Prescription medicine misuse

What is prescription medicine misuse?

Some medicines that doctors prescribe, and some that are sold over the counter, can be habit-forming. Prescription medicine misuse means taking such a medicine in a way other than intended: more often or in higher amounts than advised, for longer than planned, without a prescription, or for its calming or ‘high’ effect rather than its medical purpose.

Over time, misuse can turn into dependence. The body adapts, so the medicine seems to work less well (tolerance) and stopping brings unpleasant withdrawal symptoms. When a person also loses control over their use, doctors call it a substance use disorder.

This problem is often hidden. The tablets or syrup come from a chemist, not a dealer, and people may not realise they are dependent until they try to stop. A national survey led by AIIMS found that about 1.18 crore Indians aged 10–75 use sedative medicines without a prescription, and about 0.20% of the population need help for problems with sedative use. Pharmaceutical opioids used without a prescription are the second most commonly used type of opioid in India, after heroin.

Which medicines are commonly misused?

• Sleeping and anxiety pills. These include benzodiazepines and the newer ‘Z’ sleeping pills. They are very helpful for short-term use in anxiety, panic or sleeplessness, but dependence can develop within weeks of regular use.
• Codeine cough syrups. Codeine is an opioid. Some cough syrups combine it with other ingredients that give a sense of energy and pleasure. They are cheap and easy to get, and are often misused by young people.
• Tramadol and other opioid painkillers. These are prescribed for pain but act on the same brain systems as heroin. Regular use can lead to dependence and withdrawal, and tramadol can sometimes cause fits.
• Pregabalin and gabapentin. These are prescribed for nerve pain and some other conditions. Some people misuse them for their calming or ‘high’ effect, especially people who also use opioids.
• Other medicines with a sedating or mood-altering effect can occasionally be misused too.

How dependence can start from a genuine prescription

Most people with this problem did nothing wrong at the start. The story often goes like this:

• A doctor prescribes sleeping pills during a stressful time, painkillers after an injury, or anxiety pills during a panic attack.
• The medicine helps, so the person keeps taking it, sometimes refilling it from the chemist long after the original prescription ended.
• The body adapts. The usual dose stops working as well, so the person takes a little more.
• Missing a dose brings rebound anxiety, sleeplessness or aches, which feel like the original problem returning. So the medicine seems even more necessary.

Physical dependence is an expected effect of these medicines when they are taken regularly, even exactly as prescribed. It is not a character flaw. Some people then go on to lose control of their use. Understanding this without blame makes it much easier to ask for help.

Behaviours such as buying extra strips from different chemists or visiting several doctors for fresh prescriptions usually grow out of fear, not a wish to get high. The person dreads the sleepless nights, panic or pain that come when the medicine runs out. Recognising this fear is often the first step towards a safer plan.

Signs to look out for

You or someone close to you may have a problem if you notice several of these:

• Taking more tablets or syrup than prescribed, or more often
• Running out of medicine early, or keeping extra ‘just in case’
• Buying the medicine over the counter without a prescription, or from several chemists
• Visiting different doctors to get more prescriptions (sometimes called ‘doctor-shopping’)
• Feeling anxious, restless, shaky or unable to sleep when a dose is late
• Taking the medicine to feel calm, happy or ‘normal’ rather than for its original purpose
• Crushing tablets, mixing them with alcohol, or drinking whole bottles of cough syrup
• Daytime drowsiness, slurred speech, poor memory or unsteady walking
• Hiding medicine strips or empty bottles, or becoming defensive when asked
• Wanting to cut down, but not managing to

Why does it happen?

Several factors can raise the risk:

• Easy availability. In India, many habit-forming medicines can be bought from chemists without a valid prescription.
• Long courses without review. Medicines meant for a few weeks are sometimes continued for months or years.
• Ongoing stress, sleeplessness, anxiety or pain that has not been treated in other ways
• Mental health conditions such as depression, anxiety disorders and trauma-related problems
• Past or current use of alcohol or other substances, especially opioids
• Family history of addiction

How these medicines affect the body and mind

Long-term misuse can cause:

• Drowsiness, poor concentration and memory problems
• Falls and fractures, especially in older adults
• Road and workplace accidents
• Low mood, irritability and emotional numbness
• Constipation, hormonal and sexual problems with opioid painkillers and codeine syrups
• Dangerous slowing of breathing when these medicines are mixed with each other or with alcohol

Misuse of these medicines is also linked to a higher risk of self-harm, particularly when a person is also depressed. Help is available, and these problems often improve once the medicine is reduced safely.

Why you should never stop sleeping or anxiety pills suddenly

This is the most important safety point on this page. After weeks or months of regular use, the brain gets used to the calming effect of benzodiazepines and ‘Z’ sleeping pills. If they are stopped abruptly, or the dose is cut too quickly, the brain becomes over-active. This can cause:

• Severe anxiety, panic and restlessness
• Sleeplessness and nightmares
• Shaking, sweating and a racing heart
• Sensitivity to light and sound
• Confusion, or seeing and hearing things that are not there
• Fits (seizures), which can be life-threatening

The safe way is a gradual reduction plan made with a doctor, where the dose is lowered in small steps over weeks or months. The pace is adjusted to how you feel.

Stopping opioid painkillers or codeine cough syrups suddenly usually causes opioid withdrawal: body aches, a runny nose, loose motions and restlessness. It is very uncomfortable, though rarely dangerous on its own in otherwise healthy adults. After any break, tolerance falls, so going back to the old amount can cause an overdose. Our page on opioid addiction explains this in more detail.

When to see a psychiatrist

Consider speaking to an addiction psychiatrist if:

• You have taken sleeping or anxiety pills most days for more than a few weeks
• You have tried to cut down and felt worse, or couldn’t manage it
• You buy cough syrup, painkillers or pills without a prescription
• You take more than prescribed, or get prescriptions from more than one doctor
• You mix these medicines with alcohol or with each other
• A family member is worried about how much medicine you take

You don’t need to wait until things become severe. A review now is simpler and safer.

How it is diagnosed

A first consultation is a conversation, not a judgement. The psychiatrist will ask which medicines you take, how much and for how long, how you get them, what they were first prescribed for, withdrawal symptoms, alcohol and other substances, physical health, mood, sleep, stress and family history. It helps to bring your medicine strips, bottles and old prescriptions. With your permission, a family member can join part of the discussion.

You may be advised blood or urine tests. The diagnosis follows international criteria (ICD-11), and the plan is built around your goals. Teenagers under 18 are seen with a parent or guardian.

Treatment

Treatment is tailored to the medicine involved and to the person, and it usually combines the following.

1. A safe, gradual reduction plan

For sleeping and anxiety pills, the dose is reduced slowly in agreed steps. Sometimes the doctor first switches to a longer-acting medicine from the same family, which makes a smoother reduction possible. Regular check-ins help to adjust the pace if withdrawal symptoms become hard to manage. Even people who have taken these pills for many years can reduce and stop safely with the right plan.

2. Treatment for opioid painkiller and cough syrup dependence

When codeine syrups, tramadol or other painkillers are involved, treatment follows the same principles as for other opioids. This may include supervised withdrawal, a long-acting substitution medicine that prevents withdrawal and cravings, or a medicine that blocks opioid effects. Your psychiatrist will explain which option suits you.

All medicines must only be started, changed or stopped with your doctor. Please do not try to cut down using tablets from a chemist or a friend.

3. Better ways to manage sleep, anxiety and pain

The problem the medicine was first taken for still needs care. Treatment may include:

• Cognitive behavioural therapy for insomnia (CBT-I) and healthy sleep routines
• Therapy for anxiety and panic, and non-habit-forming medicines where needed
• Pain management with a physician, physiotherapy and safer pain relief
• Treatment for depression if it is present

4. Counselling and talking therapies

• Motivational enhancement: building your own reasons and confidence to change
• Cognitive behavioural therapy (CBT): handling urges, stress and unhelpful beliefs such as “I can’t cope without a tablet”
• Relapse prevention: planning for difficult nights, stressful days and flare-ups of pain
• Family sessions: helping family members support the plan without policing or blame

5. Treating other conditions together

Alcohol use, depression, anxiety disorders and sleep problems often go hand in hand with medicine misuse. Treating them together, known as dual diagnosis care, improves long-term recovery.

Outpatient, online or inpatient care?

• Outpatient care suits most people, with a gradual plan while living at home and working.
• Online consultations are convenient for follow-up, reduction plans and family guidance.
• Inpatient care may be advised for very high doses, fits during past withdrawal, use of several substances together, or serious medical or mental health problems.

Dr. Tarwani sees patients at Sukoon Health in Gurugram and South Delhi, where inpatient rehabilitation is also available, and online.

Recovery and relapse

Recovery is usually gradual. Some weeks feel easier than others, and sleep and mood can take time to settle after a medicine is reduced. Staying in touch with your doctor during this time matters.

A slip, such as taking extra tablets on a bad night, does not mean failure. It is a signal to review the plan with your doctor, not to give up. Many people who once believed they would need pills forever now sleep, work and manage stress well without them.

For families

Families often notice the problem before the person does. A few things help:

• Talk calmly and privately, without labels or accusations
• Remember that the problem often began with a real prescription and a real need
• Do not throw away or hide their medicines, as sudden stopping can be dangerous
• Keep medicines stored safely, especially if there are teenagers or older adults at home
• Offer to go with them to a doctor or to help collect old prescriptions
• Never share your own sleeping pills, painkillers or cough syrup with them, even with good intentions
• For elderly parents, ask for a medication review rather than stopping tablets yourself
• Look after your own health and seek support for yourself

You are welcome to consult Dr. Tarwani first, on your own, to plan the next steps.

Common myths

• “A doctor prescribed it, so it can’t be harmful.” Some prescribed medicines can cause dependence, especially when used for long periods.
• “Cough syrup is just cough syrup.” Codeine is an opioid, and codeine syrups can lead to dependence.
• “If I’m dependent, I should just stop today.” Stopping sleeping or anxiety pills suddenly can cause fits. A gradual plan is safer.
• “Only drug users misuse pills.” People of all ages and backgrounds, including professionals and older adults, can become dependent.
• “I’ll never sleep without my tablet.” With a gradual plan and the right support, many people learn to sleep naturally again.