Do so-called “smart pills” enhance performance in students? Are they part of a widespread, growing phenomenon? You would be forgiven for thinking so.
In a recent article on The Conversation, Simon Outram and Bob Stewart drew attention to questions raised by the use of “smart pills” by students.
The use of prescription stimulants such as Ritalin or Adderall by healthy students has been widely described as “cognitive enhancement” or “neuroenhancement” in the popular media and prestigious journals such as Nature.
But we need to careful! A large proportion of media articles portray “cognitive enhancement” as a common or increasing phenomena and the source for such claims is often academic articles that are speculative, overly enthusiastic and cite weak empirical evidence for their claims.
It’s reasonable to be concerned about the idea of non-medical use of stimulants among young people. Regular users may develop acute tolerance which can lead them to increase their dose to achieve the same subjective effect increasing the risk of toxicity.
Medical complications of stimulants can include seizures, cardiac arrhythmia, and an altered mental state that may range from euphoria to psychosis. In the US almost one in 20 non-medical users of prescription stimulant medications meets criteria for dependence or abuse.
We do not know whether non-medical use of prescription stimulants is currently a problem in Australian universities, or likely to become a problem in the future.
There is an extraordinary paucity of empirical evidence about such non-medical use of prescription stimulants in Australia despite Australian prescribing data showing an 87% increase in stimulant dispensing from 2002-2009.
In the absence of Australian data we are in the unhappy position of relying on data collected in the US.
Surveys of nationally representative samples of US college students suggest that 3-6% of the US college population have used prescription stimulants for non-medical purposes in the past year.
This use of stimulants may be for a range of reasons not related to academic use, such as recreational use or self-medication for perceived symptoms of attention deficit hyperactivity disorder (ADHD).
In US surveys, regular users are more likely to be male, live in a fraternity, have a lower level of academic achievement and also use illicit drugs. We should not assume that all students who use prescription stimulants without a prescription are using them to increase their academic performance.
Australian attitudes
In a qualitative study of Australian students’ attitudes towards the idea of “cognitive enhancement”, which we conducted during 2010 and 2011, we found that students often considered the practice to be akin to cheating.
Students identified two major differences between performance enhancement in sport and performance enhancement in academia:
1) Steroids may actually be effective in improving performance, whereas the use of prescription stimulants has dubious efficacy in improving cognitive performance (a finding demonstrated by empirical studies)
2) They believed the level of competition was greater in sport than in academic pursuits because sporting success was about being “the winner” whereas academic success was not necessarily dependent on doing better than everyone else.
We may have interviewed an unusually well-informed group of students but it may be that Australian students are more critical than US and Canadian students in their attitudes towards the use of “smart pills”.
We believe our students were wise to be cautious. Outram and Stewart mentioned the long history of enthusiasms for stimulants such as cocaine and amphetamines in which uncritical enthusiasm about the drug effects encourages widespread use.
It is only when use becomes common that the significant adverse effects of regular use become evident. We should avoid repeating this destructive cycle by uncritically accepting the optimistic patter of “smart-drug” enthusiasts.
We need better information about the extent of non-medical use of prescription stimulants in Australia and the motivations for such use if we are to reduce any adverse health effects and protect the health and well-being of young people.
In the meantime we should beware of inadvertently contributing to the US-led enthusiasm about so called “smart drugs”. Prescription stimulants may well be drugs but they don’t make you “smarter”.