Background: Chronic low back pain (CLBP) is a prevalent musculoskeletal condition that significantly affects individuals' daily lives worldwide. In resource-limited settings like Rajshahi Division, Bangladesh, rickshaw drivers, engaged in physically demanding work constitute a vulnerable population susceptible to CLBP. This study aimed to investigate the prevalence of prescription drug abuse, specifically non-steroidal anti-inflammatory drugs (NSAIDs), among 162 rickshaw drivers suffering from CLBP and assess its potential impact on renal function. Objective: The primary objective was to determine the prevalence of prescription drug abuse, particularly NSAIDs, among rickshaw drivers with CLBP in the Rajshahi Division and evaluate its association with renal dysfunction. Methods: A cross-sectional survey involving 162 rickshaw drivers was conducted in Rajshahi Division using a structured questionnaire. Blood and urine samples were collected to measure renal function markers, including serum creatinine and urinary albumin-to-creatinine Ratio (ACR). Data analysis encompassed descriptive statistics, chi-square tests, and logistic regression. Results: A total of 162 rickshaw drivers participated in the study (mean age: 35.4 ± 6.2 years). Most participants were male (98.8%), with an average duration of rickshaw driving experience of 8.7 ± 2.3 years. The study revealed a distressing prevalence of prescription drug abuse, notably NSAIDs, among rickshaw drivers with CLBP, with 72% self-reporting regular use without medical guidance. Logistic regression analysis demonstrated a significant correlation between prolonged NSAIDs use and elevated ACR, indicating potential renal dysfunction. Conclusions: The findings underscore the alarming rate of prescription drug abuse, particularly NSAIDs, among 162 rickshaw drivers afflicted with CLBP in Rajshahi Division. This misuse may have adverse consequences on renal function. Urgent interventions, including education campaigns targeting rickshaw drivers, are imperative to increase awareness of the risks associated with prescription drug abuse and the importance of seeking professional medical advice for CLBP management. Collaborative efforts from public health initiatives and healthcare providers are essential to mitigate the hazards related to prescription drug abuse in this context.