Off-label use of stimulants, such as Ritalin, is on the rise among college students. Studies show that 5 percent to 15 percent of students use prescription drugs as study aids, and surveys suggest the practice may be common among academics as well. The trend has sparked debates over how and when these cognitive enhancers should be used. Military personnel routinely use stimulants while on active duty, but should that practice also be permitted among surgeons working long shifts? What about scientists working late nights in the lab? Or students taking exams?
A commentary appearing today online in the journal Natureadvocates for broad access to brain-boosting drugs. According to the piece, written by a group of ethicists, psychologists, and cognitive neuroscientists, “cognitive enhancement, unlike enhancement for sports competitions, could lead to substantive improvements in the world.” While opponents have argued that the use of performance-enhancing drugs is unfair and could undermine the value of hard work, the authors say that these drugs fall into the same category as more common efforts to increase brain function, such as drinking a cup of coffee, or getting a good night’s sleep, and thus should be regulated accordingly.
One of the biggest concerns associated with broad access to these drugs is that people will feel pressured to take them to get ahead, or just to keep up. An informal survey conducted by Nature last year of 1,400 people from 60 countries found that 20 percent of respondents engaged in off-label use of drugs to enhance concentration and memory. Ritalin was the most popular, followed by Adderall. Both are prescribed for ADHD. The survey confirmed the potential for peer pressure; while 85 percent of respondents said that the use of these drugs by children under the age of 16 should be restricted, a third said they would feel pressure to give them to their children if others were using them.
The authors of the commentary also note that if cognitive enhancers are to be used more broadly, more extensive study of the risks and benefits of the drugs is sorely needed. The side effects of long-term stimulant use, especially in children, are not yet known. And the potential for dependence and abuse has not been well documented.
Michael Gazzaniga, director of the Sage Center for the Study of Mind at the University of California, Santa Barbara and one of the authors of the commentary, talked with Technology Review about the potential benefits and drawbacks of these drugs.
Technology Review: The commentary suggests that healthy adults should have access to cognitive-enhancing drugs. Why do you think this is a good idea?
Gazzaniga: Normal ageing finds one’s memorial processes not what they use to be. If there were drugs that helped and were safe, I would certainly be for them being available to the public.
TR: The commentary argues that cognitive-enhancing drugs “should be viewed in the same general category as education, good health habits, and information technology.” Why do you think this is true?
MG: All new technologies are at first resisted, even the typewriter. When changing mental states, people get antsy, especially when it appears to enhance capacity. There is somehow a sense one is cheating the system. Well, so is chemotherapy. When all of these new technologies are used in moderation and the right social context, they are a good.
TR: Do you think it’s possible to avoid making people feeling obligated to take these drugs to keep up? Especially given the huge amount of money spent on pharmaceutical advertising and the broad impact it has been shown to have?
MG: Rates of off-label drug use will stabilize. I think they will stay low. One could easily obtain Ritalin now for afternoon lassitude but the vast majority of people don’t. The afternoon cup of tea or coffee sustains and seems to do the trick for most of us.
TR: Really? What about in high-pressure situations, like academia?
MG: Remember, these drugs don’t make you smarter. They keep you awake so you can study so you can be smarter. While there are always fads of use with such products, usage will settle down to a base rate. That base rate may be higher than some people like, but it will be established no matter what the external drug policy might be.
TR: What about the potential for abuse and dependence? How would you ensure they are used responsibly?
MG: Education is the only tool that works. As we have learned from illicit drug use, it is virtually impossible to keep drugs out of a community. The rate of demand for any given drug, whether illicit or off-label legal, is set by the local social context. One can’t ensure drug products will always be used responsibly. It is up to each community to teach about the hazards of inappropriate drug use and, by doing so, control the base rate of use. It is not a perfect world!
TR: One of the major arguments against widespread use of cognitive-enhancing drugs is that it’s “the easy way out.” Why do you disagree?
MG: Most of these drugs are used in spurts when huge mental demands are called for. They are not for everyday mental routines. Having said that, I think it is a fair concern to make sure people don’t become dependent on them as a way of life. Working above one’s pay grade in the end has tremendous costs.
TR: What are some of the safety concerns? When giving drugs to healthy people, tolerance for risk is low.
MG: As it should be. Remember, do no harm. I think the concerns are on the mental states if misused. Images might be too vivid, for example. Careful tests and analysis should be run.
TR: Why do you think the idea of using drugs to enhance cognitive function makes people so uncomfortable?
MG: Messing around with the mind is a dangerous and delicate matter. None of this should be taken lightly.