As many as one in ten of us are using so called ‘Study Drugs’ to improve memory and focus. With ever-increasing pressure on both students and professionals, is the use of study drugs justified or a ‘cheat’ with a risk of harmful consequences? A recent event, hosted at St George’s, University of London, explored public knowledge and opinions about their use. Professor Raymond Hill, Dr Alistair Jennings and Mr Neil Gilbride kindly provided their expert opinions on different aspects of the topic.
When asked, 50% of the audience said they knew what a study drug was, with an even split in those that said they would, or would not, consider taking such a substance. So, what are these medications? Legal stimulants, such as caffeine and nicotine, have been used for centuries by people seeking an extra ‘kick’ and to increase concentration and stamina while studying or cramming. However, the term ‘study drug’ refers to medications that are licensed for use in the clinic but are used improperly by a person with a prescription, or, illegally by a person without any prescription at all. They include prescription medications for attention deficit disorder/attention hyperactivity disorder (ADD/ADHD) such as atomoxetine, methylphenidate and amphetamine, and also modafinil, which is used to treat narcolepsy. ADD/ADHD medications act to increase concentrations of the monoamines dopamine and noradrenaline in the synapse, which can increase concentration for these patients. The pharmacology of modafinil, however, is less clear, with evidence indicating potential activity in the dopaminergic, noradrenergic and histaminergic neurotransmission systems. When prescribed for their directed use, these medications aim to resolve deficits in behaviours associated with ADD/ADHD and narcolepsy. However, when used off-label by healthy individuals, there are reports that these drugs enhance concentration and stamina beyond normally achievable levels.
Should we worry about misuse of study drugs? One concern is that we know little about what happens after their long-term use. Certainly, these medications have passed rigorous testing in clinical trials and have been deemed safe when treating patients with certain medical disorders. However, there is evidence that they enhance dopaminergic signaling in the brain, which is an action shared by all addictive drugs. There is widespread concern that, when these medications are self-administered, without guidance from healthcare professionals as to a dosing regimen, off-label users risk developing an addiction.
In addition, the World Anti-Doping Agency bans such stimulants in athletes as they are thought to enhance athletic performance. Some people argue that, if it is considered cheating in sport, then the same ruling should be applied to students taking these medications to improve their cognitive performance. UK universities do not yet appear to have any policies in place with regards to cognitive enhancers, probably because misuse of ‘study drugs’ is a relatively new phenomenon. Most universities do have a drug policy stating that use of drugs is prohibited on campus, but this does not necessarily extend to off-label use of prescription medications to improve academic performance.
What is the evidence that these drugs actually enhance cognition? Reports, surveys and reviews from the 1930s up until today indicate that these drugs can enhance different aspects of cognition, but their effects are less straightforward and efficacious than often implied, particularly by the public media. In fact, given the evidence that listening to music can enhance both athletic and cognitive performance, perhaps students should consider popping on the radio instead of popping a pill?
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