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  • Students and “Smart Drugs”: Empirical Research Can Shed Light on Enhancement Enthusiasm
  • Bradley Partridge (bio)

Recent enthusiasm about pharmacological cognitive enhancement has often focused on the use of prescription stimulants as a study aid by US university students. Despite the illegality (in most countries) of non-prescription use of stimulants and the potential for addiction, it is often claimed that healthy students without any diagnosed disorder are increasingly using drugs such as methylphenidate and modafinil to increase their alertness, concentration or memory, in the belief that they will improve their performance during examinations or when studying (Greely et al. 2008).

Cognitive enhancement in this sense is really a form of non-medical use of prescription drugs, in that the drug is not being used for its indicated purpose and is not being used “off-label” to treat some other medical condition (Boot, Partridge, and Hall 2011). Other terms used to describe this practice include “neuroenhancement” and “cosmetic neurology” (Chatterjee 2004). The latter implies a discretionary, non-therapeutic motive to be better than well that distinguishes it from “treatment”—analogous to other bodily enhancement practices such as botox injections (to remove wrinkles), breast enlargement surgery, and the use of steroids by athletes.

Terms such as “smart drug” are somewhat loaded when referring to currently available pharmaceutical stimulants, because this tends to assume their efficacy for the purpose of improving cognition in healthy people. The assumed efficacy of so-called “smart drugs” and their use by US students has fuelled hyped media portrayals of the practice, and led some to conclude that this is a trend increasing in universities across the globe (B.J. Partridge, Bell, [End Page 310] Lucke, Yeates, and Hall 2011). The perception that the enhancement use of stimulants is common and increasing might give rise to one of two regulatory positions. Those who are alarmed by it may argue for measures to restrict or prohibit this practice, perhaps beyond the current prescription system. Alternatively, those who are excited by the prospect of enhancing cognitive capacities may argue for policies that may facilitate the practice. For example, a number of prominent bioethicists and neuroscientists have recommended a relaxation of laws that prohibit non-prescription use of stimulants, and suggest that pharmaceutical companies ought to be permitted to market drugs to healthy people for cognitive enhancement (Greely et al. 2008).

Do “Smart Drugs” Enhance Cognition?

In healthy people, stimulants may help a person stay awake, but there is only weak evidence that they improve cognition, or prevent it from deteriorating. A recent review of studies exploring the enhancing effects of prescription stimulants found the evidence to be equivocal—there were some improvements on various cognitive tasks; however, findings are mixed with many studies showing no improvement, and even impairment (Smith and Farah 2011). The evidence for the enhancing effects of prescription stimulants is even less convincing given that there may be a bias in the literature towards publishing positive findings, and there is considerable variation in study design, participant numbers, dosage, tasks used to measure “cognition” (Smith and Farah 2011). It is not clear how much application many of the studies reviewed have to real world situations, or whether improvements are the result of a placebo effect or possibly improvements in mood rather than cognition per se. A systematic review by Repantis and colleagues found that in healthy people, methylphenidate may improve memory, but there was no consistent evidence for other cognitive enhancements (Repantis, Schlattmann, Laisney, and Heuser 2010). Similarly underwhelming results were found for modafinil:

Modafinil ... was found to improve attention for well-rested individuals … but repeated doses were unable to prevent deterioration of cognitive performance … possibly inducing overconfidence in a person’s own cognitive performance

(Repantis et al. 2010).

Of concern are the possible side effects of using stimulants for non-medical purposes. Amphetamines certainly have the potential for addiction and other side effects (e.g. heart/blood pressures problems, anxiety) (Bell, Lucke, and Hall 2012), and there is also evidence that modafinil has addictive potential (Mohamed 2012). [End Page 311]

Student Use of “Smart Drugs”

A number of influential papers have described an apparent increase in the use of drugs for cognitive enhancement, particularly by students and...

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