The misuse of anti-anxiety medications without prescription is a significant concern among university students, driven by academic stress, anxiety, and inadequate mental health support. This study explores the prevalence and determinants of this practice among university students in Saudi Arabia. This quantitative, cross-sectional study surveyed 1,000 university students aged 18 and above from various institutions across Saudi Arabia. A pretested online questionnaire gathered data on demographics, awareness, prevalence, motivations, and perceptions. Descriptive and inferential statistics, including chi-square and correlation analyses, were used to interpret the findings. The study found that 23.5% of participants used anti-anxiety drugs without prescription, with 39.6% obtaining these from pharmacies and 48.2% citing academic stress as the primary motivator. Awareness of anti-anxiety drugs was high (74.8%), yet 53.6% were unsure about specific medications. Significant gender and age differences were observed, with older students (25-34) showing higher prevalence rates. The majority of respondents (87.7%) expressed willingness to discontinue misuse if adequate mental health support was available. The findings underscore the urgent need for enhanced university mental health services, stricter regulation of medication access, and targeted educational campaigns. Addressing the root causes of non-prescription drug use can mitigate misuse and improve student well-being. Future research should focus on longitudinal outcomes of implemented interventions.