Not what the doctor ordered: motivations for nonmedical prescription drug use among people who use illegal drugs

Tom May, Katy Holloway, Marian Buhociu, Rhian Hills

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Nonmedical Prescription Drug Use (NMPDU) is common among people who use illegal drugs. NMPDU is particularly problematic among this population however, as medications such as benzodiazepines and gabapentinoids can potentiate the harmful effects of opioids. Despite these harms, there is some evidence that NMPDU can have harm reducing and therapeutic potential for some people who use illegal drugs. This study provides further evidence of the motives for NMPDU among people who use illegal drugs in community and prison settings in Wales, UK.

In depth, semi-structured interviews were conducted with 60 interviewees recruited from statutory and third sector drug treatment providers operating in five towns and cities in Wales, and from two Welsh prisons. Eligibility was based primarily on whether the person was currently (or previously) a user of illegal drugs and had recent experience of NMPDU.

NMPDU was found to be largely driven by insufficient access to certain prescription medications and treatment. In this context, NMPDU played an important role in alleviating legitimate medical concerns, opioid withdrawal symptoms and the harmful effects of certain illegal drugs. The sharing and distribution of medications among peers emerged as an alternative form of support that was used to reduce harm in these scenarios.

Results suggest that the sharing and nonmedical use of medications has the potential to mitigate a number of legitimate medical concerns in the absence of treatment. Finding nuanced ways of responding to patient need whilst reducing the potential for NMPDU are therefore needed, and harm reduction strategies that harness the capacity of people who use drugs to respond to situations of peer need should be encouraged. Additional policy measures that attend to the inequities and social-structural factors that produce and maintain the need to consume prescription medications in ways that are not intended are also required.
Original languageEnglish
Article number102823
JournalInternational Journal of Drug Policy
Early online date23 Jun 2020
Publication statusPublished - 23 Jun 2020


  • Benzodiazepines
  • Gabapentinoids
  • Harm reduction
  • Nonmedical prescription drug use
  • Opioids


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