Scimex: Two UK researchers have expressed concern over the current lack of
information on the harms and benefits of long-term use of
cognitive-enhancing drugs - which can increase a person's concentration
and memory - by healthy individuals. They report that the non-medical
use of such drugs raises a host of safety and ethical concerns,
including side effects and potential abuse, particularly from sourcing
on the internet.
There is growing "lifestyle use" of cognitive-enhancing drugs – such
as methylphenidate (marketed as Ritalin) and modafinil (marketed as
Provigil) – by healthy individuals to improve concentration, memory, and
other aspects of cognitive performance. But very little is known about
the long-term effects of this non-medical use, say the authors. "We
simply do not know enough about how many healthy people are using
cognitive-enhancing drugs, in what ways and why,", explains Professor
Sahakian.
What evidence there is suggests that healthy individuals
use cognitive-enhancing drugs to gain a competitive edge at school,
university, or work, and for maintaining attention and performance when
sleep derived or jet lagged. Most research has focused on student use in
the USA with estimates varying between 5% and 35%. Worryingly, say the
authors, this might only be the tip of the iceberg and is unlikely to be
representative of usage in professional or older populations.
A
wide range of pharmaceutical substances from psychotropic medications to
nicotine and caffeine are used by patients and healthy individuals to
alter, improve, and enhance mental functioning. Most cognitive
enhancers, such as modafinil and donepezil, have been developed by the
pharmaceutical industry to treat the effects of impaired cognition in
conditions such as Alzheimer's disease, attention deficit hyperactivity
disorder (ADHD), and schizophrenia. For example, even after the
remission of psychosis in schizophrenia, full functional recovery (eg,
returning to work and independent living) is limited by debilitating
cognitive symptoms.
But non-medical use raises a host of safety
and ethical concerns including side effects and potential abuse,
particularly from sourcing on the internet. "Present cognitive-enhancing
drugs have wide ranging effects and side effects and are not
predictable. We also know next to nothing about their long-terms effects
in healthy people"*, says Dr Morein-Zamir.
The authors believe
that the use and number of cognitive-enhancing drugs is likely to grow
substantially and call on funders and policy-makers to prioritise
research into the potential advantages and dangers of their use in
healthy individuals, saying that, "reliable evidence is crucial for a
balanced view on the risks and benefits of these drugs and to set out
clear regulatory guidelines for their use."
Cognitive-enhancing
drugs are often viewed as a single class despite having distinct
pharmacological mechanisms, effects, and legal status. Therefore, a
case-by-case discussion of regulation is needed, say the authors,
considering the potential for physical and psychological dependence as
well as social harms.
According to Professor Sahakian and Dr
Morein-Zamir, while there is "great merit" in the development of new
more effective and safer cognitive enhancers, the growing off-label use
of drugs such as Ritalin (methylphenidate; prescribed for ADHD) and
Provigil (modafinil; prescribed for sleep disorders) demands that clear
information and guidelines about their benefits, risks, and safety be
made available to all health-care professional by national medical
organisations.