Before going out for a party with friends, 20-year-old Amei (pseudonym) always feels a lump in her throat and sweaty palms, fearing that she will say the wrong thing.
Then the 20-year-old Chinese college student discovered prescription drugs on social media.
She started with pregabalin, a drug commonly used to treat epilepsy, anxiety and nerve pain, and a beta-blocker, a drug commonly used to treat heart disease and also relieve the physical symptoms of anxiety. She purchased both drugs illegally from online sellers.
“I would feel high and feel like I could be the funniest person in the room,” she said. “It was like having 10 drinks and not feeling sick.”
These drugs can produce a feeling similar to being drunk when taken in large doses.
But experts warn that taking these drugs without medical supervision can be dangerous and, in some cases, life-threatening. Long-term use of these drugs can also lead to dependence; users may find themselves dependent on these drugs in any social situation. They also report experiencing symptoms such as increased anxiety, insomnia, and suicidal thoughts when they try to withdraw from the drug.
For Amei, it started out as a nightlife activity and later evolved into regular social events. Now, she takes these medications every day.
"I can't leave the house without it," she said.
Amei's situation is not an isolated case. Around the world, some young people are turning to drugs and experimental substances to replace alcohol.
Generation Z—born between 1997 and 2012—has higher levels of anxiety than any previous generation: One study found that the global incidence of anxiety disorders among 10 to 24-year-olds increased from 10 million to 16 million between 1990 and 2021. A review of 61 studies also found that anxiety among young people has increased compared with before the epidemic.
At the same time, people are looking for "healthier" alternatives to alcohol, which has given rise to a new market, with some substances being touted on social media as hangover-free social drugs.
“Young people see (these drugs) as a cleaner, safer alternative,” said Liam Knowles, an addiction researcher at Teesside University in England. “It’s a false sense of security.”
We have no way of knowing how many young people use these drugs socially, especially since many obtain them illegally.
A study published in Nature Communications estimates that total global consumption of pregabalin, one of the most commonly prescribed medications, increased more than five-fold between 2008 and 2018. Pregabalin abuse and deaths have also increased dramatically.
In China, the first case of pregabalin abuse was reported in 2024. This year, the Chinese government announced plans to tighten controls on the drug. India subsequently restricted its use in May this year. Researchers in Jordan and Ukraine have also noted an increase in abuse.
Hashtags associated with the drugs have sparked thousands of videos on social media platforms encouraging users to mix their own medications, a practice known online as "stacking."
But social media seems to be not only exposing some young people to these substances, it can also help them obtain them.
The BBC World Service discovered that some influencers were selling the drugs on their social media accounts.
Mei said she purchased the drug through Chinese social media.
"There are thousands of posts online selling this," she said. "Easy to find and easy to order."
This phenomenon is not limited to China.
Lora, a 26-year-old customer service worker from Ukraine, told the BBC it was "very easy" to get the drugs online or through friends.
"The Awake Generation"
As young people turn away from alcohol and interest in these substances grows, Gen Z has earned the nickname "Generation Sober."
According to Bloomberg, the market value of global alcohol stocks will drop by US$830 billion (5.6 trillion yuan; NT$26.5 trillion) in 2025. Researchers believe the trend is driven by changes in drinking behavior among young people due to cost and health concerns.
Knowles, the addiction researcher, said many of the young people he meets who use pregabalin recreationally are conscious about their health.
"People don't want the calories, they don't want the weight gain or the aging process," he said.
This logic resonates with Matt, a 22-year-old from the UK. He is a fitness enthusiast and believes the effects of the drugs on his body, especially his liver and heart, are "much less" than drinking alcohol.
"People in this community think (these drugs) are healthier than alcohol," he said.
"Not a free lunch"
Alcohol has been linked to at least seven types of cancer, and the World Health Organization (WHO) warned in 2023 that drinking in any amount poses risks.
Professor David Nutt, a neuropsychopharmacologist at Imperial College London who has long advocated for the relaxation of drug laws, believes the drugs Amy took may be less harmful than alcohol, even if they carry risks of their own.
That changes when pregabalin is used in large amounts, he said.
"If they use it as a narcotic to get themselves drunk, then they're at risk for addiction," he said. "In that sense, it's not a free lunch."
People who abuse pregabalin may develop a tolerance, meaning they may need larger and larger doses to achieve the same feeling of relaxation or euphoria.
High doses of pregabalin can slow breathing and in some cases be life-threatening. High doses of beta-blockers can cause fainting and a very slow heartbeat, which is very dangerous.
Dangers of dependence
Professor Emily Jones, a psychologist at King's College London, believes that comparing the physiological harms of these drugs with alcohol may miss a more fundamental question: What happens when people come to believe that they can only socialize with chemical drugs?
"It's dangerous to drink a lot of alcohol, but it's also dangerous to take medications too frequently without a doctor's supervision," she said.
She's particularly concerned that using drugs to avoid anxious feelings may reinforce a person's belief that ordinary social situations are unsafe.
"If you convince yourself that (these medications) are safe only if you take them before a night out, that belief can easily become generalized," she says.
Over time, Jones said, people may lose confidence in their ability to cope with their illness without medication.
"You lose confidence in your ability to handle things effectively," she said.
Lola also experienced this feeling of dependence.
She initially took anti-anxiety medication before parties and social events, but soon began taking it at work.
"It helps me a lot," she said. "I'm in the business of dealing with people. It makes communication and problem-solving easy."
She said she experienced episodes of depression and suicidal thoughts when she was unable to obtain the drug for two weeks.
"I didn't understand what was happening to me," she said. "I was so anxious that I couldn't eat or see my friends."
black market drugs
As more countries begin to crack down on these drugs, some believe further restricting access could pose different dangers.
This is an additional risk that drinking hard liquor does not have.
Like many people who take these drugs recreationally, Ame worries that she may never be able to completely wean herself off them.
"It's terrible, I don't know what I would do without it."
If you or someone you know is affected by the issues described in this article, your local doctor may be able to offer advice or refer you to organizations that can help.
