Recent reports in the popular press [1] suggest that smart drugs or ‘‘nootropics’’, such as Methylphenidate (Ritalin), Modafinil and Adderall (mixed amphetamine salts), are increasingly being used by the healthy to augment cognitive ability. Although current nootropics offer only modest improvements in cognitive performance, it appears likely that more effective compounds will be developed in the future and that their off-label use will dramatically increase. One sphere in which the use of these drugs may be commonplace is by healthy students within academia, with evidence suggesting users ageing from as young as 15 years old. Positions on smart drugs are being debated in the academic world on both sides of the debate, however few efforts have been made towards asking direct questions of those involved.

According to several studies students are striking deals to buy and sell prescription drugs, such as Adderall and Ritalin, not with the intention to get high, but to actually gain higher grades, to achieve an edge over their fellow students and to increase their mental capacity for learning. Simply put these prescription drugs are being abused by students in order to enhance their cognition. In one survey it is estimated that nearly 7% of students in US universities [2] have used nootropics in such a way. On some campuses this figure rises to 25% of students whom had used nootropics in the past academic year. Evidence suggests that such students are simply early adopters of a trend that is likely to grow [3], potentially even influencing high school students. Further evidence is presented by Professor Alan DeSantis,  at the University of Kentucky, who studied the use of drugs like Ritalin and Adderall because he was surprised to hear so many of his students talking about taking them. He found that among nearly 2,000 undergrads surveyed, 34 % indicated that they had taken them without a prescription, furthermore the percentage rose as students approached graduation. DeSantis commented "If you were to ask what percentage of juniors and seniors are using ADHD stimulants, the number is well above 50, pushing 60%. Add in juniors and seniors who are in fraternities and sororities, the number is up [to] 80," [4] It seems clear that cognitive enhancing drugs would be very attractive to high school and university students, essentially the largest non-therapeutic market for future nootropics could rest in this demographic [5].

Whilst much of the research on nootropics to date has focused on the United States, questions are beginning to be asked increasingly in the UK and Ireland. On 10th March 2010 it was announced that former Health Minister, Lord Darzi of Denham, is heading a study at Imperial College, London into their effects.  Professor Bert Gordijn, chair of Dublin City University's Ethics Institute, argues that there is a concern that if certain groups start to use nootropics to get an edge, then there may be societal pressure for everyone to use them. "What seems abnormal today could become normal tomorrow. We are talking about medicalisation here." [6] To date there is no empirical research in Ireland on the use of enhancement technologies. However, Professor Gordijn believes that there is a general tendency globally for such technologies, "While medicine has focused on curing disease, now it's coming up with improving on the traits of normal people”.

It should be noted that in the UK Methylphenidate (Ritalin) is a class B drug, such a classification holds penalties for both possession (5 years) and supply (14 years). Adderall and Modafinil are prescription only drugs governed under the Medicines Act and therefore should only be available by prescription. The possession of such drugs is a serious offence, however there is little based in law to say what penalties would be incurred if found in possession. Controlled drugs in Ireland are governed by the Misuse of Drugs Act 1977; Ritalin, Adderall and Modafilin do not appear under such legislation. Evidence suggests that nootropics are rapidly becoming the new drugs phenomenon, just as legal highs have become in the last 2 years.  With this in mind and until the legal and safety issues centred around nootropics have been resolved, it is essential to arm parents and careers with advice and support in dealing with the use of nootropics, along with providing education and intervention strategies targeted those most at risk - young people. A review by the office of science and technology [7] identified an upcoming change in attitudes towards drugs, misuse mainly towards cannabis and more ‘softer’ drugs. The report predicts that this more tolerant attitude will apply to cognitive enhancers. Furthermore, reports exploring the childhood use of ADHD drugs and illegal drug use later in life suggest that the long term use of such drugs may increase the risk factors in experimenting with harder drugs [8].

Some may ask that if nootropics can do all that we say they can to enhance our cognition and they are already being widely used, why do we require a prevention agenda? Truth is that because these drugs are so new and have only been tested for those whom medically require them, there is very little evidence available on the safe use by a healthy individual. Furthermore, the adolescent brain is still developing until around the age of 25, therefore the impact of these drugs on such a developing brain could be highly dangerous. Research shows, in particular relation to Ritalin, that the long term use of the drug by young people with ADHD can have a detrimental effect. Increasingly studies are linking the effects Ritalin in particular with the effect of cocaine [9]. The long-term dopamine effects of taking Ritalin for years, as many do, are another unknown. To date only two large epidemiological studies conflict. One reports more drug addiction in children with ADHD who took Ritalin compared with children with ADHD who took no drug [10]; the other shows the opposite result [11]. Once again the long term safety and effectiveness of Modafinil has not been determined.  Close to every academic from within the enhancement debate has at one time or another called for wider studies into the safety of these drugs on healthy minds before allowing this trend to develop any further.

References

1. Ann Robinson, A Pandora's box full of smart drugs, Guardian 23 February 2010.
2. S. McCabe et al, Non-medical use of prescription stimulants, Addiction 2005; 99: 96–106.
3. B. Maher, Nature 2008; 452: 674 – 675.
4. Alan D. DeSantis, Elizabeth Webb, & Seth Noar, Illicit Use of Prescription ADHD Medications on a College Campus: A Multi-Methodological Approach, Accepted for publication in the Journal of American College Health. http://www.uky.edu/~addesa01/documents/DeSantisAdderall.doc
5. Graff Low K, Gendaszek AE. Illicit use of psychostimulants among college students: a preliminary study. Psychol Health Med 2002; 7: 283–7
6. Jeremy Laurance and Susan Daly 'smart drugs' cheating our students out of their future?, July 07 2009, http://www.independent.ie/lifestyle/independent-woman/health-fitness/are-smart-drugs-cheating-our-students-out-of-their-future-1808926.html
7. Office of Science and Technology (2005). Drugs Futures 2025. 
8. S McCabe, Medical and Nonmedical Use of Prescription Drugs among Secondary School Students, Journal of Adolescent Health 2007; 40: (76–83.
9. B. Vastag, Pay Attention: Ritalin Acts Much Like Cocaine, JAMA. 2001; 286(8): 905-906 (doi:10.1001/jama.286.8.905), http://jama.ama-assn.org/cgi/content/full/286/8/905
10. Nadine M. Lambert and Carolyn S. Hartsough, Prospective Study of Tobacco Smoking and Substance Dependencies Among Samples of ADHD and Non-ADHD Participants, J Learn Disabil 1998 31: 533-544.
11. J. Biederman, T. Wilens, E. Mick, T. Spencer, and S. Faraone, Pharmacotherapy of Attention-deficit/Hyperactivity Disorder Reduces Risk for Substance Use Disorder, Pediatrics 1999; 104: e20.

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