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There is a substantial difference between the legal instrumental use of a psychoactive prescription drug (obtaining a prescription from a physician for a medical or psychiatric condition) and using the same controlled drug instrumentally, but without benefit of a prescription.Psychoactive drugs can be addictive and dangerous and put users at risk for other adverse health effects, including overdose, especially when taken along with other drugs or alcohol. Before prescribing drugs, a health care provider considers a patient's health conditions, current and prior drug use, and other medicines to assess the risks and benefits for a patient. 

When a person misuses or abuses a prescription drug, there is no medical oversight of the risks. A person can die from respiratory depression from misusing or abusing prescription painkillers; for example, opioids. Prescription sedatives like benzodiazepines can cause withdrawal seizures. Prescription stimulants such as medications for attention deficit hyperactivity disorder (ADHD) can lead to dangerous increases in blood pressure. The risks from these drugs are worse when they are combined with other drugs, or alcohol.

Additionally, when a person misuses a prescription drug, even on a single occasion, that individual might enjoy the experience so much that they begin to seek out the drug more often. Thus, drug abuse and drug dependence are serious risks of misusing prescription drugs.

Reference

https://www.drugabuse.gov/drugs-abuse/commonly-abused-drugs