Non-Medical Use of Psychotropic Medications Among Young People in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

BackgroundNon-medical use of prescription psychotropic medications (NMUPM) among adolescents and young adults in low- and middle-income countries (LMICs) is an emerging public health concern. Such practices are associated with psychiatric comorbidities, increased risk behaviors, and long-term dependence. Limited access to mental health services, weak regulatory enforcement, and the widespread availability of prescription drugs contribute to NMUPM. Despite anecdotal reports, comprehensive epidemiological synthesis across LMICs is scarce. ObjectiveTo systematically review the prevalence, patterns, psychiatric correlates, and health-system drivers of NMUPM among young people (aged 10-35 years) in LMICs and provide a pooled estimate of prevalence through meta-analysis. MethodsWe conducted a systematic review following the PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycInfo, LILACS, AJOL, WHO GIM, Google Scholar, and regional LMIC repositories were searched for studies published between 2000 and 2026 reporting NMUPM among adolescents and young people. Inclusion criteria comprised cross-sectional surveys, community or school-based studies, and national or regional surveillance reports. Data were extracted on sample size, prevalence, commonly misused drugs, sources of medication, and motivations. A random-effects generalized linear mixed model (GLMM) with logit transformation was used to estimate pooled prevalence, and heterogeneity was assessed using I{superscript 2} statistics. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) checklist. ResultsA total of 13 studies were included in the systematic review, with 10 studies (N = 6,728 participants) suitable for quantitative meta-analysis. The pooled prevalence of NMUPM among young people in LMICs was 18.4% (95% CI: 12.1-26.2%), with substantial heterogeneity (I{superscript 2} > 90%). Benzodiazepines and tramadol were the most commonly misused drugs. Primary drivers included prior experience with medications, ease of access through pharmacies or peers, and limited awareness of potential harms. NMUPM was associated with psychiatric symptoms, risky behaviors, and early progression to substance use disorders. ConclusionNon-medical use of psychotropic medications is prevalent among adolescents and young adults in LMICs, posing significant psychiatric and public health challenges. Interventions are urgently needed to strengthen regulatory enforcement, improve public awareness, enhance mental health service accessibility, and promote safe medication practices. Future research should focus on longitudinal studies to clarify causal pathways and test behavioral interventions to reduce NMUPM.