In their report in the Telegraph, @Josiensor and Rosa Silverman discuss implications of a survey from Cambridge which notes that so-called 'smart' drugs continue to be used by students to try to improve their academic performance, with methylphenidate (Ritalin) a common choice.
Why should this be of public interest?
Methylphenidate has
been in use since 1960 for treating ADHD, with effects mainly considered to be
improvement in attention and concentration. It is used to treat a number of rare
syndromes involving abnormalities in chemical transmission in the brain. The
drug is also reported to be in widespread use by students in the UK, the US and elsewhere
in the hope that it will improve studying, learning and exam performance.
1. Does it work? Studies of possible effects on studying and
learning are typically short-term and usually based on artificial tests – ie not usually test possible benefits of
the drug what students may be trying to learn, or effects on the types of exams
students may be sitting. Evidence compared to placebo of benefits or risks
appears limited to studies lasting 4 weeks or less.
2. Is
use of methylphenidate any different from using caffeine? Because of the lack of convincing evidence
of benefit from methylphenidate and concerns about serious risks,
methylphenidate is not approved for use in the absence of specified medical
conditions – e.g. ADHD. As for other drugs, the balance between risk and
benefit must be considered by prescriber and user. In the event of any benefit
for studying from the drug, others not using it are put at a disadvantage. In
contrast caffeine is widely available for those who chose to use it. Too much
caffeine, or sensitivity to caffeine can cause troublesome symptoms, including
anxiety, tremor, sleep disturbance and palpitations.
3. Risks of methylphenidate Potential
risks may be serious and include serious cardiac and psychiatric disorders.
This has lead to important restrictions by regulatory authorities such as the
FDA on use of the drug, even when the drug is medically indicated.
Withdrawal
symptoms of methylphenidate can include psychosis, depression and irritability.
Risks of the drug may be greater if there are medical problems, in particular if the
user has a medical history of cardiovascular or psychiatric problems. Use
without clinical advice may mean that important underlying conditions are not
identified, for example high blood pressure, disorders of heart rhythm, and
psychiatric risk; and potential important interactions with other drugs
(including other stimulants) may not be considered. For example:
- alcohol can delay clearance of the drug
from the body, increasing risk of adverse effects;
- concurrent use of stimulants such as
caffeine would be expected to increase risk from methylphenidate of serious
disorders of heart rhythm.
4. What about access to the drug from internet
pharmacies? For the above
reasons, licensed pharmacies would not supply methylphenidate in the absence of
specified medical conditions. Unlicensed internet pharmacies should be avoided. The
quality of medicines is not reliable, with serious risk of being supplied
poorly active or counterfeit or contaminated medicines. And medical contra-indications
need to be identified and discussed to minimize the risk of preventable serious
adverse effects.
5. Fairness and coercion There are also a number of ethical concerns
including:
a) the need to protect students and others from using
so-called ‘smart drugs’ in response to pressure to compete, both in exams and
in professional life;
b) being
fair to other students who do not have access to the drug, or do not wish to
use what may be a medically harmful pharmacological aid to improving performance in examinations or to meeting challenges at work.
