The escalating use of neuro-enhancing drugs by healthy individuals is increasingly hitting the headlines. It is estimated that nearly a quarter of US students currently use such medication to increase mental alertness, and students in Europe are gradually emulating their American counterparts. Since there is a plethora of internet sites for the purchase of neuro-enhancers, the use of these drugs, both by students who feel coerced because they don't want to be at a disadvantage compared to their drug-taking peers, and by over-ambitious members of the workforce who crave speedy promotion, will inevitably increase.
The ethical issues involved have been debated by academics, bioethicists and even 'life-style coaches' ad nauseam. For instance, the cost of regularly using such drugs is prohibitive for poorer students (from €2 to €6 per pill online), clearly an unfair situation if richer, drug-taking students are benefiting from better marks for exams and assignments. And although there is a paucity of robust data from clinical trials, students certainly believe that neuro-enhancers improve their cognitive performance. There have even been calls by university professors for random dope testing during student exams, akin to those carried out to discourage cheating in sport. Surely, though, whether such drug use is safe should be the paramount concern?
The most commonly used off-label neuroenhancers are methylphenidate (Ritalin) and 2-[(diphenylmethyl)sulphinyl]acetamide (Modafinil). Ritalin has already been used for around fifty years to treat ADHD, but production and prescription of the drug rose significantly in the 1990s. Since Ritalin increases wakefulness and vigilance, it is also used to treat narcolepsy, the disorder that causes overwhelming daytime drowsiness. While its mode of action has not been fully elucidated, it is thought to stimulate dopamine release, though data from PET studies have shown that it may preferentially bind to dopamine transporters. Modafinil, which binds to dopamine transmitters, has been in use in Europe since 1994 for treating narcolepsy.
Apart from the obvious safety issues resulting from using any drug purchased over the internet- such products may not be what they purport to be, may have expired, and are anyway taken without the benefit of a prescribing physician to advise on counter-indications and to supervise treatment- no drug is risk-free, and both Ritalin and Modafinil can cause side-effects. Ritalin is addictive, and can result in withdrawal symptoms including depression, paranoia, anxiety and sleep disturbances. And it is counter-indicated for people with extreme anxiety, a common symptom in students sitting important exams. In addition it is not usually prescribed to women during their childbearing years (nearly all female students surely fall into this group) unless the benefits clearly outweigh the risks. Modafinil can also be addictive, and although it does not result in serious withdrawal symptoms, five percent of users suffer from unpleasant side-effects including headaches, nausea, anxiety and insomnia. Modafinil can also affect the metabolism of other drugs such as oral contraceptives, leading to their ineffectiveness.
Surely, then, isn't it more important to inform healthy students (particular females) about the serious health repercussions that can result from self-medicating with neuro-enhancers than to worry about marginally elevated exam scores?
Frances Bushrod, Ph.D.
