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Smart drugs, smarter students?

12 May, 2010
Bottle for Ritalin tablets

Bottle for Ritalin tablets, empty, by Ciba Laboratories Ltd., English, 1950-1970

At a Eureka Live event at Wellcome Collection in February, Professor Barbara Sahakian of the University of Cambridge said that around 16 per cent of university students use cognitive boosting drugs like Ritalin to combat tiredness, and that this practice is spreading widely. It made me realize that cognitive enhancement in students is not just a possibility – it is already reality.

This sprung to mind when the Guardian reported this week on the increasing use of such ‘neuroenhancing’ drugs among students to boost cognitive performance. The story was based on a paper published in January by Dr Ilina Singh, Reader in Bioethics and Society at the London School of Economics and Political Science, and Professor Kelly J Kelleher from the Nationwide Children’s Hospital in Columbus, Ohio. Singh was the recipient of the first Wellcome Trust University Lectureship in Biomedical Ethics in 2006.

Singh and Kelleher looked at data on how US students under the age of 18 use prescription medications to enhance cognitive performance. Reviewing previous studies of the subject, they found a significant increase in the use of stimulant medications to suppress appetite, sleep and aid study throughout the US since their introduction over 50 years ago.

Ritalin boosts concentration and awareness. It is a widely used treatment for attention deficit hyperactivity disorder (ADHD), helping those with the disorder stay focused and less easily distracted. But you can imagine how its effects could be attractive to anyone going through a long-hard day at work or a student facing exams.

A 2005 survey of US high-school students, college students and young adults found that 2.5 per cent consistently use non-prescription stimulants. The highest rates were among college students. It’s a trend they found reported in other countries too. A study of 2000 students in the Netherlands found that 2.4 per cent of students between 12-18 years old used psychotropic drugs for non-medical purposes (50 per cent of which had used Ritalin).  A survey of 1500 Belgian students found that 3 per cent used stimulants as neuroenhancers.

In their paper, Singh and Kelleher conclude that there is an “increasing public tolerance of neuroenhancement using psychotropic drugs”. They predict that the use of such drugs is “certain to increase further” as it becomes the norm for future generations and more effective drugs become more readily available.

Their point is we need to start thinking now about how to manage neuroenhancing practices. As we develop new drugs to treat conditions such as Alzheimer’s Disease and dementia, these will offer further enhancement options and the possibility of a ‘dual market’ emerging. The doses for treating a disorder will differ from those prescribed for a short-term concentration boost, yet we know little about the long-term effects of this. Moreover, many of the drugs come with side effects and we know little about the risk of addiction.

Also, if the use of neuroenhancing drugs becomes more socially acceptable, shouldn’t everyone have access to them? And will people feel pressured to use them because everyone else is?

It’s an interesting dilemma, not least because we already use many other forms of cognitive enhancement, both pharmaceutical (caffeine tablets like ProPlus, the narcolepsy drug ProVigil) and not (Red Bull, coffee and education).  Peer pressure and affordability come into play with all these enhancements.

Some of the issues involved already apply to other, non-pharmaceutical methods. Parents already use a number of educational programmes and tricks – from playing classical music to brain training games – to try and give their child an intellectual boost. And when it comes to the schools and tuition, pushy parents and the size of the family wallet (or those willing to sacrifice the most to pay for it) have a major influence on who gets the best.

But while there are similarities, pharmaceutical enhancers seem a wholly different beast, not least because the effect of drugs is not homogeneous or predictable.

Moreover, a single drug can’t do everything and the idea of neuroenhancer drug cocktails raises other safety issues. And young people are more likely to be more vulnerable to the effects of such drugs than adults.

In their paper, Singh and Kelleher make some suggestions, one of which is to get primary care doctors (GPs in the UK) involved. Doctors could prescribe the drugs to those who want to use such drugs to boost their memory or stay awake in certain situations, such as revision periods, they suggest.

Singh and Kelleher stress that stringent safeguards would be needed to monitor this and prevent misuse, from both the children themselves and pushy parents who want their child to have an edge. But their point is that its better to have doctors involved in the process rather than teenagers buying them off the internet or trading them (a 2001 study they cite indicates that around one-fifth of all children, adolescents and young adults prescribed ADHD medications give, sell or are forced to hand over their medications to other students).

The Guardian’s coverage of this point raised alarms, particularly after they published a separate story in the same week indicating that NHS spending on ADHD drugs had increased by 65 per cent over the last four years.

There is a suspicion that increases in ADHD diagnoses reflect in part their increasing use as cognitive enhancers. But as Singh told me, “neuroenhancement using Ritalin and treatment of ADHD using Ritalin must be treated as separate concerns. To suggest they are related problems in the UK context is irresponsible.”

She pointed out that their study looks primarily at the US. Here in the UK, ADHD in young people is still an under-recognised and undertreated problem.

The biggest issue now is the relative paucity of research in this area – in the US, UK or anywhere else. We know little about how young people use neuroenhancing drugs, how prevalent such use is, or who is actually doing it – existing studies indicate a largely middle-class base, but this could easily be an artifact of their design (surveys of university students are self-selecting and not infallible).

As Singh writes in her blog:

It’s much too early to talk about regulation in the UK — we don’t even have any systematic evidence of the rates of use of cognitive enhancers among young people in the UK. We only have lots of speculation and anecdotal reports. What we need is research in this area that can inform a discussion about management and regulation.

  • Neuroenhancement in Young People: Proposal for Research, Policy, and Clinical Management
    Ilina Singh, Kelly J. Kelleher. AJOB Neuroscience, 1 (1), 2010, 3-16, DOI:10.1080/21507740903508591

Image credit: Science Museum, London, Wellcome Images

5 Comments leave one →
  1. 12 May, 2010 5:05 pm

    There was a big discussion of this in Nature a while ago. The one thing that was missing was citations of peer-reviewed research showing that these drugs actually enhance cognitive performance beyond what we see with coffee,etc. . That seems like a key step, then move on to side effects.

  2. 13 May, 2010 10:45 am

    Hi TWE, is this the Nature discussion you were referring to? It was prompted by a Commentary from Barbara Sahakian and Sharon Morein-Zamir called “Professor’s Little Helper”.

    P.S. A note for our readers – although it has been correctly copied from the journal’s website, the DOI link is not working at the moment. Here is the Open URL link to the paper instead.

  3. chad zucchetto permalink
    26 Jul, 2011 1:34 am

    wider accepted use of cognitive enhancing drugs would serve to incentivize drug companies to continue making more effective and safer versions of those drugs, as well as allow them to better treat the original disabilities that the first generations of the drugs were designed for


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