June 23, 2023 – One pill makes you larger, and one pill makes you … smarter?
Whether you’re Alice in Wonderland heading down the rabbit hole or a high school or college student trying to achieve academic excellence, researchers have an important message for you: There is no such thing as a "smart pill." In fact, nonmedical use of prescription stimulants like Adderall or Ritalin by people without a prescription can lead to unintended outcomes, including poorer grades and substance abuse.
Findings from a recent study suggested that intentional “smart drug” use by people without ADHD and with normal mental skills did not improve those skills but, rather, had the opposite effect. Although otherwise healthy people in the study who took these drugs (Ritalin, Provigil, or Dexedrine) appeared to have more motivation, they needed more time and effort to complete a complicated task, compared to people taking a dummy (placebo) pill.
“Our center is interested in how people make decisions and solve problems under conditions of risk, uncertainty, and complexity,” said Elizabeth Bowman, PhD, lead study author and business manager of the Centre for Brain, Mind, and Markets at the University of Melbourne in Australia.
“We found that with these drugs, their actual performance went down; we also found that participants with the best performance with no drugs were the ones most likely to have the largest decreases in productivity,” she said.
The drugs also are not as benign as they appear.
Bowman said that in the short term, they can cause anxiety, crankiness, and insomnia. There’s also evidence that regular use over time might bring about substance use issues that persist well into adulthood.
Old Tricks, New Drugs
Nonmedical use of prescription drugs in academic settings is hardly new. Almost 100 years ago, researchers started to explore if stimulants could improve how well math and verbal tasks were carried out.
Fast forward to the 21st century, and over 3 million adolescents between the ages of 12 and 17 have been diagnosed with ADHD, and 62% take medication for it. Data suggest that the greater the proportion of students in any given school who are prescribed ADHD medications, the higher the odds of nonmedical use of these drugs. Roughly one-quarter of adolescents are likely to be approached by their peers to sell or give away their medicines before completing secondary school (grades 8-12), and more than half during college.
The problem is huge, according to researchers.
“Our team has shown that prescription stimulants are the only prescription medication class where the number of young adults using without a prescription is greater than the number taking stimulants with a prescription,” said Sean Esteban McCabe, PhD, a professor at the University of Michigan School of Nursing in Ann Arbor, and director of the Center for the Study of Drugs, Alcohol, Smoking, and Health, known as the DASH Center.
This is especially true at campuses where fraternities and sororities and their associated partying, binge drinking, and cannabis use are widespread.
Arby, a 26 year-old consultant based in Washington, DC, reflected on his time in a fraternity at the University of Maryland-College Park.
“I could tell you that in my fraternity at any given time, we had between five and 10 individual people that were prescribed these drugs and did not take them; they ordered them to sell them,” he said. “And it wasn’t hidden either, they would talk about it in group chats and bring them to chapter meetings.”
His personal experience with the drugs spanned his entire college experience, starting with freshman year.
“I’d always had trouble sitting down and focusing and studying for these intense school projects and exams. And you know, suddenly when you get to college and the workload and the intensity goes up so much … and there’s a quick and easy solution,” he said.
The drugs “allow you to be in the library for 12, 14, 16 hours straight,” he said. “They enabled me to do things that I never thought that I could do in terms of commitment to studying and academics. And in that way, they were kind of positive for my growth, to show me that I can work really hard and do well in school and be successful.”
Arby, who asked not to use his last name to protect his privacy, is not alone in his belief that these drugs improved his overall performance. Study after study point to academic performance as the primary motivation for nonmedical stimulant use. A 2022 survey of students attending seven universities across the U.S. said they take these medications because they believe they provide better concentration, less restlessness, increased alertness, the ability to keep track of assignments, and they keep others from having an academic edge.
But nonmedical usage can also be a slippery slope.
“Over 75% of young adults who reported nonmedical use of prescription stimulants on 10 or more occasions screen positive for potential substance use disorder,” said Esteban McCabe.
Even more troubling is that 40% to 50% snort the drugs, which places them at higher risk for drug-related problems, he said.
Amelia Arria, PhD, associate chair of the Department of Behavioral and Community Health, and director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health in College Park, said she’s concerned about the negative impact on students who truly need these drugs.
“There’s a lot of evidence to support the safety and efficacy [of these drugs] when you are diagnosed with ADHD and have a physician on board and you have guidance from the physician,” she said.
But problems often arise when they are used without that supervision.
Esteban McCabe pointed to the combination of alcohol and prescription stimulants as an example.
“Many young adults who simultaneously drink alcohol and use prescription stimulants have no idea how dangerous these substances can be,” he said.
“Passing out is a protective mechanism that stops people from drinking when they are approaching potentially dangerous blood alcohol concentrations. But, if you take stimulants when you drink, you can potentially override this mechanism, and this could lead to life-threatening consequences.”
Unfortunately, high school and college kids are not alone when it comes to mixed messages about these drugs: Many parents also believe that they’re benign.
“There’s a lot of research showing that parents and caregivers are the number one influence on initiation, and parent permissiveness is a huge risk factor,” Arria said.
Sharon Levy, MD, chief of the Division of Addiction Medicine at Boston Children's Hospital and an associate professor of pediatrics at Harvard Medical School, agreed.
“Parents and other caregivers might be less concerned about the behavior because the motive seems to be reasonable,” she said
“I’ve seen kids who are in the high school age range and will borrow someone’s ADHD meds before a big final exam, and the parents are aware of it and condoning it. I think from some parents’ perspectives, a lot of kids are taking these medications, they must be safe, and for these special events, why not give them a leg up?”
Levy also said that there are a lot of missed opportunities for intervening, especially at younger ages.
“The right time to have these frank conversations happens before college,” she said. “Pediatricians are seeing these kids routinely and renewing prescriptions in kids diagnosed with ADHD – much younger than high school. When they come in for these annual physicals, there a real opportunity to start talking about things – like prescribed medications should never be shared,” she said.
Levy pointed to the tradeoff between small gains in attention and focus and large losses in sophisticated problem-solving skills, not to mention the addiction potential of stimulant use.
“Unless your attention and focus are really disordered, the tradeoff isn’t going to be worth it,” she said.