Non-Medical Use of Prescription Drugs in Bengaluru, India


Background: Non-medical prescription drug use is an ongoing problem in India, however, there is paucity of literature on patterns of use in the population.

Objective: The present study explored patterns of non-medical use of prescription medicines in in Bangalore, an urban metropolis in South India (N=717).

Methods: Participants were recruited using a mall-intercept approach, wherein they were intercepted in 5 randomly selected shopping malls, and interviewed on their use of prescription medicines.

Results: Mean age of the participants’ was 28 years (SD:5). Past 12-month non-medical use of different prescription medicine classes was as follows: i) anti-inflammatories and analgesics- 27%, ii) opioids- 17%, iii) antibiotics- 13%, iv) sedatives- 12%. Majority reported ‘use without prescription’, while ‘use in ways other than as prescribed’ was also reported. In all cases, pharmacist was the main source of obtaining the drugs non-medically. In multivariate logistic regression analyses, non-medical use was found to be significantly associated with participants’ baseline characteristics like gender, education, current employment status, marital status.

Sixty-five percent stated that “doctor’s prescription is not required for common complaints, we can decide ourselves”, while 60% stated that “it’s okay to deviate from a prescription as needed”. Hundred-percent said that ‘using prescription medicines is more socially acceptable, and safer, compared to alcohol or illicit drugs’.

Conclusion: Findings underscore the need for considering various contextual factors in tailoring preventive interventions for reducing non-medical use of prescription drugs.

Keywords: Non-medical prescription drug use, prescription drug abuse, prescription drug misuse, sedative misuse, painkiller misuse


Non-medical use of prescription medicines (operationalized as use ‘in ways other than prescribed’, or ‘when not prescribed’) is an ongoing problem in the developing world. In India, prescription drugs are regulated by the Drugs and Cosmetics Act, 1940, and the Drugs and Cosmetics Rules, 1945. Prescription drugs come under Schedules H and X of this Act. However, despite legislative regulation, easy availability of a wide range of drugs has resulted in increased proportions of drugs used without prescription. While non-medical use of pharmaceutical drugs has been steadily rising in the last decade across South Asia, documented literature has been scarce, with prescription drugs being traditionally excluded from national drug use surveys.[1] A non-data based report was released recently by the United Nations Office on Drugs and Crime (UNODC) (2011),[1] which contained inputs from experts/policy makers to assess the nature and extent of the problem of pharmaceutical drug use in South Asia. The report reiterated the magnitude of the problem, despite the absence of related baseline data.

            In India, literature concerning non-medical prescription drug use has been sporadic, with a decade or so difference between studies. Two nation-wide surveys on drug use conducted in the early 2000’s[2,3] included benzodiazepines, in addition to illicit drugs and alcohol – apart from this, there is no national data on prescription drug use. Information related to prescription drug use is largely anecdotal, available as newspaper reports, or available over the internet.[4-6] While previous studies have considered such factors as rural-urban differences, education, economic status,[7,8] given the paucity of such studies, further research is warranted to examine the patterns of prescription drug use. Although there is no baseline data to estimate the extent of the problem of prescription drug misuse in India, pharmaceutical use is a major trafficking and health concern.[1]

Non-medical use of prescription drugs is a problem in the developed world as well. Studies from advanced nations such as the United States for example, reveal that there were 2.5 million individuals aged 12 or older who misused prescription drugs for the first time in the past year, which averages to around 7,000 people initiating prescription drug misuse per day.[9] However, in developing countries, the problem needs to be viewed keeping various other contextual factors in mind, such as changing lifestyles, lack of access to quality health care, and poor legislation, all of which impact non-medical use of prescription drugs, which is already rampant.

Against this background, an urban community study on Non-medical Use of Prescription Drugs was carried out using a mall-intercept approach in Bangalore, South India. This information, reported for the past 12 months from a cosmopolitan city, provides recent data on the problem. This preliminary information can help to renew a discussion on the continuing problem of non-medical prescription drug use in the country, and aid in developing preventive strategies, and raising public awareness about the potential risks associated with such use.


Prescription medicines

Prescription medicines were operationalized as: a) medicines listed under Schedules H and X of the Drugs and Cosmetics Act, 1940 and the Drugs and Cosmetics Rules, 1945; b) Drugs listed under Schedule G, which do not need prescription but require mandatory text on the label: “Caution: It is dangerous to take this preparation except under medical supervision”. Accordingly, the categories of prescription drugs assessed include: analgesics and anti-inflammatories, sedatives, opioids, antibiotics.


All protocols were approved by the Institutional Ethics Committee. Participants were recruited using a mall-intercept approach,[10,11] wherein they were intercepted in 5 randomly selected shopping malls in Bangalore (one each from the East, West, North, South, and Central Zones), explained that a research study on prescription drug use is being conducted, and asked if they might consider participating. For those who responded positively, an initial screening was done to ascertain if: a) they were between 18-40 years of age; b) currently residing in Bangalore City. If found eligible, demographics were recorded, following which the nature and purpose of the study was explained in more detail. Those who agreed to participate further were administered written informed consent. After the interview, respondents were offered a gift coupon for Rs. 200 for redemption in the mall where data was collected, as compensation for their time. They were also given a booklet (in English/regional language) containing information about various harmful effects involved with using prescription medicines non-medically.

All interviews were carried out by two project staff with graduate education, who were trained on the study protocol. Subsequently, the first author observed at least 10% of the interviews every month, and provided regular feedback to ensure consistency and quality of the data obtained.

With regard to sample size calculation, based on anecdotal information,[12] with an expected percentage of prevalence of about 20% of prescription drugs use (e.g. painkillers) in the study population, the sample size was estimated to be 683, with 95% confidence interval of 6% target width.[13] Accordingly, the sample size for the present study was fixed at 700.

Non-medical use in the past 12 months

Non-medical use of prescription medicines in the past 12 months was assessed by asking respondents: (a) In the last 365 days, did you use (the specific class of medicines) in ways other than as prescribed (e.g. using more number of tablets than prescribed, or for longer duration than indicated in the prescription? (b) In the last 365 days, did you use (the specific class of medicines) that were NOT prescribed for you? The names of various medicines were read out to the respondents, along with popular brand names. Respondents were also shown medicine samples to enable recall of prescription drugs used in the last 12 months. Accordingly, 2 mutually exclusive categories of non-medical use were identified: (i) use ‘in ways other than prescribed’ (ii) use ‘when not prescribed’.


All information was obtained using an instrument adapted from the Washington University Risk Behavior Assessment (WU-RBA) for prescription drugs, and the Substance Abuse Module (RxSAM) for Prescription Drugs. Both instruments have good test-retest reliability.[14,15] In the present study, content validation of the adapted instrument was carried out by faculty members at NIMHANS experienced in treating patients with substance use disorders. The instrument was also translated into regional language and back-translated into English using standard procedures. The instrument was then beta-tested on 15 individuals shopping in a local super market (which was not included in the main study), before being administered to respondents in shopping malls for the main study.


For categorical data, chi-square analyses were used to assess associations between selected variables and past 12-month non-medical prescription medication use. Multivariate logistic regression was used to identify predictors of past 12-month non-medical use. For each category of prescription medicines, all variables that showed a significant level of p<0.10 in univariate analysis were included, along with other relevant variables. These variables were selected based on prior literature suggesting their association with non-medical use of prescription medications.7,8 Analyses were conducted using SAS© version 9.2 (USA).


Description of the sample

Mean age of the participants (N=717) was 28.0 years (SD: 5.0). Thirty-percent was between 18-25 years, 54% was between 26-33, and 16% was between 34-40 years of age. Forty-nine percent of the sample was female, 70% had graduate-level education or above, 62% was married, and they reported mean monthly income of Rs. 42306.0 (SD: 35604.0). Two-percent reported having suffered an accident/ injury in the past. However, none had received treatment for any medical problem in the past year; prescriptions received for any complaints were issued prior to the last 12 months.

Past 12-month non-medical use of prescription medicines

Non-medical use of any prescription drug (sedatives/ opioids/ analgesics/ antibiotics) was reported by 68% of the sample. Past 12-month non-medical use of specific prescription medicine categories are presented in Table 1.

Source of obtaining prescription medicines for non-medical use, reason for not consulting doctor

            For all categories of prescription medicines, pharmacist was the main source of obtaining the medicines non-medically. Further details are reported in Table 2


Sociodemographics and past-12 month non-medical use of prescription medicines 

Bivariate associations between past 12-month non-medical prescription drug use and sociodemographic variables are presented in Table 3.

Correlates of past 12-month non-medical prescription drug use

            Results of multivariate logistic regression analyses showing associations between past 12-month non-medical prescription drug use and selected baseline variables are reported in Table 4.



            Fifty-two percent reported having seen advertisements of various products on television, to overcome drug addictions, relieve pain, ‘increase height’, ‘increase weight’, ‘stay slim and fit’, among others (data not shown).

            Six-percent reported that they had used medicines for ‘body building’ in the last 12 months. None of them could recall the name of the medicine, and claimed that friends had suggested the medicine ‘to build personality/body, muscles’ (data not shown).

Sixty-five percent stated that “you don’t need a doctor’s prescription for getting most of the medicines we need, we can decide on our own”, while 60% stated that “it’s okay to deviate from a prescription as needed”. Hundred-percent said that “using prescription medicines is more socially acceptable, and safer, compared to alcohol, or illegal drugs like heroin”.



This is the first known study to provide information regarding the non-medical use of prescription medicines from a wider perspective in an Indian sample. The findings indicated that anti-inflammatories/analgesics were the most frequently reported class of prescription medicines used non-medically in the past 12 months (27%). It appears that anti-inflammatories/analgesics, and opioids were loosely bought over the counter, as majority reported that they had used them “without prescription”. These findings point to the unregulated availability of medicines which resulted in their non-medical use. However, with regard to sedatives and antibiotics, participants seem to have relied on a prescription for initial use (referred to as ‘floating prescriptions’),[16] although they reported that they later deviated from it and used them “in ways other than as prescribed”. This suggests that having a medical prescription might increase availability and opportunity to procure the medicines over the counter. These findings are similar to a prior report comparing heavy users and less heavy users of sedatives in an urban community sample in St. Louis, USA.[17] The study had shown that heavy users of sedatives were significantly more likely to report ‘using in ways other than as prescribed’, compared to ‘use without prescription’. Other studies have also emphasized the misuse of prescribed sedatives.[18,19]

Furthermore, in terms of specific drug categories, a few points deserve special mention. Among non-medical analgesic users, Nimesulide, which has been reported to be associated with a wide range of adverse effects, was the most frequently reported, commonly bought over the counter by the brand name ‘Sumo’. Among antibiotic users, the most frequently reported pattern was erratic use, which poses a serious danger as it can contribute to antimicrobial resistance. Among sedative users, all the “non-prescribed users”, and some of those who had used them “in ways other than prescribed”, reported ‘erratic use’ (Table 1), which can increase the risk of harmful effects such as withdrawal seizures.

Pharmacist was the main source of obtaining prescription drugs non-medically, and in a majority, he had neither checked the prescription (when available) nor asked for it. This reiterates what is already well known: the advice of pharmacists in most countries of South Asia is highly valued by customers, and pharmacists often suggest/dispense prescription medicines.[1]

The findings have several implications for the field. First, doctors need to exercise caution when issuing prescriptions, and all prescriptions should be accompanied by sound medical advice. For instance, in view of ‘erratic use’ which was reported among sedative users in the present sample (Table 1), when a prescription for sedatives is given, the dangers of overdosing (e.g. respiratory depression) and erratic use (e.g. seizures) should be explained clearly, as well as the dangers of continuing to use for reasons such as to be able to sleep, relax, relieve stress (cited by the current sample– Table 2).

Next, pharmacist training and sensitization is equally important, coupled with strict enforcement of laws in case of irresponsible dispensing. The role of pharmacists in prescription drug misuse has been mooted in literature for decades, and it is important to note from this analysis that these trends continue, and steps need to be taken to curb the same.

Third, from a public health stance, an important measure is raising health awareness in the population. In the present sample, majority were educated and relatively affluent, considering that they were mall-goers. However, 60% had opined that “doctor’s prescription is not required for common complaints, or that it is alright to deviate even if you had one”. While this may not necessarily imply that they would use prescription drugs in an irrational manner, it would still be worthwhile if they were made aware of adverse effects and drug interactions of common medicines available in the market.

In this regard, a pragmatic measure would be to incorporate this awareness as part of the public health information provided about the ill effects of addictive drugs. These days, the television and other media in the developing world are attempting to convey health warnings about the harmful effects of alcohol and tobacco. But there is practically almost no message provided about the dangers of using pharmaceutical products indiscriminately. Hence these integrated messages, focusing particularly on emerging new drugs in the market, as well as more traditional ones known to be/ likely to be frequently used, can help individuals to make informed choices.

More importantly, health care professionals have the unique potential to impact the problem of non-medical prescription drug use in terms of both prevention and active interventions. For instance, at mental health care centers, professionals need to incorporate information about the dangers of non-medical prescription drug use, into the psychoeducation provided to those who have an alcohol/ illicit drug use problem. At the community level, a practical measure can be to sensitize doctors serving at peripheral health centers about providing information to patients and families regarding the dangers of using prescription drugs non-medically.

Another important implication of the present findings is that they indicate the need for health professionals to address the reasons cited by the respondents for using prescription drugs non-medically. For instance, participants in the present report have cited reasons such as “to sleep/ relax/ for stress relief” for using habit-forming drugs such as sedatives. Similar findings were reported in St. Louis, USA,[17] where motives such as ‘stress relief, for sleep, to change mood or be happy, to get high’, were reported by more than 60% of the sample of non-medical sedative users. It thus appears that despite the vast differences in culture and value systems, the findings point to some commonalities in terms of non-medical sedative use, notably the presence of a prescription, and specific reasons cited for using non-medically.

The present findings have also indicated that past 12-month non-medical prescription medication use was associated with several sociodemographic variables, and any preventive measures undertaken should take into consideration possible factors that may have a bearing on prescription drug use.

The findings of the present report also raise issues as to why should 12% of a young, healthy sample feel the need for sedatives. Similarly, why should 27% of young, apparently healthy individuals that comprised the present sample feel the need for pain medication? Thus the data provide valuable information to health professionals who can use this knowledge to help patients/general public to cope with life circumstances without resorting to non-medical prescription drug use.

Building a positive self-image would also be an important component of this education, especially for young people, which will prevent use of drugs for purposes such as ‘body-building’ (reported by 6% of the current sample). In essence, the issue of non-medical use of prescription drugs forms part of a big picture comprising of strategies that should essentially aim at enabling individuals make informed choices and decisions, with regard to their lifestyles, health, and safety.

The findings should however be treated with caution given the small, convenient, cross-sectional sample. Also, the sample was restricted to mall goers who were primarily between 18-33 years, educated, and relatively affluent, which limits generalizability. Nevertheless, the data is recent, and provides some preliminary evidence about non-medical use of prescription medicines in one of the fastest developing cities in India. There is a pressing need to explore non-medical use of prescription medicines in this part of the world, and the present data can be a preliminary step for a larger epidemiologic study exploring non-medical prescription drug use.

The study has also made an attempt to obtain the data using a mall-intercept approach. This venue-based recruitment employed in other countries for obtaining information on public health issues,[20,21] has not so far been reported for recruiting community samples in India, to enquire about their use of drugs. Despite some inconveniences (e.g. obtaining permission from the malls, lack of space for conducting the interview, etc.), it is felt that this approach is worth exploring for obtaining health related information from the general public. In conclusion, the present report can provide some insights into developing preventive efforts and interventions to reduce non-medical use of prescription drugs.



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Table 1. Past 12-month non-medical use of different prescription medicine classes (N=717)

Non-medical use

n (%)

Used in ways other than prescribed

n (%)

Used without prescription

n (%)

Drugs used non-medically

n (%)

Analgesics and anti-inflammatories


190 (27) 24 (4) 166 (23) Nimesulide – 114 (60) (Sumo–61#, NISE – 27#, Nodard Plus-16#, Emulide Plus-8 Nicip Plus-2#); Baralgan–25 (13); Paracetamol – 14(8); Others-37 (19) (Combiflam, Diclofenac, Brufen, Aspirin, Vicks Action 500, Meftal Spas)
Opioids 115 (16) 46 (6) 69 (10) Cough syrups (Benedryl, codeine) – 106 (92); Tramadol capsules – 9 (8)
Antibiotics 92 (13) 86 (12)a 6 (1)b Ciprofloxacin, Levofloxacin, Norfloxacin, Ofloxacin–53(58); Erythromycin, Roxithromycin, Azithromycin–18(19); Metronidazole –9 (10); Amoxicillin – 7 (8); Others (Cefixime, Clavulanate, Gentamicin) – 4 (4); ‘Don’t remember’ – 1 (1)
Sedatives 88 (12)c 64 (9)c 24 (3)c Alprazolam – 25(29); zolpidem, zopiclone – 20 (23); diazepam-18 (20); others (lorazepam, clonazepam, oxazepam)–14(16);

‘don’t remember’ – 11 (12).

a34 of these used longer than prescribed, 51 had used lesser than prescribed, and one respondent used irregularly;

 bReported using 1-2 tablets of the antibiotic / starting, stopping erratically;

cAll the 24 who used ‘without prescription’, and 7 of those who used ‘in ways other than prescribed’ reported using irregularly – stopping use, restarting – and continuing this pattern on and off over a period of time









Table 2. Source of obtaining, reason for not consulting doctor (N=717)



% (n=190)


% (n=115)


% (n=92)


% (n=88)

Source of obtaining:
–          Pharmacist 98 97 50a 65
–          Family members 3 50a 22
–          Friends 13
Did the pharmacist question/

ask for prescription?

–          Yes 19b
–          No 100 100 100 81
Reason for not consulting doctor :c
– Small issue (65)

– I know pharmacist well, he gives me Sumo (55)

– If you go to doctors, they will use these simple things to make more money (26)

– Even if you go to a doctor, they will say same thing and charge 1000 rupees (or charge a lot) (29)


-Cough didn’t   subside, so continued  (48)

-Small issue (100)

– Got cured/ cough reduced, so stopped. It is small issue, why ask doctor about it (93)

– Fever did not reduce, so took more, my (family member) asked me to continue same medicine (7)

– To sleep (70)

– Stress relief (25)

– To relax (25)

– Family / friends had it, so why go to doctor (22)

– Why go to doctor for this, I can get them (sedatives) myself (65%)



                                             aApplies only to 40 respondents, 34 of whom used longer than prescribed, and 6 used without prescription. The rest had used

                                            lesser than indicated  in the prescription, so they did not have to obtain the antibiotic from any source for non-medical use (Table 1). 

                                                                   bAlthough pharmacist questioned, he dispensed the medicine when told “doctor told me to continue same medicine if needed / cannot sleep”

                                                                  cNot mutually exclusive;






Table 3. Comparison of nonmedical users with those who did not report use, by demographics (N=717)

Users (%)



(%) (n=232a)




(%) (n=115)



(n=232 a)




(%) (n=92)




p-value Users

(%) (n=88)




Age (in years)

(mean, SD)


28.5 (4.8)


28.4 (4.7)




28.7 (4.7)


28.3 (4.8)




28.1 (4.9)


28.4 (4.7)




29.3 (4.7)


28.2 (4.8)




Female, %


66 42 <0.0001* 57 46 0.06 49 48 0.84 42.0 51.0 0.14
<Graduation, % 38 27 0.01* 45 29 0.004* 34 31 0.66 17 34 0.003*


Married, % 66 60 0.18 60 61 0.98 55 61 0.34 75 61 0.01*


Currently not working, % 44 25 <0.0001* 39 27 0.02* 35 30 0.39 26 33 0.24
Income (INR)

(mean, SD)







40188.0 (33431.0) 40242.0


0.98 38504.0



39670 (34796.0)


0.68 49399.0





a232 participants did not report any non-medical use

 *Statistically significant; p≤0.05 (Chi-square/Fisher/t-test)

Table 4. Multivariate logistic regression predicting past 12-month non-medical use of prescription medicines (N=717)

Unadjusted model Adjusted model Unadjusted model Adjusted model
OR 95%CI aOR 95%CI OR 95%CI aOR 95%CI


1.004 0.96 – 1.04 1.01 0.95 – 1.08 1.01 0.97-1.06 1.05 0.92-1.13


2.66 1.77 – 4.0 1.98 1.19 – 3.28 1.54 0.97-2.42 1.36 0.75-2.47
Less than graduation education b


1.65 1.12 – 2.52 1.48 1.09 – 2.24 1.96 1.23-3.13 1.73 1.04-2.89
Married c


1.31 0.87 – 1.98 1.09 0.58 – 2.07 0.99 0.62-1.57 0.61 0.29-1.25
Currently not employed d


2.37 1.55 – 3.62 1.83 1.08 – 3.24 1.70 1.06-2.74 1.36 0.70-2.64
Income (INR) a


1.0 1.0 – 1.0 1.0 0.99 – 1.0


1.0 1.0 – 1.0 1.0 0.99 – 1.0



a Entered as continuous variables; b Graduation and above’ as the referent group;

c‘Unmarried’ as the referent group; d‘Currently employed’ as the referent group



Table 4 … Contd …










Table 4. Multivariate logistic regression … contd …


Unadjusted model Adjusted model
OR 95%CI aOR 95%CI
Age a


1.04 0.99 – 1.10 0.99 0.91 – 1.07


1.43 0.87 – 2.34 1.46 0.75 – 2.82
Graduation & above b


2.46 1.33 – 4.55 2.53 1.30 – 4.91
Married c


1.94 1.12 – 3.34 2.32 1.04 – 5.18
Currently not employed d


0.72 0.42 – 1.25 1.02 0.47 – 2.20
Income (INR) a


1.0 1.0 – 1.0 1.0 0.99 – 1.0


a Entered as continuous variables; b‘Less than graduation’ as the referent group;

c‘Unmarried’ as the referent group; d‘Currently employed’ as the referent group


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