sedation, falls, and withdrawal symptoms that can include severe anxiety, tremors, and seizures if the medicine is stopped immediately after prolonged use.

The Role of Pharmacists and Healthcare Providers.

Healthcare professionals should sit at the frontline of both the problem and its solution.Pharmacists, as the most accessible healthcare professionals for many families, also carry significant responsibility. Consistently requiring valid prescriptions for scheduled opioids and benzodiazepines, counselling patients on safe use, and referring individuals showing signs of dependence to appropriate treatment services can help close some of the gaps left by limited prescription-tracking infrastructure.

What Can Be Done: Prevention and Policy Directions

• Stronger enforcement of existing prescription-only regulations for opioids and benzodiazepines at the pharmacy level.

• A national electronic prescription-monitoring system to flag patients receiving overlapping prescriptions from multiple providers.

• Expanded, affordable access to mental health and pain-management services, particularly outside major urban centers.

• Public awareness campaigns that address the misconception that prescription medicines are inherently safer than illicit drugs.

• Routine addiction-risk screening built into standard prescribing protocols for opioids and sedatives.

• An updated, comprehensive national drug use survey to replace outdated 2013 data and guide evidence-based policy.

Conclusion.

Prescription drug misuse in Pakistan is not a distant or hypothetical concern; it is an ongoing public health issue affecting millions of people, many of whom never intended to develop a dependence. Because opioids and sedatives are legal, medically necessary, and widely available, the response cannot simply be prohibition. It requires a combination of stronger regulatory enforcement, better clinical practices among prescribers and pharmacists, improved access to mental health and pain care, and honest public awareness about the real risks these medicines carry when used outside medical supervision. Addressing the problem early, before dependence takes hold, offers the best chance of protecting individuals, families, and the wider healthcare system from its long-term consequences.

Frequently Asked Questions

1. Are tramadol and other opioid painkillers legal to buy without a prescription in Pakistan?

No. Opioid analgesics, including tramadol, are legally classified as controlled or prescription-only medicines in Pakistan. However, weak enforcement means they are sometimes sold without a prescription at the retail level, which contributes significantly to the misuse problem discussed in this article.

1. Why are women in Pakistan more likely to misuse sedatives than illegal drugs?

Research suggests this pattern is linked to easier legal access to sedatives and painkillers through pharmacies, alongside stronger social stigma around women's use of illicit street drugs. As a result, many women who self-medicate for anxiety, insomnia, or chronic pain do so using legally available prescription medicines rather than illegal substances.

1. What should someone do if they think they have become dependent on a prescribed opioid or sedative?

Anyone concerned about dependence should speak with a physician rather than stopping the medicine abruptly, since discontinuation of opioids or benzodiazepines can cause serious withdrawal symptoms. A doctor can arrange a safe, supervised tapering plan and, where needed, refer the individual to addiction treatment or mental health services.

References.

Ali, S., Ali, S. A., Ahmed, S., & Kumar, R. (2023). Exploring landscape of drug abuse trends in Pakistan: A decade and a half of clinical laboratory big data analysis. PLOS Global Public Health.

Awan, S., Malik, S. Z., & Zaman, S. (2018). Opioid use and abuse: Prescription practice, attitude, and beliefs among doctors of Karachi. Cureus.

Farooq, S., Sheikh, S., Kausar, M., & Hussain, A. (2023). Prescription drug dependence with and without concurrent illicit drug use: A multicenter cross-sectional survey among an addiction treatment-seeking population. Substance Abuse Treatment, Prevention, and Policy.

Khosa, F. (2013). Pakistan's drug problem. The Lancet, 381(9884), 2149–2150.

Naqvi, H. A., Hussain, S., Zaman, M., & Islam, M. (2009). Pattern of benzodiazepine use in psychiatric outpatients in Pakistan: A cross-sectional survey. Annals of General Psychiatry.

United Nations Office on Drugs and Crime. (2013). Drug use in Pakistan 2013: Technical summary report. Ministry of Narcotics Control, Government of Pakistan; Pakistan Bureau of Statistics; UNODC.

World Health Organization, Eastern Mediterranean Regional Office. (2017). Pattern of addiction and its relapse among habitual drug abusers in Lahore, Pakistan. Eastern Mediterranean Health Journal, 23(3).