The non-medical use of prescription drugs has become a global health concern. Non-medical usage is defined as the taking of prescription drugs, whether obtained by prescription or otherwise, except in the manner or for the reasons or time period prescribed, or by a person for whom the drug was not prescribed.1

A Trendspotter study undertaken between May and September 2019 by Ana Liffey Drug Project and the European Union Drugs Agency (EUDA) Irish National Focal Point identified converging signals of the non-medical use of pharmaceuticals in Ireland.2 The user groups identified included high-risk opioid users, prison populations, people with complex and multiple needs, and young people. Among these groups, the motivations for using street tablets were for their intoxicating effects, to enhance desired effects from illicit substances, to help withdrawal symptoms, to improve sleep, and to reduce stress.

A new national study conducted by Durand et al. presents a comprehensive analysis of prescription drug misuse in Ireland between 2010 and 2020, highlighting growing public health concerns around treatment demand, intentional drug overdoses (IDOs), and drug-related deaths (DRDs).3 In this research, which was published in the journal Drug and Alcohol Dependence, four main categories of prescription drugs with high misuse potential were examined: benzodiazepines and Z-drugs, prescription opioids (excluding those used in opioid agonist therapy), gabapentinoids (particularly pregabalin), and psychostimulants. Using three national datasets, the National Drug Treatment Reporting System (NDTRS), the National Self-Harm Registry Ireland (NSHRI), and the National Drug-Related Deaths Index (NDRDI), the research offers a detailed view of the health harms linked to these substances.

The study found that benzodiazepines and Z-drugs consistently accounted for the greatest proportion of harms across all three indicators, making up 341 per 1,000 treatment cases, 408 per 1,000 IDOs, and 546 per 1,000 DRDs. Notably, while the absolute burden remained highest for this group, the annual increase in harms was modest, indicating relative stability over time. However, the study found an alarming increase in the involvement of alprazolam and the novel psychoactive substance etizolam, particularly in fatal overdoses.

In contrast, gabapentinoids, especially pregabalin, emerged as the most rapidly escalating threat. Despite lower initial prevalence, treatment demand linked to gabapentinoids grew by 44% annually, while related DRDs rose 35% each year during the study period. IDOs involving gabapentinoids also increased steadily by 9% per year. This surge coincides with rising prescribing trends and growing misuse in combination with opioids and benzodiazepines, often contributing to lethal outcomes.

Prescription opioids were the second most involved drug class related to DRDs (207 per 1,000) but showed stable trends over time. Tramadol and codeine were the most commonly reported prescription opioids in both overdoses and deaths. Interestingly, psychostimulants played a negligible role in all three indicators, suggesting that their misuse remains limited in Ireland when compared with other prescription drug classes.

Polydrug use significantly amplified risks across all metrics. The combined misuse of gabapentinoids and benzodiazepines, or opioids, increased sharply, particularly among women. Sex differences were also evident, with women more likely to misuse gabapentinoids and prescription opioids, and men more likely to misuse psychostimulants and certain benzodiazepines.

The research highlights that harms associated with prescription drug misuse pose an urgent public health challenge. The authors suggest that the study’s findings underscore the need for targeted interventions. In particular, clinicians are urged to monitor prescribing practices closely and assess patients’ misuse risk, especially for high-risk combinations. In addition, policy measures, such as reclassifying pregabalin as a controlled drug, enhancing prescription monitoring, and implementing public education campaigns, may help curb the growing tide of prescription drug misuse in Ireland.

1    United Nations Office on Drugs and Crime (2011) The non-medical use of prescription drugs: policy direction issues. New York: United Nations. Available from: https://www.unodc.org/documents/drug-prevention-and-treatment/nonmedical-use-prescription-drugs.pdf

2    Duffin T, Keane M and Millar SR (2020) Street tablet use in Ireland: a Trendspotter study on use, markets, and harms. Dublin: Ana Liffey Drug Project. Available from: https://www.drugsandalcohol.ie/31872/

3    Durand L, Arensman E, Corcoran P, et al. (2025) Harms associated with prescription drug misuse in Ireland: a national observational study of trends in treatment demand, non-fatal intentional drug overdoses and drug related deaths 2010–2020. Drug Alcohol Depend, 272, 112669. Available from: https://www.drugsandalcohol.ie/43321/