World drug report 2014, reported that 162–324 million (3.5% to 7%) of the world’s population aged 15–64, used illicit drugs like cannabis, OPI, COC, or amphetamine-type stimulants [10]. While recent reports of 2023 state that the number of drug abusers increased, from 240 million in 2011–296 million in 2021, accounting for 5.8% of the global population aged 15–64 [11].

The ongoing study incorporates valuable insights, including data from a 2008 investigation that conducted 17,714 urine toxicology tests where BZO emerged as the most prevalent drug among the subjects [12]. The hike in drug abuse faced by Pakistan is significant being a country where usage of these drugs such as cocaine, cannabinoids are illegal. The overall positivity rate (4.8%) from our data were comparable to US positivity rates for drugs of abuse, which was 4.6% in 2021 according to the Quest Diagnostics Drug Testing Index [13].

In this decade-and-a-half-long study of clinical laboratory data, it is evident that THC was the most frequently ordered test among the urine toxicology test panel, with a positivity rate of over 50%. In Pakistan, research suggests that around 6.7 million individuals are engaged in drug abuse, with 4.25 million among them experiencing dependency and requiring extended residential treatment. Despite these alarming figures, there is a lack of preventive measures or policies addressing drug offenses. Among the drug abusers surveyed, 78% attributed their involvement to factors like peer pressure, family conflicts, stress, and financial troubles. Additionally, 24% of the participants acknowledged turning to substance abuse out of curiosity and a pursuit of pleasure [14].

Previous studies have reported that mostly males are more inclined toward substance abuse in comparison with females [15,16,17,18]. Our study also forges the same hypothesis as the number of males was dominant in our data, the consumption was common in middle-aged men (70%).

Pakistan is considered to be one of the largest producers of THC. With an estimated 219 million users (4.3% of the adult population worldwide), cannabis will continue to be the most commonly used substance in 2021. Though men make up the majority of cannabis users worldwide (about 70%), the gender gap is narrowing in some subregions, where women make up 42% of cannabis users [11]. Within our study setup, THC is the most frequently reported drug, with distribution patterns varying among provinces. Cannabinoids emerged as the most frequently tested drug within AJK, indicating a notable prevalence, while other drugs were either not reported or reported at minimal levels within this region. The positivity rate, although varying in Sindh and Punjab, consistently showed THC as the most frequently ordered test, suggesting a higher positivity. In terms of gender-based results, reports of THC consumption remained prominent among males aged over fifteen years, while females were also reported with a lesser margin of difference.

As suggested by our laboratory data, BZO is the second most highly consumed drug, in many parts of the world there has been an increase in the use of psychoactive substances, primarily BZO and BAR. When BZO were introduced into clinical practice (in the 1950s), they were considered efficacious minor tranquilizers, largely devoid of unwanted side effects, in contrast to the barbiturates. Continued use of BZO has often been oversimplified, and they still continue to be the most widely prescribed psychoactive drugs worldwide. Popularity of BZO among drug addicts has grown as they are not only inexpensive, but also treat a variety of conditions such as sleep disturbances and anxieties. They have been used with some frequency in drug abusers, mostly in the context of poly drug abuse. Due to the possible behavioral and physical side effects, as well as the negative impacts on the economy and society, psychoactive medicine use requires healthcare practitioners to prescribe prescriptions carefully. In Pakistan, most of the medications, even those that are psychotropic, are widely accessible without a doctor’s prescription that may result in significant health and societal risks. Pakistan is reported to have a 41% drug misuse rate [19] for BZO and another study reported that around 84% were cases of self-poisoning [20]. Women are more prone to exhibit depressive and anxiogenic behavior, the data is depicting the same. Benzodiazepine abuse is found more commonly within females in comparison with male with almost twice a difference in positivity rate 44.5% and 25.2% and several previous studies have comparatively reported same that men were less prone than women to abuse benzodiazepines [21,22,23].

ALC misuse accounts for 3.5% of global drug abuse and is the fourth leading cause of disability in underdeveloped nations [24]. It is the third most common substance abuse tested globally, with 5.8% of the population testing positive. According to the WHO survey from Pakistan gender differences vary by 17% to 1% [25]. ALC is consumed intentionally as a “drink of choice” at social events [26]. The study conducted in Karachi estimates that 28% stress coping, 47% social influence, and 45% marital or parental problems are the factors which contribute to initiation of ALC use [27,28]. The current study shows ALC is the third most requested test and fourth most frequently reported positive substance abuse in Pakistan, with male consumption consistently insignificantly higher than female consumption.

In 2021, an estimated 60 million people, primarily heroin users, engaged in non-medical opioid use, with 31.5 million using OPI. Pakistan’s 2006 National Assessment Report on Problem Drug Use reveals 628,000 estimated opiate users, with nearly 77% using heroin [29]. A study conducted in 2019 reported that around 60.7% of the study population abused heroin, marking nearly 80% of the study cohort from Peshawar [14]. Similarly, OPI misuse was readily reported within AJK in our study. From the current study it is evident that OPI is the third most ordered test within this region. However, Punjab excels in the positivity rate with nearly treble of positive sample in contrast with Sindh. The problem is aggravated by heroin (opiate) use as it is cheap and readily available due to the country’s widespread border engagement with Afghanistan, and so consumption is hiking as the day passes.

Stimulant drugs COC and AMP are consumed by 0.4% and 0.6% of the global population [12,15]. Our findings show that no rising trend of COC and AMP positivity was seen over the years. These findings concur with previously reported findings [12]. Amphetamine consumption was reported to be equal among females and males in the current study, and there has been a decline in the number of tests ordered over the years. The current study highlights Pakistan’s increasing drug prevalence and calls for targeted policies to address cannabis use. It suggests strengthened prevention programs, improved regulation, better access to treatment, regional disparities, and youth-centric interventions. The study emphasizes the need for education, community organizations, and social services to promote awareness and support.