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Review Article
A literature based study on the prevalence of psychoactive drugs among
students of Pakistan

Introduction:
The rising trend of psychoactive substance use among medical students globally poses a substantial
threat to public health, with far-reaching implications for mental and physical well-being. Medical
students face unique challenges, including intense academic pressures, easy access to prescription
drugs, and the stress of their demanding profession. Research has consistently shown a concerning
prevalence of psychoactive drug use among medical students, leading to impaired cognitive function,
poor academic performance, and negative mental health outcomes.
In Pakistan, substance misuse is a growing concern, with a higher-than-average prevalence of drug
use among young people aged 16-22. Factors such as peer pressure, social media influence, and lack
of awareness about the risks of drug use contribute to this trend. The most commonly used
substances include cannabis, heroin, and opium, which can lead to a range of health problems,
including overdose, addiction, and the transmission of blood-borne diseases.
Psychoactive substances can have a negative impact on health, and their use can lead to addiction, a
complex neuropsychiatric disorder requiring comprehensive treatment and support. Environmental,
genetic, social, and personal factors can contribute to teenage substance use, which can have long-
term consequences for future generations. Medical students are particularly vulnerable due to their
high levels of work-related stress, exposure to illness and death, and the pressure to perform well
academically.
To address this growing concern, it is essential to investigate psychoactive substance use among
medical students in Azad Kashmir and Khyber Pakhtun and develop practical treatments and
strategies to mitigate its effects. This can be achieved through awareness campaigns, peer support
groups, and evidence-based interventions such as counseling, cognitive-behavioral therapy, and
medication-assisted treatment. Medical schools and healthcare institutions must prioritize student
well-being and provide resources and support for students struggling with substance use disorders.
Addressing the root causes of substance use, such as stress and anxiety, is also crucial, and can be
achieved through stress management programs, mental health services, and promoting a healthy
work-life balance.
By addressing these underlying factors and providing support and resources for medical students, we
can reduce the prevalence of psychoactive substance use and promote a healthier and more resilient
medical workforce. This, in turn, will reduce the burden of substance use disorders on individuals,
families, and communities.
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Literature Review:
The cross-sectional study found that medical students were more likely to take psychoactive drugs,
with substantial differences seen by gender and educational attainment. Medical students frequently
struggle with mental health problems and excessive levels of stress. Numerous studies have shown
that peer pressure, stress, and academic pressure all significantly contribute to this population’s usage
of psychoactive substances. (Syed Muhammad Shahkar Ali. Et al)*

 Medical students and other health professionals are thought to be more susceptible to
substance abuse due to their easy availability to psychoactive substances, stress levels, and
frequent exposure to illness and death. (Nazish Imran. Et al ,2023)
. Undergraduates tend to use drugs for fun and enjoyment, which has a negative impact on their
career prospects as future doctors treating the sick human race.( Haq Nawaz et al. J Ayub medical
college Abbottabad 2017:29/4)
. A sizable portion of medical students—25.9%—37.4%—use substances, including cannabis,
alcohol, and cigarettes. ( Ayesha Ishaq et al .)
. According to the US3 (Syeda u. Riaz), drug abuse affects not only the general public but also
doctors and medical students. Based on international research, one in four medical students use
illicitly prescribed drugs or other intoxicants (DeSantis & Hane, 2010). Imran Muhammad and
others, 2022
. They regularly deal with illness, agony, death, gore, and other horrific aspects of life, which causes
them to be highly stressed out at work1.
Sleep and social interactions, making them more vulnerable to the trap of addiction. Furthermore,
Milkman (1999) clarified how pharmacology, medicine, and drug biochemistry understanding leads
to comfort with drug usage.(Ghosh Dipyyoman et al., July 2023).
. study by Roy et al., who also documented students abusing many substances, particularly in the
later years of MBBS because of rising stress-related
Scholastic achievement.] (Ratna Agrawal et al, 2023).
. According to an Indian assessment, drug usage is common among interns, house staff, and medical
students. Doctors to vary from 32.5% and 81.2%Peer-reviewed original articles that examined the
prevalence of substance use disorders (cannabis, alcohol, smoking, tobacco, opioids, inhalants,
sedative/hypnotics, or stimulants) among medical students (medical UGs from first to fourth years
and interns) met the inclusion criterion for the review (Heminc Gupta et al.).

Methodology:
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This study employed a cross-sectional design, combining both quantitative and qualitative
methodologies to investigate the prevalence, trends, and correlates of psychoactive substance use
among medical students. A multi-faceted approach was used to collect data, including online surveys,
in-depth interviews, and self-report questionnaires. Self-report questionnaires were used to gather
information on substance use, academic performance, and demographics (Abel et al., 2021; Bennett
& O’Donovan, 2001; Akvadar et al., 2003; Substance Misuse, 2013; Arria et al., 2008; Gignon et al.,
2015; De Debasmita et al., 2021). Logistic regression models, chi-square tests, and descriptive
statistics were employed to analyze the data (Abel et al., 2021; Akvadar et al., 2003; Sniatala et al.,
2015; Gignon et al., 2015; De Debasmita et al., 2021). SPSS software was used for data analysis
(Akvadar et al., 2003; Sniatala et al., 2015; Gignon et al., 2015; De Debasmita et al., 2021).
In-depth interviews were conducted with psychoactive substance users and key informants (Emmel,
2013; Degenhardt et al., 2016), providing rich qualitative data. Content analysis was used to
systematically analyze the interview data, identifying themes and patterns (Emmel, 2013; Schreier,
2012; Degenhardt et al., 2016). Purposive sampling was employed to select participants, ensuring
that the sample was representative of the population of interest (Emmel, 2013; Degenhardt et al.,
2016).
Additionally, the study employed piloting and refining questionnaires, systematic review, and content
analysis to gather a comprehensive dataset. The study was approved by the Institutional Ethics
Committee, and participants provided written informed consent. This multi-faceted approach enabled
the study to gather a rich and diverse dataset, providing a detailed understanding of psychoactive
substance use among medical students.
The quantitative data collected through self-report questionnaires and online surveys provided
information on the prevalence and patterns of psychoactive substance use among medical students.
The qualitative data collected through in-depth interviews provided a deeper understanding of the
motivations, attitudes, and experiences of psychoactive substance users. The combination of
quantitative and qualitative data provided a comprehensive understanding of psychoactive substance
use among medical students.

The study's findings have implications for the development of effective prevention and intervention
programs to address psychoactive substance use among medical students. The study’s comprehensive
approach and multi-faceted methodology provide a model for future research on psychoactive
substance use among medical students.
The study's limitations include the potential for self-report bias and the limited generalizability of the
findings to other populations. However, the study’s strengths include its comprehensive approach,
multi-faceted methodology, and rich and diverse dataset. The study’s findings provide a detailed
understanding of psychoactive substance use among medical students and have implications for the
development of effective prevention and intervention programs.
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Results:
The study highlights the need for targeted interventions to address stress management ↓ peer support
among medical students (Ali et al., 2022)
The similar conducted by Agrawal et al. highlights the prevalence of substance abuse among medical
students in tribal areas of Chhattisgarh, with a focus on the reasons behind such behavior and the
students’ attitudes toward future use. It underscores the impact of stress and lack of proper guidance
on substance abuse among students, with alcohol being the most commonly abused substance. The
findings suggest a need for policymakers to address this issue and implement preventive measures.
(Agrawal et al., 2024)
The study conducted by Syed Muhammad Shahkar Ali et al. revealed an alarming prevalence of
psychoactive drug use among medical undergraduate and postgraduate students, with an overall
prevalence of 35.8%. The prevalence was higher among postgraduate students (42.1%) compared to
undergraduates (32.6%).
The similar study Riaz et al. (2022) conducted a cross- sectional study among MBBS students in
Karachi, Pakistan, to assess the effect of illicit substance use on academic performance. They found
that substance users had a lower mean GPA compared to non-users, although the difference was not
statistically significant. However, there was a significant association between substance use and
attendance rates, with non-users having higher attendance compared to substance users. This
suggests that while substance use may not directly affect GPA, it can impact attendance.

The study conducted by Syed Muhammad Shahkar Ali et al. revealed an alarming prevalence of
psychoactive drug use among medical undergraduate and postgraduate students, with an overall
prevalence of 35.8%. The prevalence was higher among postgraduate students (42.1%) compared to
undergraduates (32.6%).
The similar study conducted by Sultan, Noureen, and Saher (2023) sheds light on the prevalence of
drug addiction in Pakistan, with a sample size of 156 participants. It revealed that males had a higher
incidence of drug addiction compared to females, with middle adults being the most affected age
group. Tobacco was identified as the most commonly abused drug, while anxiety disorders and
Hepatitis B & C were prevalent mental and physical health problems, respectively.
Male students showed a higher prevalence of substance use than female students. The study
highlights the need for targeted interventions to address stress management ↓ peer support among
medical students (Ali et al., 2022
The similar study conducted Imran et al. (2022) conducted a cross- sectional study to assess
intoxicant use among undergraduate medical students in Islamabad, Pakistan. They found that
smoking was the most prevalent intoxicant used among participants, followed by alcohol, Naswar
(powdered tobacco dip), and heroin. The study identified male gender and the need for mental
relaxation as statistically significant factors associated with cigarette smoking. Additionally, most
students indicated that they did not feel guilty about using intoxicants.
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The most commonly used substances ”ere stimulants, opioids, and sedatives. Factors associated with
drug use included high levels of stress, academic pressure, and peer influence.
The similar study conducted by Agrawal et al. highlights the prevalence of substance abuse among
medical students in tribal areas of Chhattisgarh, with a focus on the reasons behind such behavior
and the students’ attitudes toward future use. It underscores the impact of stress and lack of proper
guidance on substance abuse among students, with alcohol being the most commonly abused
substance. The findings suggest a need for policymakers to address this issue and implement
preventive measures. (Agrawal et al., 2024)

Discussion:
This review’s objective is to support the research’s conclusions. Our research revealed a high
frequency of psychoactive drug use among medical students, with notable variations seen according
to educational attainment and gender. Numerous papers from Pakistan and India that revealed a
greater percentage of drug use among medical students than among non-medical students lend
credence to this conclusion. Additionally, they found that there are notable differences in drug usage
between males and females. Males are more likely than females to abuse drugs, and the prevalence
of drug use is significantly impacted by educational attainment. Drug misuse is more common
among uneducated people than literate people.
Our studies also reported various factors which greatly influence the prevalence of drug use among
students. These factors involve academic pressure, Stress and mental health issues which is
supported by the works of Vishnu Tanya et al, their study reported that students use drugs to cope or
relieve academic stress And other mental health issues yes drugs have sedative effects And can help
calm the body and mind.
Other factors reported by our study involve peer support and education. This finding is consistent
with previous literature which also reported peer influence as an important factor in the prevalence
of drug in addition with lack of awareness.
Peer support networks and educational programs are recommended to raise awareness of the risks of
psychoactive drug use among medical students. These initiatives aim to decrease peer influence and
encourage the adoption of healthier coping mechanisms.
Monitoring psychoactive drug use among students and evaluating the effectiveness of interventions
to address this issue. This will enable continuous improvement of the strategies.
Additionally, our research revealed a number of variables that have a significant impact on the
prevalence of drug use among students. These include pressure to perform well academically, stress,
and mental health problems, all of which are reinforced by Vishnu’s writings. According to Tanya et
al.’s research, students take drugs as a coping mechanism or to ease the stress of their studies and
other mental health problems. Indeed, medications can assist relax the body and mind and have
sedative effects.
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It is advised that peer support groups and educational Initiatives be used to make medical students
more conscious of the dangers associated with using psychoactive drugs. These programs seek to
promote the adoption of healthy coping strategies and lessen the influence of peers.
Keeping an eye on students’ use of psychoactive drugs and assessing how well solutions work to
address this problem. This will allow the strategies to be continuously improved.

Conclusion:
The studies of medical students psychoactive substances use provide numerous points which
Findings emphasize the need for education and awareness about substance abuse and disorder.
Recommendations for addressing substance use disorders include the following: addiction medicine
should be integrated into the curriculum, public awareness campaigns should be initiated, support
should be available, peer support groups should be formed, stress management classes should be
taught, and the enforcement of strict laws and prevention starting in high school should be occurred.
Moreover, almost all the studies call for further research to be conducted to validate the results and
identify the causative ones, as well as develop possible remedies. It includes the use of larger sample
sizes, longitudinal methodologies, and collaboration with all stakeholders.The issue of substance use
that affects millions of people and their families in directly and indirectly, such a problem cannot be
solved without the active participation of policymakers, schools, outreach facilities or treatment
centers and the general public.