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Not so ‘smart’ drugs

Caffeine and contemplation

Dominique Thompson

Monday, 20 August 2018

AdobeStock_124348890_smart_drugs.jpgOne in 12 UK adults has taken ‘smart’ drugs in an attempt to improve their cognitive performance, according to a recent survey of over 1050 people. And the Global Drug Study of 2017 showed that 23% of UK respondents had used them in the previous year. Interestingly, such ‘study drugs’ are not only being used by stereotypically stressed students. In fact, the majority of those asked were using them in the workplace, to increase focus in meetings or to ‘up their game’ in the highly competitive environment at work.

So how often do you ask your patients if they are using smart drugs?

These medications are potentially addictive, and come with significant side effects, including headaches, raised blood pressure, arrhythmias, seizures, gastrointestinal upset, insomnia, depression and anxiety. They will interact with prescribed medications of course, will be affected by alcohol, and could potentially exacerbate an undiagnosed, underlying condition. Maybe it’s time to consider adding that question to your consultation ‘patter’, as the UK general public returns from the summer break, the students go back to university, and the pressures of work and studies pile on…?

In an increasingly competitive world, taking smart drugs has become common in many workplace environments, including in medicine, in the scientific research field and in the IT industry. Whether people see themselves as ‘biohackers’ optimising their brain’s potential, like a budget version of Bradley Cooper in Limitless, or whether they are just desperately trying to stay awake to complete long shifts and repetitive tasks, more people are risking their health by buying and taking a variety of drugs to get through the day, and stay ahead of the game. The internet has been described as a ‘pharmaceutical candy shop’, but that’s no longer just applicable to students, it applies to frantic parents juggling home lives and careers, as much as to young academics striving to get ahead of the pack.

Many people who take the ADHD medications in particular may tell you that they notice a significant improvement in their focus when they take them, so may be reluctant to stop. But in these cases it is worth considering screening for ADHD itself, as they may be starting from a position of attention deficit of course!

Medications that are normally prescribed for ADHD and narcolepsy are the most commonly used (Ritalin or Provigil), but non-UK medicines such as Adderall (a combination of two amphetamines) are also popular, and high risk. They are often taken without the buyer knowing exactly what is in the tablet, and without understanding the risks of interactions with usual medications, or of underlying conditions. You may be surprised to hear that other drugs used for ‘cognitive enhancement’ in this way include donepezil, selegiline, thyroxine and piracetam. Worth bearing in mind if any of your patients’ supplies appear to be going astray or ‘used’ at an unexpectedly high rate. They may be being ‘diverted’ (possibly without the patient’s knowledge).

No one knows what the long-term risks of smart drug use might be, as they haven’t been investigated or monitored in this way, so if you do ask those patients who appear to be very stressed, especially about work (for example about sales targets or staff cutbacks and they ‘could be next’) or academic pressures, about such drugs, then try to encourage them to reconsider their choice to use them. Using cognitive enhancers may be ethically dubious to some people, but perhaps more importantly it’s a sad reflection of the pressures of our society, making people feel that they have to take them to keep up. Perhaps that could be the ‘hook’ for them to consider alternative coping strategies, or even career choices…‘Smart drugs’ don’t actually make you smart, so the smartest choice might be to quit!

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Dominique Thompson

Dominique has been a student health GP since 2000, developing innovative new services to treat eating disorders and personality disorder in primary care. She was the GP member of the NICE Eating Disorders Committee 2017. She was a Pulse ‘GP hero’, in 2014, and a ‘Rising Star’ in 2016. Dominique writes about young adult wellbeing and mental health, in both the medical and non-medical press. Her latest adventure is as an independent consultant in student health and wellbeing www.buzzconsulting.co.uk. She is fuelled by caffeinated drinks.
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