University students are embarking on dangerous self-experimentation with ‘smart drugs,’ the latest trend to boost examination performance. With the three-fold increase in tuition fees and accumulation of debt, some students are resorting to more sinister methods to increase academic performance and job prospects.
Conventionally students have relied on caffeine and sugar as their primary sources of stimulation. However the popularity of cognitive enhancing drugs is increasing exponentially in student communities, particularly among those studying competitive and academically demanding subjects.
Cognitive enhancement is the process of medically augmenting higher brain functions involved with attention, information processing and memory, without a medical need. Methylphenidate (Retilin), modafinil, donepazil and amphetamines (Adderall) are the most commonly abused. They are usually prescribed by registered clinicians for a myriad of diseases ranging from attention deficit/hyperactivity disorder (ADHD), dementia, shift-working sleep disorder and narcolepsy.
Both modafinil and methylphenidate increase the availability of dopamine and noradrenalin in areas of the brain that manage attention and behaviour. Increasing the activity of these substances promotes arousal and increases attention, concentration and memory. Hence methylphenidate is particularly efficacious in ADHD patients and Modafinil, intended for narcoleptics and shift-working sleep disorder, successfully promotes wakefulness.
A 2012 survey revealed that 10% of Cambridge university students have taken modafinil to prepare for exams. This year alone, the Medicines and Healthcare Products Regulatory Agency retrieved £12.2 million of unlicensed medications in the UK, including modafinil and methylphenidate.
Increased vigilance in prescribing and distribution is urged by the Care Quality Commission (CQC), amid concerns of the 53% (237,000) increase in NHS prescriptions since 2007. Their annual report stated, “We are [also] aware of the possibility that methylphenidate could be diverted and abused, and for this reason we recommend that its use should be monitored carefully. We are aware of reports in the media and scientific literature that it is being abused as a ‘smart’ drug to improve cognitive function; the long-term risks of this practice are not known.’ The National Institute of Health and Clinical Excellence (NICE) have also encouraged doctors to limit prescribing methylphenidate as a first line drug for children with mild-moderate ADHD amid these trends.
It seems paradoxical to explore potential effects of medications in healthy patients, who lack medical necessity. However, the scarce, conflicting evidence base is the greatest danger in experimenting with these drugs. Long-term effects, adverse events and dose-effects are largely unknown in healthy populations. Current research is limited by small patient cohorts and varied patient demographics. Often factors such as patient IQ are undocumented and disregarded in analysis, which may bias results. This lack of baseline measurements greatly reduces the ability to draw conclusions from research findings.
What does current evidence show?
Studies have demonstrated that higher-performing students benefit the least from modafinil. In other words, the extent of cognitive improvement depends on the user’s IQ. Improved accuracy and cognitive benefits were only attainable in lower IQ users, with a lower baseline memory. Hence there is an element of probability, and the potential for efficacy may be hindered by pre-existing factors.
There is also evidence that a single dose of modafinil can improve cognitive function, but increases anxiety with repeated use. A profound increase in memory and wakefulness occurred with prolonged sleep-deprivation. However, after repeated intake in sleep-deprived individuals, declining cognitive performance could not be improved with modafinil. It was only able to maintain wakefulness and induce a false sense of confidence in the user’s own abilities. Moreover, it is thought that the expectation of these medications to increase ability greatly exceeds their actual effects.
Research also shows that a single dose of methylphenidate can improve memory and motivation, but not in sleep-deprived users. Furthermore, multiple doses of methylphenidate taken in sustained sleep deprivation (thirty-six and sixty-four hour periods) does not reduce sleepiness and only marginally improves attention and cognitive function. Contrastingly, other studies contend that memory and logical reasoning is enhanced in sleep-deprived groups relative to a placebo.
Overall, most studies suggest that cognitive enhancers ultimately hinder academic performance. Not getting enough sleep stops the memory consolidation process that occurs when sleeping. The user might have an adverse reaction to the medication and may enter a state of euphoric wakefulness that limits their productivity and sleep. Potential side-effects include: headaches, sleep difficulties and insomnia, nausea and vomiting, reduced appetite as well as psychological effects such as depression, anxiety, addiction and personality changes. More serious effects include toxicity, allergic reactions and fatal cardiac arrhythmias.
Aside from the scientific facts, the bottom line is the ethical standpoint. These drugs may advantage some adventurous groups, but in doing so can inadvertently pressure other students into self-medicating and infringe on their decision-making. Methylphenidate is a class B drug in the UK; possession without a prescription from a registered medical professional can lead to five years imprisonment. Supplying the drug can lead to a fourteen year sentence. Furthermore, purchasing these drugs is fuelling and expanding a black market, the implications of which include potentially consuming drugs with unknown contents that have not be quality-assessed or approved for safety by UK regulating bodies.
If the problem continues, you may find yourself having to take a drug test before you sit your end of year finals.